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Paediatrica Indonesiana Impact of Iron Therapy on Mentzer Index and Red Cell Distribution Width Index in Primary School Children

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Paediatrica Indonesiana Impact of Iron Therapy on Mentzer Index and Red Cell Distribution Width Index in Primary School Children Paediatrica Indonesiana VOLUME 49 July NUMBER 4 Original Article Impact of iron therapy on Mentzer index and red cell distribution width index in primary school children with iron deficiency anemia Budi Andri Ferdian, Nelly Rosdiana, Bidasari Lubis Abstract utritional anemia is commonly found in Background Iron deficiency anemia (IDA) remains a common GHYHORSLQJFRXQWULHVLQWKH\HDU QXWULWLRQDOSUREOHPHVSHFLDOO\LQVFKRRODJHFKLOGUHQ'XHWR RIWKHFXUUHQWZRUOGSRSXODWLRQ the many examinations that are needed to be performed and the VXIIHUHGIURPLURQGHILFLHQF\DQG invasive gold standard procedure, an easy and simple alternative N examination to diagnose IDA is needed. of world population was anemic, with more than Objective To determine the impact of iron therapy on Mentzer half of these people having iron deficiency anemia and red cell distribution width (RDW) indexes of children with (IDA).Iron deficiency may also cause impairments IDA. in a child’s growth and development, as well as Methods A randomized open clinical trial was conducted in primary school aged children in North Aek Nabara, between decreased immunity and a lack of concentration 1RYHPEHUDQG1RYHPEHU,'$ZDVGHWHUPLQHGEDVHG during learning. There is no single test to diagnose on WHO criteria. Subjects with severe anemia were excluded. iron deficiency with or without anemia. The gold Subjects were randomly assigned to groups that received either standard for identifying iron deficiency is bone iron therapy or a placebo. marrow biopsy stained with Prussian blue. However, Results7KUHHKXQGUHGVXEMHFWVIURPDJHGWR\HDUVROG ZHUHUHFUXLWHGDQGVXEMHFWVFRPSOHWHGWKHVWXG\7KHPHDQ the procedure is invasive so that indirect assays RDW index of the iron and placebo groups after three months are generally used. There are two types of test. REVHUYDWLRQZHUH 6' DQG 6' +HPDWRORJLFWHVWVDUHEDVHGRQUHGEORRGFHOO 5%& respectively. The mean Mentzer index mean for the iron therapy features, while biochemical tests are based on markers DQGSODFHERJURXSVDIWHUWKUHHPRQWKVREVHUYDWLRQZHUH 6' DQG 6' UHVSHFWLYHO\ Conclusion After therapy, there are no significant differences in either the Mentzer or RDW indexes between the therapy and placebo groups. [Paediatr Indones. 2009;49:195-9]. Presented at the Workshop & Symposia: New Trend in Pediatrics Problem -DQXDU\0HGDQ,QGRQHVLD Keywords: anemia, iron supplementation, RDW, Mentzer )URPWKH'HSDUWPHQWRI&KLOG+HDOWK0HGLFDO6FKRRO8QLYHUVLW\RI North Sumatera, H. Adam Malik Hospital, Medan, Indonesia. Reprint request to%XGL$QGUL)HUGLDQ0''HSDUWPHQWRI&KLOG Health, Medical School, University of North Sumatera, H. Adam Malik +RVSLWDO-O%XQJD/DXQR0HGDQ,QGRQHVLD7HO )D[([email protected]. Paediatr Indones, Vol. 49, No. 4, July 2009195 Budi Andri Ferdian et al: Impact of iron therapy on Mentzer index and red cell distribution width index of iron metabolism e.g. zinc protoporphyrin (ZPP), FRQFHQWUDWLRQRIKHPRJORELQRIOHVVWKDQJGOIRU and serum ferritin concentration. Hematologic tests children aged 6 – 14 years. Iron deficiency anemia is are more widely available and less expensive than GLDJQRVHGLIKHPRJORELQFRQFHQWUDWLRQLVJGO biochemical tests.5,6 0&9I/5':!0HQW]HULQGH[! Another method to diagnose IDA is to start iron DQG5':LQGH[! WKHUDS\WKLVLVHDV\SUDFWLFDOVHQVLWLYHDQGFRVW All subjects were randomly assigned to either HIIHFWLYHHVSHFLDOO\LQKLJKULVNFKLOGUHQZLWK,'$ receive iron therapy or placebo. Iron was given daily Iron preparation is given at a dose of 6 mg/kg body as capsule containing 5 mg elemental salt iron per ZHLJKW$IWHUWRZHHNVDQLQFUHDVHRIPRUHWKDQ kg body weight The placebo, was also given daily in PJGOLQKHPRJORELQOHYHOFRQILUPVWKHGLDJQRVLV the same form as the iron capsule. Both therapy and of IDA.However, the clinician is often confronted placebo were given until the 4th month of the study. with microcytic anemia in populations with a higher Blood examinations were done at three different time prevalence of thalassemia.6 To distinguish between SRLQWVDWWKHVWDUWRIWKHVWXG\ 'HFHPEHU RQ iron deficiency from minor thalassemia, the Mentzer WKHthGD\ 0DUFK DQGLQWKHth month of LQGH[ 0&95%& DQG5':LQGH[ 0&95%& VWXG\ 1RYHPEHU $OOEORRGVSHFLPHQVZHUH x RDW) can be used. Mentzer index of at least analyzed for hemoglobin concentration, hematocrit, LQGLFDWHV,'$ZKLOHDQLQGH[RIOHVVWKDQLV erythrocyte count, mean corpuscular volume indicative for thalassemia. Similarly, a RDW index of 0&9 PHDQFRUSXVFXODUKHPRJORELQ 0&+ DWOHDVWLVLQGLFDWLYHIRU,'$ZKHUHDVDQLQGH[RI mean corpuscular hemoglobin concentration OHVVWKDQLVLQGLFDWLYHIRUWKDODVVHPLD5,6 Previous 0&+& UHGEORRGFHOOGLVWULEXWLRQZLGWK 5': studies in Indonesia only examined the relationship Mentzer index, and red blood cell distribution width between erythrocyte index and RDW index to index (RDW Index). Blood samples were measured confirm the diagnosis of IDA. We investigated the using a photometry procedure using an autoanalyzer use of Mentzer and RDW indexes for the diagnosis $%;0LNURV)UDQFH of IDA. 7KHVWXG\GDWDZHUHSURFHVVHGXVLQJ6366IRU :LQGRZVY 6366,QF&KLFDJR ,QGHSHQGHQW WWHVRU:LOFR[RQ6LJQUDQNVWHVWZDVXVHGWRDQDO\]H Methods the data. The results were considered to be significant LI37KLVVWXG\ZDVDSSURYHGE\WKH(WKLFDO This randomized open trial was conducted over 5HYLHZ&RPPLWWHHRI0HGLFDO)DFXOW\8QLYHUVLW\RI PRQWKVIURP1RYHPEHUWR1RYHPEHU North Sumatra, Medan, Indonesia. 7KHVWXG\SRSXODWLRQZDVFKRVHQIURP local primary school children from the PTPN III Plantations in Aek Nabara, Kecamatan Bilah Results Hulu, Labuhan Batu District, North Sumatera Province, Indonesia. 3UHOLPLQDU\VFUHHQLQJRISULPDU\VFKRROFKLOGUHQ :HLQFOXGHGSULPDU\VFKRRODJHFKLOGUHQ DJH \LHOGHGFKLOGUHQZLWK,'$DQGIXOILOOHGWKH \HDUVROG ZKRVXIIHUHGIURP,'$ZKR agreed eligibility criteria. These subjects were randomized to follow the study until completion, and provided XVLQJEORFNUDQGRPL]DWLRQUHVXOWLQJLQVXEMHFWV written informed consent from their parents. We LQWUHDWPHQWJURXSDQGLQSODFHERJURXS$WWKH excluded children who suffered from severe anemia, beginning of our study, we determined that there severe infection, both with or without malnutrition. were no significant differences between the iron %RG\ZHLJKWDQGKHLJKWZHUHPHDVXUHGZLWK0,& therapy and placebo groups with respect to sex, age, ERG\VFDOH DFFXUDWHWRNJIRUZHLJKWDQGFP body weight, height, and hemoglobin concentration for height). and other blood parameters (Table 1). During the %ORRGVDPSOHVFRQVLVWLQJRIDSSUR[LPDWHO\ study period, two subjects in the iron therapy group ml of peripheral capillary blood was taken from the were lost to follow up, therefore the study was fingers. We used WHO criteria for anemia, i.e. the FRPSOHWHGZLWKVXEMHFWV 196Paediatr Indones, Vol. 49, No. 4, July 2009 Budi Andri Ferdian et al: Impact of iron therapy on Mentzer index and red cell distribution width index $IWHUGD\VRIWKHUDS\WKHKHPRJORELQ Discussion FRQFHQWUDWLRQKHPDWRFULW0&+DQG0&+&LQ the iron therapy group increased, and there was 2XWRIVXEMHFWVZKRZHUHLQLWLDOO\UHYLHZHG also a slight decrease in the value of RDW index. ZHUHIRXQGWRKDYH,'$DQGZHUH A similar trend also occurred in the placebo group UHFUXLWHG2IWKHVHVXEMHFWVFRPSOHWHGWKLV (Table 2). study. This study used simple techniques to confirm ,URQWKHUDS\ZDVFRQWLQXHGXQWLOGD\V6HYHQ the diagnosis of IDA i.e. hemoglobin concentration, months after the end of therapy, the hematological 0&95':0HQW]HULQGH[DQG5':LQGH[7KH values of the subjects were measured again. The hemoglobin concentration and the hematocrit test KHPRJORELQFRQFHQWUDWLRQKHPDWRFULW0&+DQG were not the examination of choice due to poor 0&+&KDGDOOGHFUHDVHGZKLOHRWKHUYDULDEOHVVXFK sensitivity in detecting IDA. However, as hemoglobin as RDW, Mentzer and RDW indexes had increased. concentration and the hematocrit test are easy This trend was seen in both the iron therapy and the and accessible, they may be used as part of the placebo groups (Table 2). iron deficiency screening tests and can also help to determine the severity of the anemia.5,6 These tests are not specific for the diagnosis of IDA because the etiology of anemia is very broad.5,6,11 The best diagnosis, based on sensitivity and Table 1. Subject characteristics specificity, for IDA may be based on microcytic Characteristic Iron therapy Placebo K\SRFKURPLF5%&LQSHULSKHUDOEORRGVPHDULQ Age, mean (SD) mo 121.18 (17.88) 121.21 (15.49) FRQMXQFWLRQZLWKDIHUULWLQVHUXPYDOXHRI Sex mcg/l. However, these are not a common test for IDA Male 22 27 as these are relatively expensive.5,15 Female 29 26 0&9FDQEH Body weight, mean (SD) kg 27.89 (6.11) 25.47 (5.49) used to determine whether the anemia is microcytic, Height, mean (SD) cm 130.0 (8.39) 127.0 (8.19) normocytic, or macrocytic. As RDW has a lower Hemoglobin, mean (SD) g/dl 10.32 (1.22) 10.09 (1.42) specificity, it can not be used as part of screening Hematocrit, mean (SD) % 32.26 (5.05) 31.41 (5.05) Erythrocyte, mean (SD) 106/μl 5.01 (3.80) 4.37 (0.7) WHVW\HWLWLVXVHGZLWK0&9WRGHWHUPLQHWKHW\SHRI /%8OGCP 5& ƀ 72.66 (2.77) 72.58 (4.10) DQHPLDIRUH[DPSOHLQFUHDVHG5':DQGGHFUHDVHG MCH, mean (SD) pg 23.40 (2.59) 23.29 (2.50) RI0&9LQGLFDWHVLURQGHILFLHQF\ MCHC, mean (SD) g/dl 31.93 (3.13) 32.32 (3.16) RDW, mean (SD) % 15.81 (2.11) 15.79 (2.12) Iron preparation therapy can be given through Mentzer index, mean (SD) 16.50 (3.02) 17.26 (4.63) either oral or parenteral route, although oral iron RDW index, mean (SD) 261.11 (64.06) 279.98 (121.13) preparations are easier to administer. The side effects Table 2. Hematological variables between iron treatment and placebo groups at 90 days and 8 months after discontinuation of iron therapy After 90 days After the treatment stopped of treatment
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