Value of anemia as a predictor of iron deficiency in children

Objective: To find out the validity of assumption that anemia is used as an indicator of iron deficiency and children found to be anemic are put on supplemental iron. Method: In this cross sectional study, children between 5-12 years of were tested for anemia and iron deficiency. Hemoglobin (Hb) of less than 11.5 gm/dl was defined as anemia. Serum iron < 115 mcg/dl and TIBC of > 360 mcg/dl were used as an indicator of iron deficiency. Results: Out of 319 school children, 87 (27%) were found to be anemic. Out of these, almost half (43 children) had no associated iron deficiency. Also, 130/319 (40.7%) children had depletion of iron stores, and out of these only 44 had anemia and 86 had iron deficiency without anemia. This makes both specificity and sensitivity of anemia low for iron deficiency. Positive predictive value of anemia for depleted iron stores was 50.6%. Sensitivity of anemia for depleted iron stores was 33.8%. Conclusions: Since low hemoglobin is not a sensitive indicator of iron deficiency, and since iron deficiency is wide spread and causes multiple problems in children, we suggest that hemoglobin level should not be taken as the only indicator of iron status in children.