School of Biomedical Sciences

COMPARISON OF VARIOUS ANALYTES TO EXPLORE MEASURE FOR IRON

STATUS AMONG PAEDIATRICS

Proposal Assessment Form

Name of Student: - resubmission date 10th of July 21 Student number:

COMPARISON OF VARIOUS ANALYTES TO EXPLORE MEASURE FOR IRON
Title of project: STATUS AMONG PAEDIATRICS
SECTION COMMENTS MARK
Quite repetitive in places and could be written more succinctly. Background to 4
Scientific abstract justify research is lacking.
(10 marks)
A good outline of the proposed study but not written in lay terminology. 4
Lay summary Please adhere to strict word limits.
(10 marks)
Background does not clearly justify the need for the study as there is a lack of 15
appropriate scientific literature to support the statements provided. The detail
provided is quite basic and does not reflect the research in the area. Whilst
Background there are lots of references included in the bibliography, these have not been
(including aim and cited throughout. Key literature is omitted e.g., Pfeiffer and Looker 2017 AJCN
hypothesis) Some information included in this section would be better placed in methods.
(40 marks) Hypothesis is not clearly defined – this should be a testable statement.
Aim is somewhat clear. How will you determine which method is the most
appropriate – do you propose a gold-standard reference method to make
comparisons to?
Structure of methods is improved but lacks detail in relation to justification of 14
sample size, reference levels to be used and details on some of the assays to
be employed.
Some of the information included in this section would be better suited to the
Proposed methods background.
(30 marks) Justify the reason for analysing CRP in this study.
As all samples are from healthy individuals these results will not be
generalizable to include those with hematological disorders which you have
alluded to may impact results. You may want to mention this as a limitation.
Data analysis described does not address the aim of the study.
Overall written Scientific expression must be improved e.g., in scientific abstract ‘a hectic 4
task’, ‘into the bargain’, ‘handy research work.’
expression,
Word limits have not been adhered to and there are spelling and grammatical
presentation and errors throughout.
referencing Referencing issues
(10 marks)
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Ethics and Other Ethical approval YES NO

(In each case, please Costings YES NO
tick to indicate if
appropriate) Health and safety YES NO
Overall comments on the quality of this proposal:

Please note that the project can not commence unless an appropriate work-based supervisor is in place.
There are substantial ethical implications of the proposed project and appropriate ethical approval must be sought
before commencing the research.
Costings and Health & Safety issues have not been adequately addressed.

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3. DECLARATIONS

Declaration by Workplace Supervisor

I confirm that.
 all risks and procedural implications have been considered.
 the project will be conducted at all times in compliance with the research description/protocol
and in accordance with Governance requirements on recording and reporting.
 this application has not been submitted to and rejected by another committee.

Print Name
Sign
Date

Declaration by Student

"I declare this is all my own work and does not contain unreferenced material copied from any
other source. If it is shown that any material has been plagiarised, I understand that a mark of zero
may be awarded and the reason for that mark recorded on my student record."

Print Name
Sign
Date 20/02/2021

4. PROJECT DETAILS

COMPARISON OF VARIOUS ANALYTES TO EXPLORE MEASURE

Project title
FOR IRON STATUS AMONG PAEDIATRICS

Key Words (5 max)

Abridged Project title (65

characters including spaces)

Project Discipline HAEMATOLOGY & BIOCHEMISTRY

4. PROJECT DETAILS

COMPARISON OF VARIOUS ANALYTES TO

Project title EXPLORE MEASURE FOR IRON STATUS AMONG
PAEDIATRICS 

Key Words (5 max)

Abridged Project title (65

characters including
spaces)

Project Discipline HAEMATOLOGY & BIOCHEMISTRY

Lay summary (maximum 150 words)

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Describe your proposed research in a way that will be clear to members

the public who do not have a grasp of medical or scientific terminology
The currently proposed research aims to determine the most potent biomarker for iron level
indication in paediatrics’ blood sample in the UK. Collection of data will be from
paediatric clinic, hospital, with subjects ages range from neonates up to 16 years old.
Samples will be collected for best analyte determination of iron level estimation in
paediatrics. It will help to identify the best biomarker in a way that the obtained results,
though efficacious method to estimate the level of iron which could be due to several
factors. It will be meaningful to understand the prognosis of anaemia, furthermore the
assessment of iron level through sTFR indicates the type of anaemia as well (Van Rheenen,
2013). It will be able to report results within 6 months. The data will be analysed in terms
of descriptive, correlational, regression analysis and statistics will be determined through
ANOVA after cleaning data and excluding outliers. 

Lay
summary
word count 147
=

Scientific abstract (maximum 200 words)

The study aimed to compare various analytes to explore measure for iron
status among paediatrics. According to Sypes et al. (2019) of 187
countries, the global prevalence of anaemia was 33% in 2010. An iron
deficiency with the greatest burden on children under five and women was
the leading cause of anaemia. Biochemical iron status assessments rely on
serum-based indicators such serum ferritin (SF), transferrin saturation and
the soluble transferrin receptor (sTfR). These indicators present challenges
for clinical practise and national nutritional surveys, which are often based
Abstract on the combination of several indicators for the iron status interpretation.
word count Blood samples will be taken in lavender EDTA tubes and serum separator tubes
= 202 by research assistants integrated in primary care practises who are skilled
phlebotomists (Ratcliffe et al., 2016). Data will be analysed using
conventional guidelines and relevant statistical methods based on sample
size and analyte distribution for our primary purpose. Outliers were
removed, and data was categorized gender-wise. As interpretation of iron
level and iron related could be a hectic task and could only be understood
through several testing such as sTfR provide sufficient data to differentiate
between iron deficiency anaemia and anaemia due to chronic diseases but
lacks standardization and cut-off values.

5. PROPOSED INVESTIGATION
To include background, hypothesis, project aims, proposed methods (including statistical
approaches and power calculation), a project timeline (e.g., Gantt chart) and references.  Expand
this section as necessary to include all required information.  Take note of individual word counts
specified throughout.

Background (maximum 750 words)

The interest in determining iron status was developed more easily in the early 2000s
(Parkin et al., 2016). Assessments for certain of the ferritin model's indicators were labour
demanding and no longer frequently utilised, and finding laboratories willing to continue to
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do them became increasingly problematic. The survey's complexity and

cost could be reduced by using a simpler technique with fewer markers of iron status.
Around the same time, a WHO recommendation on the use of SF and sTfR to measure
populations' iron status was published (31) and a fully automated Roche sTfR test was
introduced, which gave better sample output and accuracy than the Ramco sTfR test
(Özdemir, 2015).
The global prevalence of anaemia in 2010 was 33 percent, according to a survey involving
187 countries (Oatley et al., 2018). The leading cause of anaemia was an iron deficiency,
with children under 5 years of age and women having the greatest burden. Traditionally, in
subjects with microcytic hypochromic anaemia, the diagnosis of iron deficiency anaemia
(IDA) relies on simple measures of serum iron, transferrin, and ferritin. However, anaemia-
related iron deficiency and other disorders, such as chronic disease anaemia and
haemoglobinopathies, frequently coexist, requiring more improvement of diagnostic
strategies, therefore the current diagnostic methods do not do justice to the detection of
iron level in sample, leading to worst scenarios, early detection in infancy or young
children is important allowing iron treatment that may result in normal mental motor
development and present irreversible disability (Ito et al., 2014).
This study targets out the most potent iron level bioindicator through comparisons of
various assessment techniques such as Haemoglobin, Serum Ferritin, Transferrin saturation
soluble transferrin receptor (sTfR) as well as erythrocyte protoporphyrin.  The
recommended research proposal aims to discern the most potent biomarker for iron
estimation in paediatrics’ blood samples. Past studies have never compared these
estimation techniques to distinguish the most potent biomarker from the pool (Girelli et al.,
2016). Into the bargain, this study will be handy research work which will aid the
practitioners and clinicians in assessing the iron levels and for further assessments.
 STfR concentration is a functional ID indication that is not an acute reactant, but due to a
lack of standardised testing, common reference ranges, and common breakouts, it can be
difficult to interpret (Georgieff, 2017). The best markers for determining excess iron status
are unknown. Hepcidin, non-transferrin-bound iron, and reticulocyte indices are all
investigated in research settings. Serum-based markers are usually tested on fully
automated clinical analyzers in most hospitals. While worldwide reference materials have
existed for many years, the variability of the antibodies used and the lack of
physicalchemical reference procedures for determining 'real' concentrations are key
obstacles to immunoassay standardisation.

Commonly used indicators' nature

Iron balancing is a highly controlled process that is reflected in a variety of iron status
markers (Donker et al., 2014). The rigorous absorption regulation is its distinguishing
feature. Iron shops, iron transit (iron for cellular usage), and functional iron are the three
primary divisions that explain the insufficiency of iron status. The depletion of each
compartment leads in a new iron deficient phase. Short-term changes in physiological iron
demands are met by the release of iron stores, which are most commonly found as
intracellular ferritin in hepatocytes and specialised macrophages. Stainless bone-mole iron
is the "gold standard" indicator for estimating the extent of the iron store, but it is not a
realistic measurement for obvious reasons. Although serum ferritin (SF) represents a minor
portion of the body's ferritin pool, its concentration reflects the quantity of iron stored. The
initial iron deficit (ID) phase, i.e., iron depletion, is reached when iron shops are depleted,
but no erythropic repercussions have yet been attained (Cox et al., 2016).

Diagnostics for Iron Deficiency:

Iron deficiency without anaemia indicates that haemoglobin synthesis is impaired, but that
haemoglobin concentration has not decreased enough to decrease. Haemoglobin (Hb) is a
commonly used ID screening test, but it has poor specificity and sensitivity when used
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alone. Its sensitivity is poor since individuals with baseline Hb values

need to lose 20-30 percent of their body Fe in the upper range of normal before their Hb
falls below the anaemia cut-off. Its specificity is limited and other than ID, there are
several causes of anaemia. ID diagnosis by SF concentration, as is the case with ACD, is
complicated by concomitant inflammation (Berlin et al., 2011). Lack of assay
standardisation for sTfR, a less inflammatory-affected functional ID predictor, results in a
lack of common reference ranges and cut-offs.

Background word count = 749

Hypothesis (maximum 100 words)

Various techniques, known to estimate iron level in blood Serum in the blood of
paediatrics in the UK context. The total body iron stores (TBI) model, in which the log
ratio of sTfR to SF is assessed, has been used more recently in paediatrics to assess iron
status. The combined concentrations of sTfR and SF span the entire range of iron status. It
is hypothesised that TBI is a continuous measure that can be used to predict the absence of
bone marrow iron better than SF concentration alone. For additional advancements in iron
status assessment, more thought should be given to methodology, indicator interpretation,
and analytic standardisation.

Hypothesis word count = 107

Project aims (maximum 150 words)

The study aims to evaluate the efficiency and comparability of the most common
laboratory methods used to detect iron deficiency, depletion or overload in serum or
plasma ferritin concentration in the context of UK. 
Various Analytes to Measure Iron Status in Paediatrics
Biochemical assessment of iron status relies primarily on serum-based markers. To
determine the method, which is the most appropriate researcher will utilise a gold-
standard reference method to make comparisons (Raiten et al., 2011). The various
analytes that the study will use for iron status determination are:
● Haemoglobin.
● Serum Ferritin.
● Transferrin saturation.
● Soluble transferrin receptor (sTfR). 
● Erythrocyte protoporphyrin.
OBJECTIVES
1. The study aims to explore the best indicator to measure the iron level in paediatrics
aged 0 to 16 years of age. 
2. The study will also explore whether target sample suffer from iron deficiency or not.

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Project aims word count = 143

Proposed methods (maximum 1000 words) 

Including statistics and a power calculation, if applicable (if n/a, please justify why not)
Methods
word count Procedure:
= 990
During routine appointments at the hospital children's parents will be
required to read and to sign the consent form if they agree their children’s
bloods to be processed and results to be used for the research purpose as
well.  Blood samples will be collected from healthy children recruited.
Outliers will be eliminated for our primary goal; age partitions will be
selected, and variance analysis and comparisons will be made between
adjacent partitions pairwise; reference intervals and 90 percent CIs will be
measured. The proportion of children misclassified using the lower limit
reference interval relative to cut off values will be calculated for our
secondary reason. Biochemical indicators of iron level will be compared
with bone marrow iron. 
Through Serum Ferratin:
 Serum ferritin levels will be determined by the enzyme immunoassay method,
using commercial kits. The method for measurement of Ferritin on the cobas®
e601 is a sandwich principle with a total duration time of 18 minutes. The 1st
incubation uses 10 µL of sample, a ferritin-specific antibody, and a labelled
ferritin-specific antibody to form a sandwich complex. The 2nd incubation occurs
after the addition of microparticles that cause the complex to bind to the solid
phase.

Through Haemoglobin:

This procedure will be used to measure haemoglobin adducts of acrylamide and its
primary metabolite glycidamide in human whole blood or erythrocytes.
Specifically, the reaction products with the N terminal valine of the haemoglobin
protein chains (N- [2- carbamoylethyl] valine and N-[2-hydroxycarbamoyl-ethyl]
valine for acrylamide and glycidamide adducts, respectively) will be measured.

Through Transferrin Saturation:

Serum iron is bound to transferrin, but only about one third of the iron binding
sites are saturated with iron. The unsaturated iron-binding capacity of transferrin
(UIBC) denotes the available iron-binding sites of serum. The amount of iron that
serum transferrin can bind when completely saturated with an excess of Fe+3 is
the total iron-binding capacity (TIBC). The method1,2 measures the TIBC by first
saturating the transferrin with excess of Fe+3. The remaining iron is adsorbed with
magnesium carbonate, and once the binding process is complete the quelator is
removed by centrifugation, and an assay for iron content performed in the
supernatant. From this measurement the TIBC value is obtained.

Soluble Transferrin Receptor:

Tina-quant soluble transferrin receptor (sTfR) will be conducted and it is a particle

enhanced immunoturbidimetric assay that uses Roche kits on the Cobas® c501
clinical analyser. Latex particles coated with anti-sTfR antibodies react with the
antigen in the sample to form an antigen/antibody complex.

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Through Erythrocyte protoporphyrin:

Porphyrins and heme components will be extracted from whole blood into a 4:1
mixture of ethyl acetate-acetic acid. Porphyrins are then separated from heme by
back-extraction into a 1.5 M hydrochloric acid solution, and quantitatively
determined by molecular fluorometry using a spectrofluorometer calibrated with
protoporphyrin IX (PPIX) standard solutions.

Sample:
Blood samples will be taken in lavender EDTA tubes and serum separator tubes by
research assistants integrated in primary care practises who are skilled
phlebotomists. At the practise sites, blood samples will be refrigerated and sent to
the laboratory the same day.

The sample will consist of paediatrics’ aged 0 to 16 years. The study

comprises children with their primary care doctor who had a regular visit
appointment. At the practice locations, blood samples will be refrigerated
and transported to the laboratory, blood samples will be examined fresh
within 4-6 hours of collection. Samples will be analysed on the Sysmex
XN-3000 Haematology Analyser for haematology parameters; samples
were analysed on the Beckman Coulter Unicel DxI 600 platform for
chemistry analytes.  For SF, IS 80/602 was the traceability chain used. The
lower detection limit level for CRP is 0.15 mg/l.
70 to 80 samples are planning to be used as a size of the research. Data will
be collected from paediatrics clinics in National Health Service hospitals.
Inclusion criteria for the sample will be that children must be healthy and lie
in the age range of new-born babies to 16 years older. Children having any
kind of health issues or disability or suffering from any kind of illness will
be excluded from the study, and families who cannot communicate in
English will be excluded from the study as well. Random sampling
techniques will be used to collect blood samples of healthy children. 
One of the major limitations of this study is that, as all samples are from
healthy individuals these results will not be generalizable to include those
with haematological disorders which researcher has alluded to may impact
results.
Data Analysis
Data will be analysed using conventional guidelines and relevant statistical
methods based on sample size and analyte distribution for our primary
purpose. Scatter plots, histograms, and probability plots will be used to
visually inspect the data. Outlier identification techniques will be used to
identify and remove outliers. The data will be separated by gender
(male/female). The age groups will be determined using epidemiological
data on the increasing prevalence of iron deficiency as well as overall child
growth and development. Because it is well known that the age of highest
prevalence for iron deficiency is 1–3 years, we created a separate partition
for this age group.
T-test and ANOVE will be used to compare various analytes which explore
measure for iron status among paediatrics. The T-test will be run to find
gender differences in iron level among children and their means will be
compared as t-test allows us to compare the average values of the two data
sets as we can compare our test results, obtained through various analytes
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for iron level testing. ANOVA will be used to investigate the effect of age
on Iron status among children, as it is helpful for testing three or more
variables, and it is results also contain fewer type 1 error. Therefore, we’ll
compare our means through ANOVA as well, analysis through these two
statistical models will provide a very comprehend, detailed result, and so
the study will be successful in determining the most potent biomarker for
iron testing.

Project timeline (weekly schedule showing all aspects of the work e.g., literature reviews,
instrument training, experiments, preparation of assessments e.g., as a Gantt chart)

The literature review will be completed within a time frame of 2 weeks. While data
collection will be completed within 10 weeks. Finally, results and analysis will be done
within two weeks.

 
 
6. ETHICS 
Please discuss these requirements with your Supervisor(s) before completing this section.  
All students are required to complete and submit a Biomedical Sciences Research Ethics Filter
Committee pre-screening form and obtain approval from the Committee before you can commence
your research.  You will find the form and guidelines for completion within the Research Proposal
folder on Blackboard.  Please complete and submit the form via the Ethics Management System by
29 November in order to receive this feedback ASAP and to help you complete the next section.  
th

Ethical approval

What Category of research does your project fit into?

Category A, B, C, D, method development/comparison, service evaluation/audit

Does the project require ethical approval? 

Please provide details of the Research Ethics Committee who
has approved this research.  This may be the BMS Filter
Committee or an external Committee.  Please ensure you
forward a copy of any external approval to the BMS Ethics
☐ Yes, already in
Filter Committee via the Ethics Management System along
place                      
with the pre-screening form.

☐ Yes, in Please provide details of the Ethics Committee to which this

progress                    application will be sent or where the application is currently

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under review:

If ethical approval is not required, please justify.  

There is no ethical concern with this research as the research will
only be proceeded if the blood is taken from paediatric with the
consent of their parent, apart from this, no other factor or
methodology in this research can be examined for ethical
☐ No                       concerns.

7. OTHER CONSIDERATIONS 
Costings*

Please list the itemised costs of consumables & materials required for this project.
Add additional rows as required
DESCRIPTION COST, £

Not sure yet as there is no

evaluation of costs so far

TOTAL COST £

*The following are not included as expenses.

Financial or personnel services (e.g., finance, accounting, tendering, marketing); Salaries,
recruitment costs, staff facilities or development (e.g., transport, health and safety, training);
Overheads
Commercialisation

Are the results of this research likely to have operational or commercial potential? 
  ☐ Yes                      ☐ No                      

If yes, what type of ☐ Reduce operational costs        ☐ Improve

benefit might your performance             
project lead to?
☐ New product or practice           ☐ Improved technical
capability

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☐ Better for staff/patient               ☐ Research

commercialisation

Indicate briefly why the The research will provide the best biomarker for iron level
research outcomes may estimation and could speed up the process for further
have operational or assessments. The procedure for iron estimation then, will be
commercial potential less time consuming, less hectic and less labouring.

Health and Safety

Indicate the Risks and COSHH directly associated with this project. 
Overall, there is no significant factor that is associated with this research, only blood
collection will have to be carried out properly.

           

7. Subjects:

a. How many subjects will be recruited to the study (by group if appropriate)?

N/A
b. Will any of the subjects be from the following vulnerable groups -

YES NO

Children under 16 X

Adults with learning or other disabilities X

Very elderly people X

Healthy volunteers who have a dependent or X

subordinate
relationship to investigators

Other vulnerable groups X

If YES to any of the above, please specify and justify their inclusion.
N/A

c. Inclusion and exclusion criteria

Please indicate the inclusion criteria for the project
Not applicable

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References

References:
Aladhadhi, A.M., Alqahtani, K.M., Etaiwi, S.T., Bajafar, A.A., Nono, A.F., Aldrees, S.E., Almutawa, S.M.
and Alghraibi, S.A., 2018. Pediatrics Iron deficiency anemia from diagnosis to treatment. The Egyptian
Journal of Hospital Medicine, 73(8), pp.7268-7273.
Baker, R.D., and Greer, F.R., 2010. Diagnosis and prevention of iron deficiency and iron-deficiency
anaemia in infants and young children (0–3 years of age). Paediatrics, 126(5), pp.1040-1050.
Berlin, T., Meyer, A., Rotman-Pikielny, P., Natur, A., and Levy, Y., 2011. Soluble transferrin receptor as a
diagnostic laboratory test for the detection of iron deficiency anaemia in the acute illness of hospitalized
patients. The Israel Medical Association journal: IMAJ, 13(2), pp.96-98
Cox, K.A., Parkin, P.C., Anderson, L.N., Chen, Y., Birken, C.S., Maguire, J.L., Macarthur, C., Borkhoff,
C.M., Abdullah, K., Bayoumi, I. and Carsley, S., 2016. Association between meat and meat-alternative
consumption and iron stores in early childhood. Academic pediatrics, 16(8), pp.783-791.
Donker, A.E., Raymakers, R.A., Vlasveld, L.T., van Barneveld, T., Terink, R., Dors, N., Brons, P.P.,
Knoers, N.V. and Swinkels, D.W., 2014. Practice guidelines for the diagnosis and management of
microcytic anemias due to genetic disorders of iron metabolism or heme synthesis. Blood, The Journal of
the American Society of Hematology, 123(25), pp.3873-3886.
Georgieff, M.K., 2017. Iron assessment to protect the developing brain. The American Journal of Clinical
Nutrition, 106(suppl_6), pp.1588S-1593S.
Girelli, D., Nemeth, E. and Swinkels, D.W., 2016. Hepcidin in the diagnosis of iron disorders. Blood,
127(23), pp.2809-2813.
Hershko C. Assessment of iron deficiency. Haematologica. 2018 Dec;103(12):1939-1942. doi:
10.3324/haematol.2018.205575. Epub 2018 Nov 30. PMID: 31013471; PMCID: PMC6269318.
Ito, S., Ikuta, K., Kato, D., Shibusa, K., Niizeki, N., Tanaka, H., Addo, L., Toki, Y., Hatayama, M.,
Inamura, J. and Shindo, M., 2014. Non-transferrin-bound iron assay system utilizing a conventional
automated analyzer. Clinica Chimica Acta, 437, pp.129-135.
Oatley, H., Borkhoff, C.M., Chen, S., Macarthur, C., Persaud, N., Birken, C.S., Maguire, J.L., Parkin, P.C.
and TARGet Kids! Collaboration, 2018. Screening for iron deficiency in early childhood using serum
ferritin in the primary care setting. Pediatrics, 142(6).
Özdemir, N., 2015. Iron deficiency anemia from diagnosis to treatment in children. Turkish Archives of
Pediatrics/Türk Pediatri Arşivi, 50(1), p.11.
Parkin, P.C., DeGroot, J., Maguire, J.L., Birken, C.S. and Zlotkin, S., 2016. Severe iron-deficiency
anaemia and feeding practices in young children. Public health nutrition, 19(4), pp.716-722.
Parkin, P.C., Hamid, J., Borkhoff, C.M., Abdullah, K., Atenafu, E.G., Birken, C.S., Maguire, J.L., Azad,
A., Higgins, V. and Adeli, K., 2017. Laboratory reference intervals in the assessment of iron status in
young children. BMJ paediatrics open, 1(1).
Piva, E., Brugnara, C., Spolaore, F. and Plebani, M., 2015. Clinical utility of reticulocyte parameters.
Clinics in Laboratory medicine, 35(1), pp.133-163.
Raiten, D.J., Namasté, S., Brabin, B., Combs Jr, G., L'Abbe, M.R., Wasantwisut, E. and Darnton-Hill, I.,
2011. Executive summary—biomarkers of nutrition for development: building a consensus. The American
journal of clinical nutrition, 94(2), pp.633S-650S.
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Ratcliffe, L.E., Thomas, W., Glen, J., Padhi, S., Pordes, B.A., Wonderling, D., Connell,
R., Stephens, S., Mikhail, A.I., Fogarty, D.G. and Cooper, J.K., 2016. Diagnosis and management of iron
deficiency in CKD: a summary of the NICE guideline recommendations and their rationale. American
Journal of Kidney Diseases, 67(4), pp.548-558.
Sypes, E.E., Parkin, P.C., Birken, C.S., Carsley, S., MacArthur, C., Maguire, J.L., Borkhoff, C.M.,
Aglipay, M., Anderson, L.N., Dai, D.W. and Keown-Stoneman, C., 2019. Higher body mass index is
associated with iron deficiency in children 1 to 3 years of age. The Journal of pediatrics, 207, pp.198-204.
Van Rheenen, P., 2013. Less iron deficiency anaemia after delayed cord-clamping. Paediatrics and
international child health, 33(2), p.57.

 
 
 
 
 
 

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