From the Guidelines
The most reliable iron studies labs for pediatric patients include serum ferritin, transferrin saturation, complete blood count (CBC), and serum iron with total iron binding capacity (TIBC). According to the most recent guidelines, serum ferritin is a key marker for iron deficiency, with levels below 15 μg/L indicating absent iron stores 1. Serum ferritin levels below 12 ng/mL are indicative of iron deficiency in children, and transferrin saturation should be above 16% in well-nourished children. A CBC provides important context through hemoglobin, hematocrit, mean corpuscular volume (MCV), and red cell distribution width (RDW) values. For infants and young children, a morning fasting sample is preferred to minimize diurnal variation in iron levels. When interpreting results, it's essential to consider that ferritin is an acute phase reactant that can be falsely elevated during inflammation or infection, so C-reactive protein (CRP) may be added to assess for underlying inflammation 1.
In pediatric patients receiving parenteral nutrition, iron status should be monitored regularly to prevent iron deficiency and iron overload, with serum ferritin and hemoglobin being key markers 1. The guidelines recommend routine provision of iron in parenteral nutrition for patients receiving long-term PN who cannot maintain adequate iron status using enteral iron supplements 1. Parenteral iron can be given daily added to PN solution or as intermittent, separate infusions, with a recommended dose of 200-250 mg/kg/day in preterm infants and 50-100 mg/kg per day up to a maximum dose of 5 mg/day in infants and children 1.
It's crucial to note that iron sucrose is the most studied iron preparation in children, and although it's not approved for pediatric use in Europe, it's approved in the USA for use in children from 2 years of age 1. When monitoring iron status, it's essential to consider the potential for inflammation or infection to affect ferritin levels, and sequential testing may be necessary in unclear cases, particularly when distinguishing iron deficiency anemia from anemia of chronic disease or when monitoring response to iron supplementation therapy 1.
From the Research
Most Reliable Iron Studies Labs in Pediatrics
- The most reliable iron studies labs in pediatrics are those that use serum or plasma ferritin concentration as an index of iron deficiency and overload 2.
- Ferritin is an iron storage protein and its concentration in the plasma or serum reflects iron stores; low ferritin indicates iron deficiency, while elevated ferritin reflects risk of iron overload 2.
- A study published in the Scandinavian journal of clinical and laboratory investigation established pediatric reference intervals for biochemical markers essential in the assessment of iron status, including ferritin, iron, transferrin, and transferrin saturation 3.
- The study found that the prevalence of iron deficiency in 6-12-year-old children was 8.2%, which is higher than reported in other populations 3.
- Another study published in Critical reviews in clinical laboratory sciences found that using transferrin saturation as a diagnostic criterion for iron deficiency can be beneficial, especially in patients with chronic inflammatory diseases 4.
- The study suggested that transferrin saturation can be used in addition to ferritin in the diagnosis of iron deficiency 4.
Key Findings
- Ferritin concentration is a reliable test for iron deficiency in people presenting for medical care, with a sensitivity of 79% and specificity of 98% at a threshold of 30 μg/L 2.
- The prevalence of iron deficiency in 6-12-year-old children is 8.2% 3.
- Transferrin saturation can be used as a diagnostic criterion for iron deficiency, especially in patients with chronic inflammatory diseases 4.
Laboratory Tests
- Serum or plasma ferritin concentration is a common laboratory test used to diagnose iron deficiency and overload 2.
- Transferrin saturation is another laboratory test that can be used to diagnose iron deficiency 4.
- Other laboratory tests, such as iron and transferrin, can also be used to assess iron status 3.