Association Between Serum Ferritin and Red Cell Indices for Identifying Iron Deficiency Anaemia in Children Under Five Years: A Cross-Sectional Study
TL;DR
Serum ferritin concentrations were significantly associated with several red cell indices, particularly MCH and MCV, while RDW-CV demonstrated the greatest ability to distinguish children with IDA from those with normal ferritin levels, and routine CBC parameters, especially RDW-CV, MCH, and MCV, may serve as practical and cost-effective screening tools for the early detection of iron deficiency in resource-limited settings.
Abstract
Iron deficiency anaemia (IDA) remains the most common nutritional deficiency among children under five years of age and is associated with adverse effects on growth, immunity, and neurocognitive development. Red cell indices derived from routine complete blood count (CBC) testing may provide practical markers for the early identification of IDA. To evaluate the association between serum ferritin concentrations and red cell indices and to identify haematological parameters useful for detecting iron deficiency anaemia among children aged 1–5 years. A cross-sectional analytical study was conducted at Ibn Rushd Medical Laboratory, Tobruk, Libya, between January 2025 and May 2026. A total of 291 children aged 1–5 years who underwent CBC and serum ferritin testing were included. Children with haematological disorders other than IDA, chronic illnesses, acute infections, recent blood transfusions, or incomplete records were excluded. Participants were categorised into an IDA group (serum ferritin <12 ng/mL; n = 36) and a normal ferritin group (≥12 ng/mL; n = 255). Group comparisons were performed using Student's t-test and Mann-Whitney U test, while Pearson's correlation coefficient was used to assess associations between serum ferritin and haematological indices. A p-value <0.05 was considered statistically significant. Iron deficiency anaemia was identified in 12.4% of the study population. No significant differences were observed between the two groups regarding age (p = 0.109) or sex distribution (p = 0.237). Children with IDA had significantly lower haemoglobin, hematocrit, red blood cell count, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and mean corpuscular haemoglobin concentration (MCHC) values compared with children with normal ferritin levels (p <0.05). Red cell distribution width coefficient of variation (RDW-CV) was significantly higher in the IDA group (18.08 ± 4.59%) than in the normal ferritin group (15.57 ± 4.12%, p <0.001). Serum ferritin demonstrated significant positive correlations with MCH (r = 0.213, p <0.001), MCV (r = 0.211, p <0.001), haemoglobin (r = 0.170, p = 0.004), hematocrit (r = 0.167, p = 0.004), and MCHC (r = 0.153, p = 0.009). Iron deficiency anaemia remains an important health concern among children under five years of age in Tobruk, Libya. Serum ferritin concentrations were significantly associated with several red cell indices, particularly MCH and MCV, while RDW-CV demonstrated the greatest ability to distinguish children with IDA from those with normal ferritin levels. Routine CBC parameters, especially RDW-CV, MCH, and MCV, may serve as practical and cost-effective screening tools for the early detection of iron deficiency in resource-limited settings.