title: Zinc protoporphyrin/heme ratio for diagnosis of preanemic iron deficiency.
abstract: OBJECTIVE
  Iron deficiency anemia is known to impair cognitive and psychomotor development. The zinc protoporphyrin/heme (ZPP/H) ratio is a simple, accurate, and sensitive laboratory screening test that detects early iron depletion before the onset of anemia. The objective of this work was to evaluate this test in a primary pediatric practice setting.
  
  
  METHODS
  The iron status of a cohort of 361 children was screened during routine examinations at a community pediatric practice. Whole blood hemoglobin concentration, hematocrit ratio, serum transferrin saturation, ferritin concentration, and the ZPP/H ratio were measured. The ZPP/H ratio then was evaluated as a single indicator of iron status by comparing it with other tests for detecting the onset of iron deficiency and for monitoring recovery after iron supplementation.
  
  
  RESULTS
  Significant age- and sex-related differences in the ZPP/H ratio were found. In this cohort, serum ferritin concentration and the ZPP/H ratio independently identified the same fraction of iron-deficient patients (3%-4%), and both tests were more specific than was either hemoglobin or hematocrit. A concordance of three iron status parameters changed the prediction of iron deficiency to </=1%. Children <3 years of age and adolescent girls had significantly higher ZPP/H results.
  
  
  CONCLUSIONS
  The prevalence of iron deficiency anemia in the typical healthy American pediatric population is low, but iron deficiency without anemia remains relatively common at some stages of development. Increase in the ZPP/H ratio is demonstrated to be a sensitive, specific, and cost-effective test for identifying preanemic iron deficiency in a community pediatric practice. anemia, nutrition, development.
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, Washington 98195, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Rettmer
authors.forename: T H
authors.initials: TH
authors.lastname: Carlson
authors.forename: M L
authors.initials: ML
authors.lastname: Origenes
authors.forename: R M
authors.initials: RM
authors.lastname: Jack
authors.forename: R F
authors.initials: RF
authors.lastname: Labb
mesh_terms: D000293:Adolescent; D000367:Age Factors; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D004791:Enzyme Inhibitors / Q000097:blood*; D005260:Female; D005293:Ferritins / Q000097:blood; D006403:Hematologic Tests; D006418:Heme / Q000032:analysis* / Q000037:antagonists & inhibitors; D006419:Heme Oxygenase (Decyclizing) / Q000037:antagonists & inhibitors*; D006801:Humans; D007223:Infant; D007501:Iron / Q000097:blood; D000090463:Iron Deficiencies; D008297:Male; D011524:Protoporphyrins / Q000097:blood*; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D012737:Sex Factors; D014168:Transferrin / Q000032:analysis
chemical_list: D004791:Enzyme Inhibitors; D011524:Protoporphyrins; D014168:Transferrin; C017803:zinc protoporphyrin; D006418:Heme; D005293:Ferritins; D007501:Iron; D006419:Heme Oxygenase (Decyclizing)