The role of haematological indices in predicting early iron deficiency among pregnant women in an urban area of Sri Lanka

Abstract

BackgroundEarly detection and treatment of iron deficiency during pregnancy is crucial for optimum pregnancy outcomes. Anaemia is a late indictor of iron deficiency measured as Hb < 11 g/dL, and is widely used as a proxy for iron deficiency. We aimed to evaluate the role of red cell indices as a screening tool for early detection of iron deficiency among pregnant women in an urban area of Sri Lanka.MethodA cross-sectional study was conducted among 110 apparently healthy pregnant women ≤12 weeks of gestation attending antenatal clinics in Colombo, Sri Lanka. Women already on nutritional supplements were excluded. Full blood count, serum ferritin (SF) and high sensitive C-reactive protein (hs-CRP) assessments were performed. The women with evidence of inflammation as indicated by hs-CRP > 10 mg/L were excluded (N = 20) from data analysis. Anaemia (Hb < 11 g/dL) and iron deficiency (SF < 30 μg/L) were defined according to WHO guidelines. Receiver operating characteristics curves were used to derive red blood cell indices that showed the optimal cut-offs in detecting early iron deficiency.ResultsOf the 90 women, 63 (70.0%) were iron deficient (SF < 30 μg/L), out of whom 10 (15.9%) were identified as having iron deficiency anaemia (Hb < 11 g/dL). A high sensitivity (> 70%) in the prediction of iron deficiency was obtained for the optimal cut-off values of Hb < 12.2 g/dL, MCV < 83.2 fl, MCH < 26.9 pg and MCHC 33.2 g/dL while maintaining a specificity > 40%.ConclusionIron deficiency can be predicted in early stages using Hb and red cell indices, which is much less expensive. This could be a useful method in areas with limited resources and a high prevalence of iron deficiency.

A possible role for hepcidin in the detection of iron deficiency in severely anaemic HIV-infected patients in Malawi

“…The best, though still suboptimal, conventional peripheral blood marker for iron deficiency, was MCV. Microcytosis is commonly used as a screening test for iron deficiency [34,49,50]; however, MCV has not been found to be an accurate predictor of BM-ID [10,11,48]. Our findings confirm this as MCV did not have a high sensitivity or specificity and the AUC ROC was of low diagnostic value.…”

Role of Reticulocyte Parameters in Anemia of First Trimester Pregnancy: A Single Center Observational Study

“…This observation further suggests that Ret-He may be helpful to differentiate between Hb in predicting early iron deficiency among pregnant females but reticulocyte parameters were not studied. 16 Another interesting finding observed in the present study was that cutoff of 29.4 ng Ret-He was specific (87%) for the diagnosis of IDA in pregnant females with positive predictive value of 73%. Previous studies have observed variable cutoffs of Ret-He in IDA ranging from 26 to 30.9 pg.…”

“…Rabindrakumar et al also evaluated hematological indices MCV, MCH, MCHC, and Hb in predicting early iron deficiency among pregnant females but reticulocyte parameters were not studied. 16 …”

UK guidelines on the management of iron deficiency in pregnancy

“…One study in Sri Lanka found the MCHC to have the best sensitivity for detection of iron deficiency, compared with Hb and the other red cell indices (Rabindrakumar, et al , ). This has not been supported by UK studies (Vora et al , ) but potential biomarkers need to be further investigated to find a practical, cost effective measure for the early detection of iron depletion.…”