Serum Ferritin an Indicator of Iron Deficiency Anemia in Children with Normal Hemoglobin

Abstract

Objective: To determine the diagnostic accuracy of serum ferritin in diagnosis of iron deficiency in children with normal haemoglobin taking composite non-invasive laboratory reference as gold standard.

Study Design: A cross-sectional validation study
Place and Duration of Study: This study was conducted at the Department of Paediatrics KRL Hospital Islamabad Pakistan, from 15th January to 15th July 2026.

Methods: A total of 165 children aged 6 months to 5 years with normal haemoglobin and clinical suspicion of iron deficiency were included. Serum ferritin was compared with a composite non-invasive laboratory reference
comprising adjusted serum ferritin, soluble transferrin receptor, transferrin saturation and reticulocyte haemoglobin content. Data were analysed using Statistical Package for the Social Sciences version 26. Diagnostic performance was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and receiver operating characteristic curve.

Results: The mean age was 2.86 ± 1.29 years, mean weight was 16.52 ± 3.93 kilograms and mean serum ferritin level was 35.03 ± 22.99 micrograms per litre. There were 91 (55.2%) males and 74 (44.8%) females. Serum ferritin
identified iron deficiency in 90 (54.5%) children, while the composite laboratory reference detected 74 (44.8%) cases. Serum ferritin showed sensitivity of 87.84%, specificity of 72.53%, positive predictive value of 72.22%, negative predictive value of 88.00% and overall diagnostic accuracy of 79.39%.

Conclusion: Serum ferritin was a useful and sensitive test for detecting iron deficiency in children with normal haemoglobin.