© 1996 Oxford University Press
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Iron Deficiency and Anaemia in Children with a High Prevalence of Haemoglobinopathies: Implications for Screening
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*The Research Institute for Health Sciences, Chiang Mai University Thailand
**Department of Pediatrics, Chiang Mai University Thailand
Department of Pediatrics, Louisiana State Univetrsity Medical School New Orleans, LA, USA
Reprint requests: Dr George J Fuchs, International Centre for Diarrheal Disease Research, GPO Box 128, Dhaka 1000. Bangladesh
Linpisam S (Research Institute for Health Sciences, Chiang Mai University, Thailand), Tienboon P, Promtet N, Putsyalnunt P, Santawanpat and Fuchs G J. Iron deficiency and anaemia in children with a high prevalence of haemo-globinopathies: Implications for screening. International Journal of Epidemiology 1996, 25: 1262–1266.
BACKGROUND: Haemoglobin (Hb) concentration is used as a sole test for iron deficiency anaemia (IDA) in most developing countries since most anaemia is believed to be due to iron deficiency and confirmatory testing is generally unavailable. Yet the validity of this approach in regions where haemoglobinopathies are endemic has not been documented.
METHODS: Haemoglobin and serum ferritin (SF) were measured in 559 Northern Thai children aged 6 months to 13 years of age. The sensitivity of SF to identify iron deficiency was also assessed in a subsample of children with low or low normal Hb and normal SF by testing the Hb response to a trial of oral iron.
RESULTS: While anaemia was common (27%), IDA constituted 19% and none of all anaemia in preschool and school age children, respectively (P < 0.002). Iron depletion was similarly more prevalent in younger children (P < 0.0002). Children with IDA were younger (P < 0.001) and the anaemia more severe (P < 0.0001) compared to those with non-IDA. Of anaemic children with normal SF values who received a therapeutic trial of iron, only 6% responded with an increase in Hb of 
1g/dl.
CONCLUSIONS: For populations such as ours most anaemia is not due to iron deficiency and a single Hb determination is therefore not acceptable for a presumptive diagnosis of IDA.
Keywords Iron deficiency, anaemia, ferritin, haemoglobinopathy, children, Thailand, Southeast Asia
Revised 1 May 1996
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