Diagnosis of iron deficiency anemia in a rural population of children. Relative usefulness of serum ferritin, red cell protoporphyrin, red cell indices, and transferrin saturation determinations

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Abstract
The diagnostic usefulness in iron deficiency anemia of serum ferritin, red cell protoporphyrin (Epp), mean corpuscular volume, mean corpuscular hemoglobin (MCH), and transferrin saturation measurements has been studied in a population of 294 children aged 1 to 6 yr. Of the children studied 19% had hemoglobin below 11 g/dl. Iron deficiency, diagnosed by at least two abnormal independent laboratory parameters, was the cause of anemia in all except two cases. The Pearson correlation coefficient for hemoglobin was highest with MCH, followed in decreasing order of magnitude by MCV, Epp, transferrin saturation, and finally by ferritin. Sensitivity and specificity were highest for MCH and lowest for ferritin. Of anemic, iron deficient individuals 97 to 100% could be identified by low MCH, 88 to 100% by transferrin saturation, 66 to 83% by ferritin, and 61 to 74% by Epp. In contrast, only 0 to 6% of normal, nonanemic individuals had low MCH, 0 to 4% had high Epp, but 21 to 39% had low transferrin saturation and 25 to 39% had low ferritin. Although reduced serum ferritin in anemic individuals is good evidence of iron deficiency, a significant proportion of anemic iron-deficient patients is missed by this procedure rendering it less useful than other, less expensive laboratory methods.