Justification of Universal Iron Supplementation for Infants 6-12 months
in Regions with a High Prevalence of Thalassemia
Abstract
Background: With a possible increased risk of iron absorption for those
with thalassemia, many clinicians hesitate to adopt a universal iron
supplementation program for all infants. Therefore, we aimed to
determine thalassemia prevalence in 6 to 12-month old infants, along
with the iron status of those with and without thalassemia. Procedures:
We performed a cross-sectional descriptive study of healthy infants
attending the Well Baby Clinic at Thammasat University Hospital. All
enrolled were evaluated for complete blood count, hemoglobin
electrophoresis, iron parameters, and molecular genetics for common α-
and β-thalassemia. Results: Overall, 97 of 206 (47%) participants had
thalassemia minor, Hb E traits being the majority; none had thalassemia
intermedia or major. Familial history of anemia or thalassemia was an
increased risk for detecting thalassemia minor in offspring (OR 5.18;
95% CI 2.60-10.33, P=0.001). Between normal and iron-replete
thalassemia minor infants, there were no statistical differences in
transferrin saturation, serum ferritin, and hepcidin. However, one-third
of those with thalassemia minor (31/97) also had iron deficiency anemia
(IDA) with a similar risk of having iron deficiency to infants without
thalassemia. There was no hepcidin suppression in our infants with
thalassemia minor compared to healthy controls. Conclusions: In
Southeast Asia, thalassemia and IDA are endemic, and infants with
thalassemia minor, particularly Hb E and β-thalassemia trait, are also
at risk of IDA; thus, our short-term universal iron supplementation
program for 6 to 12-month old infants should not increase the risk of
those with thalassemia minor developing iron overload in the future.