Prevalence and treatment of iron deficiency in children with cystic fibrosis.

OBJECTIVES

People with cystic fibrosis (CF) are at risk of iron deficiency (ID), and although well established in adults, data in children are limited. We assessed iron status in a cohort of children with CF and evaluated the effectiveness of ID management.

METHODS

We retrospectively analysed iron status and treatment data from medical records of 190 children with CF (aged 1-16 years) assessed routinely in 2021 and 2022 at the Royal Brompton Hospital (RBH), London. Ferritin, mean corpuscular volume (MCV), and haemoglobin were used to determine the prevalence of ID, ID erythropoiesis (IDE) and ID anaemia (IDA) using RBH definitions.

RESULTS

The proportion of children with abnormal iron status indices decreased between the assessments (2021 - 63% vs. 2022 - 54%, p = 0.03). Prevalence of ID without anaemia (51% vs. 44%, p = 0.12), IDE (8% vs. 6%, p = 0.63), and IDA (4% vs. 3%, p = 1.00) did not differ between assessments. Sixty children received dietary advice for ID without anaemia, and iron supplements were prescribed for six and seven children with IDE and IDA, respectively. Change in iron status indices between assessments did not differ between treated and untreated children, although ferritin increased in the seven children treated for IDA (p = 0.04). There was a positive association between highly effective modulator therapy and change in MCV.

CONCLUSIONS

ID remains an issue in children with CF, warranting annual monitoring of iron status. Management with dietary advice and/or iron supplementation showed limited effectiveness using our criteria for abnormal iron status.