PREVALENCE OF IRON DEFICIENCY IN CHILDREN WITH SICKLE CELL DISEASE AS SEEN IN UBTH, BENIN CITY

Abstract

Iron deficiency is the commonest nutritional disorder world-wide while
Sickle cell disease is the commonest genetic disorder affecting Nigerian
children. Iron deficiency was thought to be uncommon in children with SCD
because of the chronic haemolysis and recurrent transfusions associated with the
disorder. This study was therefore done to determine the presence and
prevalence of iron deficiency in children with SCD seen in UBTH.
This is a hospital-based cross sectional study aimed at determining the
nutritional status (using the modified Wellcome classification for subjects aged
< 5years and the WHO BMI for age and gender z scores reference charts for
subjects ≥ 5years); the pattern of haemoglobin concentration, MCV (using an
automated counter) and serum ferritin levels (using an immunoassay technique)
in children with SCD. Using appropriate MCV for age values and serum ferritin
less than 25ng/ml, these indices were used to determine the prevalence and
spectrum of iron deficiency in children with SCD aged 1-18years seen in
UBTH. The prevalence of iron deficiency in transfused and non transfused
subjects was also determined.
One hundred subjects comprising 60 males and 40 females were studied.
The overall prevalence of iron deficiency was 47%. Twenty seven males and
twenty females were iron deficient giving a prevalence of 45% and 50%
respectively.
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The mean serum ferritin increased with increasing age up to the age of
fifteen years after which there was a decline. The serum ferritin level was
comparable in both sexes (p=0.27). The mean serum ferritin level for the
deficient and non deficient subjects was 11.9±7.4ng/ml and 66.8±31.4ng/ml
respectively (p<0.0001).
Underweight subjects were less likely to be iron deficient compared to
obese children and this was statistically significant (p=0.009). Also, there was a
significant association between subjects from the low socio economic class and
iron deficiency (p=0.03). Although not statistically significant, the age specific
prevalence of iron deficiency was highest in subjects aged 1-6years.
Subjects who had not received any previous blood transfusions were
1.7times more likely to be iron deficient compared to those who had been
transfused. The interval between the last blood transfusion and study time was
significantly associated with the presence of iron deficiency as subjects who had
not been transfused in the last five years were three times more likely to be iron
deficient (p=0.006).
In conclusion, iron deficiency was seen in 47% of children with sickle
cell disease attending the Outpatient Clinic of the University of Benin Teaching
Hospital, Benin City, Nigeria.
The findings in this study support the use of iron supplements given at
intervals to children with sickle cell disease especially those who have not
received any previous blood transfusions and are aged less than six years.
Regular health education in the out-patient clinics emphasizing ingestion of iron
rich foods such as liver, red meat etc especially in growing children should also
be encouraged.

PREVALENCE OF IRON DEFICIENCY IN CHILDREN WITH SICKLE CELL DISEASE AS SEEN IN UBTH, BENIN CITY