Using complete blood count parameters in the diagnosis of iron deficiency and iron deficiency anemia in Filipino women

Ana Kriselda B Rivera; Angelica Anne E Latorre; Keiko Nakamura; Kaoruko Seino

doi:10.2185/jrm.2022-047

Using complete blood count parameters in the diagnosis of iron deficiency and iron deficiency anemia in Filipino women

J Rural Med. 2023 Apr;18(2):79-86. doi: 10.2185/jrm.2022-047. Epub 2023 Apr 5.

Authors

Ana Kriselda B Rivera^{1

2}, Angelica Anne E Latorre^{1

3}, Keiko Nakamura¹, Kaoruko Seino¹

Affiliations

¹ Department of Global Health Entrepreneurship, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan.
² Department of Nutrition, College of Public Health, University of the Philippines Manila, Philippines.
³ Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila, Philippines.

Abstract

Objectives: Correct diagnosis of iron deficiency remains challenging due to the cost of ferritin tests. Physicians, especially those in resource-limited settings, may resort to a complete blood count (CBC) when considering iron deficiency and anemia due to its accessibility. Although this has been practiced, it is still beneficial to assess whether CBC parameters exhibit the diagnostic capability of discriminating such medical conditions. Materials and Methods: Serum ferritin and CBC were performed on venous blood samples of 170 Filipino women aged 18-44 years. The diagnostic ability of the CBC parameters to detect iron deficiency and iron deficiency anemia was analyzed using receiver operating characteristic (ROC) curves. Iron deficiency was defined as a ferritin level <30 µg/L, while iron deficiency anemia was defined as a ferritin level <30 µg/L with hemoglobin level <120 g/L. Results: Ferritin levels correlated with red blood cell (RBC) count and hematocrit levels. With an area under the ROC curve (AUC) of 0.60, a hematocrit cutoff value of 38.5% was found to have low discriminating power in diagnosing iron deficiency only. Five parameters were observed to have higher discriminating powers for iron deficiency anemia: RBC count cutoff at 4.04 × 10¹²/L with AUC of 0.73, mean corpuscular volume (MCV) at 84.10 fL with AUC of 0.77, mean corpuscular hemoglobin concentration (MCHC) at 337.5 g/L with AUC of 0.80, mean corpuscular hemoglobin (MCH) at 29.15 pg with AUC of 0.81, and hematocrit at 35.5% with AUC of 0.96. Conclusion: CBC parameters can be a satisfactory discriminator for iron deficiency anemia among the women studied. However, further studies are needed to elucidate its utility in discriminating iron deficiency. With further investigations in this field, the potential use of CBC as a diagnostic tool for iron deficiency and iron deficiency anemia is promising, particularly in rural areas.

Keywords: Philippines; anemia; complete blood count; iron deficiency; women.