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EFFECTIVENESS OF ZINC PROTOPORPHYRIN/HEME RATIO IN IDENTIFICATION OF IRON DEFICIENCY IN A GROUP OF PRESCHOOL AGED CHILDREN

Background and aim: Iron deficiency anemia (IDA) is the ultimate result of untreated iron deficiency. Zinc protoporphyrin (ZPP)/heme ratio levels are a direct marker of iron status in the bone marrow during erythropoiesis. We studied the value of this index in screening for iron depletion or for deficiency in children seen for routine examination in a community pediatric practice. Subjects and methods: The present cross sectional study consisting of 95 child aged 36 years old was recruited from outpatient pediatric clinic in Alzahraa University Hospital, Faculty of Medicine for Girls, Al-Azhar University during the period from (April 2020 - April 2021). All participants were subjected to full medical history taking, thorough clinical examination and standard laboratory assessment including complete blood count, serum iron, serum ferritin, TIBC and ZPP/H was assessed. Results: The present study included 95 preschool children. They included 25 anemic children (26.3 %) and 70 non-anemic children (73.4 %). Comparison between anemic and non-anemic children revealed that anemic children had significantly higher ZPP/H [median (IQR): 97.8 (91.13–100.2) versus 51.05 (43.21–75), p(cid:31)0.001]. Correlation analysis identified significant inverse correlation between ZPP/H and Hb (r=-0.573, p<0.001), and S.ferritin (r=-0.267, p=0.009) and positive correlation with RDW (r=0.439, p<0.001) and TIBC (r=0.484, p =0.000). ROC curve analysis recognized ZPP/H as a reliable diagnostic marker for anemia (AUC=0.819) with sensitivity and specificity of 92.00 and 78.57 respectively. Conclusions: ZPP/H ratio can be considered as a reliable marker for diagnosis of iron deficiency with or without anemia in preschool children. It’s well-correlated with other markers of anemia.