A study on iron deficiency in adolescents Toshisada Morita Department of Pediatrics (Chief: Prof. Yutaka Ueda), The Second Department of Biochemistry Director: Prof. Yoshio Yoshino), Nippon Medical School ( The iron status of 1198 high school students, aged 16-18 years, was evaluated by measuring hemoglobin (Hb), hematocrit (Ht), red blood cells (RBC), serum iron (SI), total iron binding capacity (TIBC) and transferrin saturation (TS) from peripheral blood. The average value of Hb concentration was 14.7 }0.9g/dl in males and 12.7 }1.0 al in females. The frequency of anemia in adolescents who had Hb levels less than 13 al in males and 12 g/dl in females was 3.5% and 15.9%, respectively. In addition, a concentration of serum ferritin (SF) and free erythrocyte porphyrins (FEP) was measured in 28 anemic males, 62 anemic females, 90 nonanemic males and 150 nonanemic females. The geometric mean of SF was 62.1 ng/ml (arithmetic mean : 73.6 }40 ng/ml) in nonanemic males and 18.1 ng/ml (arithmetic mean : 30.6±27ngirrd) in nonanemic females. The percentage of subjects with a low SF concentration below 10 ng/m/ in nonanemic females was 26.0% in contrast to 1.1% in nonanemic males. In order to standardize the diagnostic parameters of screening for latent iron deficiency, individual parameters indicating iron deficiency were defined by the author as follows: SF below 10 ngirni, TS below 15%, and FEP above 70pgf di RBC. In each of these three parameters, the incidence indicating iron deficiency was the highest with SF. Accordingly SF was supposed to be the most sensitive parameter for iron deficiency within these three. A low rate of latent iron deficiency was present in nonanemic males with Hb level above 13 g/dl, and on the other hand, the incidence of latent iron deficiency was 34.9% and 28% in two groups of nonanemic females who had Hb values of 12 `12.9 and 13 `13.9g/dl in the same order. Distinct differences were observed in the values of the parameters for evaluating iron status between male and female subjects. These findings suggest that the combination of these parameters make the diagnosis of iron deficiency more reliable than the information derived from a single parameter. Key words: adolescent, iron deficiency anemia, latent iron deficiency, serum ferritin, free erythrocyte porphyrins Present address: Department of Pediatrics, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113 Japan
Fig. 1 Standard curve of 2-site immunoradiometric assay for serum ferritin
Fig. 2 Distribution of Hb concentrations in adolescents aged 16 `18yr Table I Average values of hematologic parameters
Table 2 Incidence of low Hb concentration in adolescents aged 16-48 yr (male : less than 12 and 13 g/dl, female : less than 11 and 12 g/dl) Table 3 Average value of free erythrocyte porphyrins in adolescents (pg/dl RBC) Fig. 3 Relationship between free erythrocyte porphyrins and transferrin saturation in anemic adolescent females r=-0.54(p<0.001)
Fig. 4 Serum ferritin levels in anemic and nonanemic adolescents, The horizontal bars depict the geometric means Fig. 5 Serum ferritin in nonanemic (Hb13 g/d0 adolescent males aged 16-18 yr
Fig. 6 Serum f erritin in nonanemic (Hb12 g/dl) adolescent females aged 16-18 yr Fig. 7 Incidence of low serum ferritin for each group of Hb concentration in adolescents
Fig. 8 Relationship between serum ferritin and free erythrocyte porphyrins in anemic adolescent females aged 16-48 yr.35 (p<0.01) 0 Table 4 Hematologic values in anemic and nonanemic adolescents
Table 5 A single or combined incidence of parameters indicating iron deficiency within stepwise separated groups of Hb concentration in adolescent males (SF,10 ng/ml, TS1596, FEP70 pg/dl RBC) Table 6 A single or combined incidence of parameters indicating iron deficiency within stepwise separated groups of Hb concentration in adolescent females (SF 10 ng/m/, TS. 1596, FEP 70 tigldl RBC)
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