Association Between Iron-Deficiency Anemia and Stroke in Young Children
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Status:
Completed. Results published November 2007.
Purpose:
To determine if iron-deficiency anemia is associated with stroke in young children.
Year Started:
2002
Year Finished:
2004
Design:
Prospective, case-controlled, registry-based, database comparison study.
Inclusion Criteria
Patients ages 12 to 38 months from the Canadian Pediatric Ischemic Stroke Registry were selected if they had arterial ischemic stroke (AIS), defined as a focal neurologic deficit of acute onset shown in an MRI scan of the brain, or sinovenous thrombosis (SVT), defined as headache, altered level of consciousness, seizure, or focal neurologic deficit with venography (computed tomography or MRI) showing occlusion or focal reduction of flow within cerebral venous sinuses or cerebral veins and who had parental consent.
Control subjects: subjects selected from a database of children enrolled in an observational study of iron deficiency who attended a well-child visit at a university-affiliated community-based pediatric practice in Toronto between November 2002 and March 2004, whose blood work and parental consent had been obtained.
Exclusion Criteria
Children with sickle cell disease, chronic systemic disease (excluding IDA), malignancy, cerebral arterial disease, meningitis, encephalitis, head trauma, recent surgery, heart disease, or indwelling catheters.
Control subjects: acute febrile illness at enrollment, history of illness or medication associated with iron deficiency or anemia, previous diagnosis of iron depletion or anemia, current use of iron supplements, and breast milk or formula as primary source of milk at or within 8 weeks of enrollment (which provides more available iron).
Patient Involvement:
Patients were prospectively enrolled in 2 databases. For both case patients and control subjects, mean corpuscular volume (MCV), platelet count, and hemoglobin and serum ferritin levels were collected at baseline. Iron-deficiency anemia (IDA) was defined as serum ferritin level of <12 ug/L, MCV of <73 fL, and hemoglobin level of <110 g/L. Thrombocytosis was defined as a platelet count of >450 x 109/L.
Primary Outcome:
Association between iron-deficiency anemia (IDA) and stroke.
Results:
Mean and median hemoglobin levels were significantly lower in case patients than in control subjects (88 and 92 g/L vs 116 and 120 g/L, respectively; P < .01) as were mean and median corpuscular volumes (MCV's) (65 and 57 fL vs 76 and 77 fL, respectively; P < .01). The mean and median platelet counts were significantly higher in case patients than in control subjects (458 and 415 x 10.9/L vs 358 and 351 x 10.9/L, respectively; P < .05) and IDA was significantly more common among case patients (8 of 15 [53%]) than control subjects (13 of 143 [9%]; OR: 12; 95% CI: 4–37). Thrombocytosis was also more common among case patients (7 of 15 [47%]) than control subjects (21 of 133 [16%]; OR: 5; 95% CI: 2–14).
Source of Information:
Pediatrics. 2007 Nov;120(5):1053-1057.
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This information last updated on: 11/5/2007
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