Optimizing diagnostic biomarkers of iron deficiency anemia in community-dwelling Indian women and preschool children

The detection of iron deficiency anaemia is challenged by the paucity of diagnostic tests demonstrating high sensitivity and specificity. Using two biomarkers zinc-protoporphyrin/heme and hepcidin, we established the diagnostic cut-off values for iron deficiency anaemia in preschool children and women. We randomly selected non-anaemic individuals (n=190; women=90, children=100) and individuals with iron deficiency anaemia (n=200; women=100, children=100) from a preexisting cohort of healthy preschool children and their mothers. The diagnostic performance of these biomarkers was estimated by analyzing receiver operating characteristic curves. Diagnostic cut-offs with a high predictive value for iron deficiency anaemia were selected. Median zinc-protoporphyrin/heme and hepcidin values in non-anaemic children were 49 mu mol/mol heme and 42ng/mL respectively and in non-anaemic women were 66 mu mol/mol heme and 17.7ng/mL respectively. Children and women with iron deficiency anaemia had higher zinc-protoporphyrin/heme ratios (children=151 mu mol/mol heme and women=155 mu mol/mol heme) and lower hepcidin levels (children=1.2ng/mL and women=0.6ng/mL). A zinc-protoporphyrin/heme ratio cut-off >90micromole/mole heme in children and >107micromole/mole heme in women was associated with a high diagnostic likelihood for iron deficiency anaemia (children, likelihood ratio=20.3: women, likelihood ratio=10.8). Hepcidin cut-off values of <= 6.8ng/mL in children and <= 4.5ng/mL in women were associated with a high diagnostic likelihood for iron deficiency anaemia (children, likelihood ratio=14.3: women, likelihood ratio=16.2). The reference ranges and cut-off values identified in this study provide clinicians with guidance for applying these tests to detect iron deficiency anaemia. Erythrocyte zinc-protoporphyrin/heme ratio is a valid point-of-care biomarker to diagnose iron deficiency anaemia.