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Is Erythrocyte Protoporphyrin a Better Single Screening Test for Iron Deficiency Compared to Hemoglobin or Mean Cell Volume in Children and Women?
Nutrients. 2017 May 31; 9(6)N

Abstract

Hemoglobin (Hb), mean cell volume (MCV), and erythrocyte protoporphyrin (EP) are commonly used to screen for iron deficiency (ID), but systematic evaluation of the sensitivity and specificity of these tests is limited. The objective of this study is to determine the sensitivity and specificity of Hb, MCV, and EP measurements in screening for ID in preschool children, non-pregnant women 15-49 years of age, and pregnant women. Data from the National Health and Nutrition Examination Surveys (NHANES) (NHANES 2003-2006: n = 861, children three to five years of age; n = 3112, non-pregnant women 15 to 49 years of age. NHANES 1999-2006: n = 1150, pregnant women) were examined for this purpose. Children or women with blood lead ≥10 µg/dL or C-reactive protein (CRP) >5.0 mg/L were excluded. ID was defined as total body iron stores <0 mg/kg body weight, calculated from the ratio of soluble transferrin receptor (sTfR) to serum ferritin (SF). The receiver operating characteristic (ROC) curve was used to characterize the sensitivity and specificity of Hb, MCV, and EP measurements in screening for ID. In detecting ID in children three to five years of age, EP (Area under the Curve (AUC) 0.80) was superior to Hb (AUC 0.62) (p < 0.01) but not statistically different from MCV (AUC 0.73). In women, EP and Hb were comparable (non-pregnant AUC 0.86 and 0.84, respectively; pregnant 0.77 and 0.74, respectively), and both were better than MCV (non-pregnant AUC 0.80; pregnant 0.70) (p < 0.01). We concluded that the sensitivity and specificity of EP in screening for ID were consistently superior to or at least as effective as those of Hb and MCV in each population examined. For children three to five years of age, EP screening for ID was significantly better than Hb and similar to MCV. For both non-pregnant and pregnant women, the performance of EP and Hb were comparable; both were significantly superior to MCV.

Authors+Show Affiliations

Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, 30300 GA, USA. zam0@cdc.gov.Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, 30300 GA, USA. rnf2@cdc.gov.Nutrition for Health and Development, World Health Organization (WHO), Geneva 1201, Switzerland. grummerstrawnl@who.int.Department of Pediatrics, Columbia University, New York, 10032 NY, USA. gmb31@cumc.columbia.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28561801

Citation

Mei, Zuguo, et al. "Is Erythrocyte Protoporphyrin a Better Single Screening Test for Iron Deficiency Compared to Hemoglobin or Mean Cell Volume in Children and Women?" Nutrients, vol. 9, no. 6, 2017.
Mei Z, Flores-Ayala RC, Grummer-Strawn LM, et al. Is Erythrocyte Protoporphyrin a Better Single Screening Test for Iron Deficiency Compared to Hemoglobin or Mean Cell Volume in Children and Women? Nutrients. 2017;9(6).
Mei, Z., Flores-Ayala, R. C., Grummer-Strawn, L. M., & Brittenham, G. M. (2017). Is Erythrocyte Protoporphyrin a Better Single Screening Test for Iron Deficiency Compared to Hemoglobin or Mean Cell Volume in Children and Women? Nutrients, 9(6). https://doi.org/10.3390/nu9060557
Mei Z, et al. Is Erythrocyte Protoporphyrin a Better Single Screening Test for Iron Deficiency Compared to Hemoglobin or Mean Cell Volume in Children and Women. Nutrients. 2017 May 31;9(6) PubMed PMID: 28561801.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is Erythrocyte Protoporphyrin a Better Single Screening Test for Iron Deficiency Compared to Hemoglobin or Mean Cell Volume in Children and Women? AU - Mei,Zuguo, AU - Flores-Ayala,Rafael C, AU - Grummer-Strawn,Laurence M, AU - Brittenham,Gary M, Y1 - 2017/05/31/ PY - 2017/04/13/received PY - 2017/05/19/revised PY - 2017/05/24/accepted PY - 2017/6/1/entrez PY - 2017/6/1/pubmed PY - 2018/4/17/medline KW - erythrocyte protoporphyrin KW - hemoglobin KW - iron deficiency KW - mean cell volume KW - receiver operating characteristic curve KW - serum ferritin KW - serum transferrin receptor KW - total body iron KW - zinc protoporphyrin JF - Nutrients JO - Nutrients VL - 9 IS - 6 N2 - Hemoglobin (Hb), mean cell volume (MCV), and erythrocyte protoporphyrin (EP) are commonly used to screen for iron deficiency (ID), but systematic evaluation of the sensitivity and specificity of these tests is limited. The objective of this study is to determine the sensitivity and specificity of Hb, MCV, and EP measurements in screening for ID in preschool children, non-pregnant women 15-49 years of age, and pregnant women. Data from the National Health and Nutrition Examination Surveys (NHANES) (NHANES 2003-2006: n = 861, children three to five years of age; n = 3112, non-pregnant women 15 to 49 years of age. NHANES 1999-2006: n = 1150, pregnant women) were examined for this purpose. Children or women with blood lead ≥10 µg/dL or C-reactive protein (CRP) >5.0 mg/L were excluded. ID was defined as total body iron stores <0 mg/kg body weight, calculated from the ratio of soluble transferrin receptor (sTfR) to serum ferritin (SF). The receiver operating characteristic (ROC) curve was used to characterize the sensitivity and specificity of Hb, MCV, and EP measurements in screening for ID. In detecting ID in children three to five years of age, EP (Area under the Curve (AUC) 0.80) was superior to Hb (AUC 0.62) (p < 0.01) but not statistically different from MCV (AUC 0.73). In women, EP and Hb were comparable (non-pregnant AUC 0.86 and 0.84, respectively; pregnant 0.77 and 0.74, respectively), and both were better than MCV (non-pregnant AUC 0.80; pregnant 0.70) (p < 0.01). We concluded that the sensitivity and specificity of EP in screening for ID were consistently superior to or at least as effective as those of Hb and MCV in each population examined. For children three to five years of age, EP screening for ID was significantly better than Hb and similar to MCV. For both non-pregnant and pregnant women, the performance of EP and Hb were comparable; both were significantly superior to MCV. SN - 2072-6643 UR - https://www.unboundmedicine.com/medline/citation/28561801/Is_Erythrocyte_Protoporphyrin_a_Better_Single_Screening_Test_for_Iron_Deficiency_Compared_to_Hemoglobin_or_Mean_Cell_Volume_in_Children_and_Women L2 - https://www.mdpi.com/resolver?pii=nu9060557 DB - PRIME DP - Unbound Medicine ER -