OCTOBER 2010

DELHI PSYCHIATRY JOURNAL Vol. 13 No. 2

Original Article

Iron Profile Estimation in Children of Behavioral Disorders

Shruti. Srivastava*, Bhatia MS**, Rusia U***, Rusia A**** *Lecturer, **Professor and Head, ***Professor, Department of Pathology, ****Resident Department of Psychiatry, U.C.M.S & Guru Tegh Bahadur Hospital, University of Delhi, Delhi-110095

Abstract Background: Iron deficiency causes abnormal dopaminergic neurotransmission and may contribute to behavioral disorders. Objective: Iron Profile Estimation in Children (5-14 yrs) of Behavioral Disorders. Design : Cross-sectional study. Setting: Child Guidance Clinic of University College of Medical Sciences and Guru Tegh Bahadur Hospital. The sample consisted of Forty children in the age group of 5 to 14 years suffering from behavioral disorders. Haemoglobin , Mean Corpuscular Volume, Mean Corpuscular Hemoglobin, Serum Iron ,Total Iron Binding Capacity, Peripheral smear, Percentage transferrin saturation , serum ferritin estimations were done. The behavioral symptoms were scored on Achenback Child Behavior Checklist. Results: Iron deficiency anemia was present in 75% of the children with behavioral symptoms. Serum ferritin was abnormal (<20micrograms/litre) in 67.8% of the children. There was statistically significant association between pica and iron deficiency anemia(p<0.001).Serum ferrittin levels correlated negatively with behavioral symptoms (r=-.067), though not significant. Key words: Iron deficiency Anemia, Serum ferritin Introduction The WHO estimates that more than two billion people in the world are anemic, which is about one third of the World population.1 UNICEF reports that 90% of all types of anemia in the world are due to iron deficiency.The estimated prevalence of Iron deficiency anemia among pregnant women and young children being 49.7% and 74% respectively.2 Attention-deficit/hyperactivity disorder (ADHD) affects 5% to 10% of school-aged children .The disorder is characterized by inappropriate impulsivity, overactivity, inattention, and altered executive functions. The symptoms of ADHD may be caused by dopamine dysfunction. Iron is a coenzyme of dopamine synthesis. In the brain, iron is bound to ferritin, the levels of which are decreased by iron deficiency and increased by iron supplementation. Low ferritin levels in childhood have been reported to affect the development of the central nervous system, leading to mental retardation and behavioral disorders3. Material and Methods In this cross-sectional hospital based study, we estimated iron profile in children with behavioral disorders. Forty consecutive children in the age group of 5-14 years were diagnosed as behavioral disorders including ADHD by psychiatrists using ICD - 10 Criterion in a tertiary care teaching hospital. All children were recruited after taking informed consent from parents or legal guardians. The children with other physical or neurological diagnosis were excluded. The Child Behaviour Checklist developed by T M Achenbach was administered to all the forty children for the evaluation of their behavioral problems. It has 113 item behavioral problem checklist with a seven part social competence checklist. The CBCL has been tested in large populations and is fairly easy to administer. It is used in both clinical settings and research. A limitation of the CBCL is that syndromes from the scale do not necessarily correspond with DSM-IV .After the completion of
339

Delhi Psychiatry Journal 2010; 13:(2) Delhi Psychiatric Society

DELHI PSYCHIATRY JOURNAL Vol. 13 No. 2

OCTOBER 2010

CBCL, serum ferritin levels were measured using commercially available kits (based on immunoenzymatic calorimetric method), as were blood hemoglobin, Mean Corpuscular Volume, Mean Corpuscular Hemoglobin , Serum Iron, Total Iron Binding Capacity, Peripheral smear, Percentage transferrin saturation levels. The following criteria were used for diagnosing Iron deficiency anemia: 1. Hemoglobin < 11g/dl (3-6 years) and < 12g/ dl (6-12 years) 2. Percentage transferring saturation < 16% and/or serum ferritin <16 micrograms/litre Statistical analyses were performed using the t test and X2 test for between-group comparison of biological measures and Pearson test for correlations between symptom severity and serum ferritin levels. The mean age of the sample was 9.72 + 3.19 years with 65% male and 35% female children. Table-I. Distribution of hemoglobin in patients with behavioral disorders (N = 40)
Age (years)/ Sex 3-5 F M 6-9 F M 10-14 F M Number Hb Average 9.7 12.1 9.1 10.7 9.6 11.6 11.0 10.3 11.3 Comparison with Normal Values D N D D D N D D D

Table-II . Compete blood counts of patients with behavioral disorders (N= 40).
Parameter Hb (g/dl) MCV (fl) Serum Iron (micrograms/dl) TIBC (micrograms/dl) % TS Serum ferritin(micrograms/l) Range 3.4-13.9 55-95.5 19-134 229-533 4.7-33.3 3-115 Mean + S.D. 10.73 + 2.57 77.73 + 10.46 65.625 + 29.31 339.87 + 78.25 19.23 + 9.18 34.94 + 27.03

Conclusion There is a need for correction of Iron deficiency anemia at a war footing especially in a developing country like India as it leads to behavioral problems. References 1. World Health Organization. Iron deficiency anemia, assessment , prevention and control. A guide for program managers. WHO, Geneva, 2001. 2. Shali T, Singh C, Goindi G. Prevalence of anemia amongst pregnant mothers and children in Delhi. Indian J Pediatr. 2004; 71 : 946. 3. Grantham-McGregor S., Ani C. A review of studies on the effect of iron deficiency on cognitive development in children. J Nutr. 2001; 131 : 649S-668S. 4. Bhatia MS, Rai S, Singhal PK, Nigam VR, Bohra N, Malik SC. Pica:Prevalence and etiology. Indian Pediatr. 1988; 25 : 1165-70. 5. Geissler PW, Mwaniki DL, ThiongO F, Michaelsen KF, Friis H. Geophagy, iron status and anemia among primary school children in Western Kenya. Trop Med Int Health, 1988; 3(7) : 529-34. 6. Konofal E, Lecendreaux M, Arnulf I, Mouren MC. Iron deficiency in children with attention deficit/hyperactivity disorder. Arch Pediatr Adolesc Med. 2004; 158 : 1113-1115. 7. Oner O, Alkar OY, Oner P. Relation of ferritin levels with symptom ratings and cognitive performance in children with attention deficithyperactivity disorder. Pediatr Int. 2008; 50(1) : 40-4. 8. Millichap JG, Yee MM, Davidson SI. Serum ferritin in children with attention-deficit hyperactivity disorder. Pediatr Neurol. 2006 Mar; 34(3) : 200-3.

5 1 4 11 5 6 24 8 16

Results and Discussion Iron deficiency anemia was present in 75% of the children with behavioral disorders. Serum ferritin was abnormal (<20micrograms/litre) in 67.8% of the children. There was statistically significant association between pica and iron deficiency anemia (Chi square test df = 1, p < 0.001). Similar findings have been observed in other studies.4,5 Serum ferrittin levels correlated negatively with behavioral symptoms (r = -.067, N = 40, p > 0.05), though not significant. Some of the previous studies have found low serum ferritin levels to correlate with higher behavioral symptoms and more cognitive deficits.6,7 Another study by Millichap JG did not find serum ferritin levels to play causative role in ADHD.
340

Delhi Psychiatry Journal 2010; 13:(2) Delhi Psychiatric Society