Background: Iron deficiency anemia(IDA) has been still recognized as a major
medical problem affecting considerable proportion of the world's population at all ages,
especially, in infants and young children. With the eletronic counters routinely used, it
has become practical to determine the concentration of hemoglobin and red cell indices
and red cell distribution width(RDW) concurrently in association with the iron battery
according to the feeding practices.
Methods: From March 1992 to August 1994, infants and children aged 6 to 24
months who had been admitted to Inha General Hospital were investigated for the
evidence of iron deficiency. The children were divided into 3 groups, i.e., children who
were exclusively breast-fed(Group A, n=299), those who were given iron-fortified
formula milk since birth(Group B, n=608), and those who were given breast milk for 5∼
6 months and then switched to the iron-fortified formula at 5-6 months of age(Group C,
n=121).
Results: Among 1,028 patients(M:F=l.6:1) the mean hemoglobin values in Group A
were 10.1±1.6g/dL(mean±SD), significantly lower than in Group B of 11.9±1.1g/dL and
in Group C of 11.9±1.2g/dL(P <0.005, respectively). The mean MCV values in Group A
were 66.7±9.lfL(mean±SD), significantly lower than in Group B of 76.9±7.3fL and
Group C of 74.9±5.2fL(P<0.005, respectively).
Out of 146(14.2%) found to have hemoglobin<10g/dL, prevalence rate for anemia of
Group A was 34.8%(104/299), significantly higher than 5.6%(34/608) of Group B and
6.6%(8/121) of Group C(P<0.001, respectively). Among 177(17.2%) children who were
classified microcytic by MCV <70fL, prevalence rate of Group A was 39.5%(118/299),
significantly higher than 7.1%(43/608) of Group B and 13.2%(16/121) of Group C. Among
209(20.3%) children who had RDW≥15%, prevalence rate of Group A was
44.1%(132/299), compared with 9.7%(59/608) of Group B and 14.0%(18/121) of Group C.
Out of 146 patients with anemia, 87.7%(n=128) had iron deficiency. The sensitivity of
MCV values<70 fL was 85.2%, and specificity was 92.4%. The sensitivity of RDW
values≥15% was 78.6% and specificity was 87.9%. The sensitivity of serum ferritin
concentrations< 10ng/mL and transferrin saturation<15% was 58.2%, 91.4% respectively.
Conclusion: By combining the hemoglobin with MCV and RDW in screening for iron
deficiency, the diagnostic accuracy of IDA can be increased. And we reaffirm the use of
appropriately iron-fortified weaning foods or the routine iron supplement starting at 6
months of age in exclusively breast-fed infants and perhaps somewhat earlier if solid
foods have been started.

Keywords: Anemia, Iron deficiency, Infant, Breast milk Formula, Red cell indices