7
7
Table 6 shows that 40.6% of patients who had a high
PCV were also iron deficient, using the criteria of Bess-
man et al , whereas none of patients with PCVs within
haematocrit, haemoglobin concentration, MCV, MCHC
and peripheral blood film examination are easy to per-
form, relatively inexpensive and are e,f9fective in identi-
4
1
the normal range, were iron deficient.
fying iron deficiency when present. These methods
were employed in this study and in the absence of more
expensive tests like serum transferrin and serum ferritin,
14 (35%) of the 40 children with CCHD with iron defi-
ciency were identified.
Table 6: Relationship between haematocrit level and
presence of iron deficiency
Haematocrit
Iron defi-
ciency
Absent
Iron defi-
ciency
Present
Total
The prevalence obtained in this study is similar to the
37% prevalence reported by Kaemmerer, et al in 52
7
N
%
N
%
N
2
%
German adults with CCHD. The figure is however much
higher than the 16.9% quoted in anoth2er report from
Kenya among 112 children with CCHD. The findings
in this study are therefore consistent with previous re-
ports showing that iron deficiency is a common feature
in patients with CCHD. Notably, iron deficiency was
present in 40.6% of children in the present study with
high PCV levels but in none of the 6 patients whose
PCVs were normal. This proportion is high enough for
concern and might justify a practice of instituting judi-
cious iron therapy in patients with high PCVs , on the
assumption that deficiency is likely to be present.
Low
1
50.0
1
50.0
100.0
Normal
High
6
100.0
59.4
0
0.0
6
100.0
100.0
19
13
40.6
32
Total
26
65.0
14
35.0
40
100.0
Chi square = 0.271, p = 0.603
Discussion
CCHD is known to be associated with a reduction in
oxygen delivery to the tissues. Iron deficiency in CCHD
has been shown to be associated w0ith a further reduction
The subjects of this study were majorly patients with
Fallot’s tetralogy, which is to be expected, being the
most common CCHD. The apparent ‘under-
representation’ of TGA and TA, though indeed known
to be much less common than Fallot’s tetralogy, may be
because some whose data were not complete were ex-
cluded from analysis.
1
in oxygen delivery to the tissues. This further worsens
the tissue hypoxaemia in individuals with CCHD. Clear
recommendations for the supplementation of iron in
children with CCHD are lacking. Our findings suggest
that iron deficiency is common in Nigerian children with
CCHD. Further studies using the gold-standard tests
would still be required in order to verify the figures ob-
tained in this study. In the interim, it is recommended
that all children with CCHD should have routine assess-
ment of the simple haematological indices for prompt
detection and judicious treatment of iron deficiency.
Children with CCHD often experience severe hypoxae-
mia which may cause damage to the organs, particularly;
the lungs, kidneys, musculoskeletal system and the cen-
tral nervous system (CNS). A major compensatory
mechanism to combat tissue hypoxaemia is secondary
erythro, p6 oiesis with consequent increase in the red cell
5
mass. This study showed that 32 (80.0%) of the cases
had high haematocrit values. Iron deficiency is reported
to be common in individuals with 2C,7,C8HD even in the
Conflict of Interest: None
Funding: None
presence of high haematocrit levels.
These groups of
children are often assumed not to be iron deficient be-
cause of the elevated red cell mass.
Acknowledgement
The use of simple red cell indices has been shown to be
effective in identifying iron deficie1ncy in individuals
suspected to be deficient in iron. Measurement of
I wish to acknowledge Dr AE Orimadegun for assis-
tance in the preparation of the manuscript.
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