High risk factors of iron deficiency in children with congenital heart disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Xiaofeng ,  WANG Xu , PAN Tuo , LI Dan

PICU of Pediatric Cardiac Center, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

WANG Xu, Email: fwpicu@163.com

Keywords：

Congenital heart disease; cyanosis; iron deficiency; anemia; children

DOI：

10.7507/1007-4848.201612058

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Objective To investigate the iron deficiency (ID) in children with congenital heart disease (CHD) and find high risk factors of ID. Methods The clinical data of 227 pediatric patients with CHD from February to June 2016 were retrospectively analyzed. The incidence of ID according to the result of iron metabolism examination (serum ferritin <12 μg/L as the diagnostic criteria) was investigated. According to their basic CHD types, patients were divided into a cyanotic group and an acyanotic group. We tried to find the high risk factors of ID in those pediatric CHD patients by comparing their age, gender, growth condition and blood routine test results. Results There were 19.8% pediatric CHD patients complicated by ID. The incidence of ID in the cyanotic patients was higher than that in the acyanotic patients (31.0% vs. 17.3%, P=0.045). In both groups, ID patients presented the characteristics of younger age, higher anemia rate, lower mean corpuscular volume (MCV), lower mean corpuscular hemoglobin (MCH), lower mean corpuscular-hemoglobin concentration (MCHC) and longer red blood cell distribution width (RDW). Conclusion Cyanosis, younger age (infant), anemia, decreased MCV, decreased MCH, decreased MCHC and increased RDW are high risk factors of ID in CHD children.

Citation： WANG Xiaofeng, WANG Xu, PAN Tuo, LI Dan. High risk factors of iron deficiency in children with congenital heart disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(8): 585-588. doi: 10.7507/1007-4848.201612058 Copy

1.	Cook JD. Diagnosis and management of iron deficiency anemia. Best Pract Res Clin Haematol, 2005, 18(2): 319-332.
2.	Baker RD, Greer FR. Diagnosis and prevention of iron deficiency and iron deficiency anemia in infants and young children (0-3 years of age). Pediatrics, 2010, 126(5): 1040-1050.
3.	Diller GP, Dimopoulos K, Broberg CS, et al. Presentation, survival prospects, and predictors of death in Eisenmenger syndrome: a combined retrospective and case-control study. Eur Heart J, 2006, 27(14): 1737-1742.
4.	Tay EL, Peset A, Papaphylactou M, et al. Replacement therapy for iron deficiency improves exercise capacity and quality of life in patients with cyanotic congenital heart disease and/or the Eisenmenger syndrome. Int J Cardiol, 2011, 151(3): 307-312.
5.	Algarín C, Nelson CA, Peirano P, et al. Iron-deficiency anemia in infancy and poorer cognitive inhibitory control at age 10 years. Dev Med Child Neurol, 2013, 55(5): 453-458.
6.	Amin SB, Orlando M, Wang H. Latent iron deficiency in utero is associated with abnormal auditory neural myelination in ≥35 weeks gestational age infants. J Pediatr, 2013, 163(5): 1267-1271.
7.	Low M, Farrell A, Biggs BA, et al. Effects of daily iron supplementation in primary-school-aged children: systematic review and meta-analysis of randomized controlled trials. CMAJ, 2013, 185(17): E791-E802.
8.	Jankowska EA, von Haehling S, Anker SD, et al. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives. Eur Heart J, 2013, 34(11): 816-826.
9.	von Haehling S, Gremmler U, Krumm M. Prevalence and clinical impact of iron deficiency and anaemia among outpatients with chronic heart failure: The PrEP Registry. Clin Res Cardiol, 2017, 106(6): 436-443..
10.	Ruiter G, Lankhorst S, Boonstra A, et al. Iron deficiency is common in idiopathic pulmonary arterial hypertension. Eur Respir J, 2011, 37(6): 1386-1391.
11.	Jankowska EA, Malyszko J, Ardehali H, et al. Iron status in patients with chronic heart failure. Eur Heart J, 2013, 34(11): 827-834.
12.	Pozzo J, Fournier P, Delmas C. Absolute iron deficiency without anaemia in patients with chronic systolic heart failure is associated with poorer functional capacity. Arch Cardiovasc Dis, 2017, 110(2): 99-105.
13.	Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart FailureAssociation (HFA) of the ESC. Eur Heart J, 2016, 37(27), 2129-2200.
14.	Ponikowski P, van Veldhuisen DJ, Comin-Colet J, et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J, 2015, 36(11): 657-668.
15.	Rhodes CJ, Howard LS, Busbridge M, et al. Iron deficiency and raised hepcidin in idiopathic pulmonary arterial hypertension clinical prevalence, outcomes, and mechanistic insights. J Am Coll Cardiol, 2011, 58(3): 300-309.
16.	Van De Bruaene A, Delcroix M, Pasquet A, et al. Iron deficiency is associated with adverse outcome in Eisenmenger patients. Eur Heart J, 2011, 32(22): 2790-2799.
17.	Mehmood M, Agarwal R, Raina A, et al. Hemodynamic response to treatment of iron deficiency anemia in pulmonary arterial hypertension: longitudinal insights from an implantable hemodynamic monitor. Pulm Circ, 2016, 6(4): 616-618.
18.	Lang’o MO, Githanga JN, Yuko-Jowi CA. Prevalence of iron deficiency in children with cyanotic heart disease seen at Kenyatta National Hospital and Mater Hospital Nairobi. East Afr Med J, 2009, 86(12 Suppl): S47-S51.
19.	Terlemez S, Tunaoğlu FS, Göktaş T, et al. The effects of iron treatment on viscosity in children with cyanotic congenital heart disease. Hematology, 2017, 22(1): 30-35.
20.	Sazawal S, Dhingra U, Dhingra P, et al. Efficiency of red cell distribution width in identification of children aged 1-3 years with iron deficiency anemia against traditional hematological markers. BMC Pediatr, 2014, 14: 8.
21.	Thomas DW, Hinchliffe RF, Briggs C, et al. Guideline for the laboratory diagnosis of functional iron deficiency. Br J Haematol, 2013, 161(5): 639-648.

1. Cook JD. Diagnosis and management of iron deficiency anemia. Best Pract Res Clin Haematol, 2005, 18(2): 319-332.
2. Baker RD, Greer FR. Diagnosis and prevention of iron deficiency and iron deficiency anemia in infants and young children (0-3 years of age). Pediatrics, 2010, 126(5): 1040-1050.
3. Diller GP, Dimopoulos K, Broberg CS, et al. Presentation, survival prospects, and predictors of death in Eisenmenger syndrome: a combined retrospective and case-control study. Eur Heart J, 2006, 27(14): 1737-1742.
4. Tay EL, Peset A, Papaphylactou M, et al. Replacement therapy for iron deficiency improves exercise capacity and quality of life in patients with cyanotic congenital heart disease and/or the Eisenmenger syndrome. Int J Cardiol, 2011, 151(3): 307-312.
5. Algarín C, Nelson CA, Peirano P, et al. Iron-deficiency anemia in infancy and poorer cognitive inhibitory control at age 10 years. Dev Med Child Neurol, 2013, 55(5): 453-458.
6. Amin SB, Orlando M, Wang H. Latent iron deficiency in utero is associated with abnormal auditory neural myelination in ≥35 weeks gestational age infants. J Pediatr, 2013, 163(5): 1267-1271.
7. Low M, Farrell A, Biggs BA, et al. Effects of daily iron supplementation in primary-school-aged children: systematic review and meta-analysis of randomized controlled trials. CMAJ, 2013, 185(17): E791-E802.
8. Jankowska EA, von Haehling S, Anker SD, et al. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives. Eur Heart J, 2013, 34(11): 816-826.
9. von Haehling S, Gremmler U, Krumm M. Prevalence and clinical impact of iron deficiency and anaemia among outpatients with chronic heart failure: The PrEP Registry. Clin Res Cardiol, 2017, 106(6): 436-443..
10. Ruiter G, Lankhorst S, Boonstra A, et al. Iron deficiency is common in idiopathic pulmonary arterial hypertension. Eur Respir J, 2011, 37(6): 1386-1391.
11. Jankowska EA, Malyszko J, Ardehali H, et al. Iron status in patients with chronic heart failure. Eur Heart J, 2013, 34(11): 827-834.
12. Pozzo J, Fournier P, Delmas C. Absolute iron deficiency without anaemia in patients with chronic systolic heart failure is associated with poorer functional capacity. Arch Cardiovasc Dis, 2017, 110(2): 99-105.
13. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart FailureAssociation (HFA) of the ESC. Eur Heart J, 2016, 37(27), 2129-2200.
14. Ponikowski P, van Veldhuisen DJ, Comin-Colet J, et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J, 2015, 36(11): 657-668.
15. Rhodes CJ, Howard LS, Busbridge M, et al. Iron deficiency and raised hepcidin in idiopathic pulmonary arterial hypertension clinical prevalence, outcomes, and mechanistic insights. J Am Coll Cardiol, 2011, 58(3): 300-309.
16. Van De Bruaene A, Delcroix M, Pasquet A, et al. Iron deficiency is associated with adverse outcome in Eisenmenger patients. Eur Heart J, 2011, 32(22): 2790-2799.
17. Mehmood M, Agarwal R, Raina A, et al. Hemodynamic response to treatment of iron deficiency anemia in pulmonary arterial hypertension: longitudinal insights from an implantable hemodynamic monitor. Pulm Circ, 2016, 6(4): 616-618.
18. Lang’o MO, Githanga JN, Yuko-Jowi CA. Prevalence of iron deficiency in children with cyanotic heart disease seen at Kenyatta National Hospital and Mater Hospital Nairobi. East Afr Med J, 2009, 86(12 Suppl): S47-S51.
19. Terlemez S, Tunaoğlu FS, Göktaş T, et al. The effects of iron treatment on viscosity in children with cyanotic congenital heart disease. Hematology, 2017, 22(1): 30-35.
20. Sazawal S, Dhingra U, Dhingra P, et al. Efficiency of red cell distribution width in identification of children aged 1-3 years with iron deficiency anemia against traditional hematological markers. BMC Pediatr, 2014, 14: 8.
21. Thomas DW, Hinchliffe RF, Briggs C, et al. Guideline for the laboratory diagnosis of functional iron deficiency. Br J Haematol, 2013, 161(5): 639-648.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

High risk factors of iron deficiency in children with congenital heart disease

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