Response to Iron Therapy in Children with Microcytic Erythrocytes

Abstract

Abstract: Microcytic erythrocvtes are common indings among Thai chicken due to high prevalence of iron deticiency and thalassemia traits. We studied the effect of iron treatment in children (1-15-year) with microcytosis (mean corpuscular volume MCV < 80 iL). Shrty children with microcytic erythrocytes were given iron sultate (3 mg elemental iron/kg/day) orally for 3 weeks, after which a CBC was repeated to determine hemoglobin response. A hemoglobin typing was done on each case to identify thalassemia trait. HbE trait were identifi ified in 24 (40.0%), beta-thalassemia trait in 2 (3.3%), HbCS in 1. Alpha-thalassemia-1 trait (diagnosed when normal Hb typing and low MCV despite iron treatment! were identified in 14 (23.3%) and no thalassemia in 19 (31.7%) children. After treatment with iron, hemoglobin increased in 24 cases, 10 of whom more than 1 gidl. Children with lower hemoglobin level had better response to iron therapy than non-anennic children. When red cell indices were used in a formula: Hb x 7.2) - MOV, a value less than 12 predicted response to iron therapy (sensitivity = 87.5%, speciticity 72.2%). A cost analvsis showed that if all children with
microcytic erythrocytes were treated with iron, followed by hemogicbin typing if MCV remained < 78 iL, the average cost per case would be 297.16 Baht. If only children whose (Hb x 7.2) - MCV < 12 were given mon therapy followed by hemoglobin typing if MCV remained < 78 fl, the average cost per case would be 2:4:78 Baht. In conchusion, iron theraby should be given to children with
microcytic enthroccytes and hemoglobin < 12 g/dl or it (Hb x 7.2)-MCV <12. If MCV remain 76 IL post-treatment, a hemoglobin should be done to diagnose thalassemia trait.