PLATELETS ABNORMALITIES IN CHILDREN WITH IRON DEFICIENCY ANEMIA

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INTRODUCTION
Iron deficiency (ID) is the most prevalent micronutrient deficiency worldwide, and nearly two billion individuals have anemia (Abdel-Aaty et al., 2015).Moreover, ID is a condition when the body lacks sufficient iron to maintain normal physiological functions.It is defined as decreased total body iron or, in some cases, serum ferritin level <12 mg/l in children up to 5 years and <15 mg/l in children 5 years and older (Özdemir, 2015).Since anemia is the most crucial indicator of iron shortage, the terms ID and IDA are commonly utilized reciprocally.
IDA has reached epidemic proportions in developing countries and has become a major global public health problem, affecting mainly 0-5-year-old children and young women of childbearing age, especially during pregnancy.In Egypt, IDA was found to be the most common cause of anemia among infants  5.The patient has the right to withdraw from the study at any time.
6.The researcher explained to the patient the aim of the study.

Financial Disclosure/ Funding:
The authors received no financial support for the research, authorship, and/or publication of this article.

Sample size:
The sample size estimation was done using the Epi info7 program for sample size calculation, setting the confidence level at 95% and margins of error at 10% and based on the work done by Sobeih et al (2020), a total of 130 patients was estimated to be sufficient sample size.

Inclusion criteria:
Both sex under the age of 18 years who were newly diagnosed with IDA based on: 1. Red cell distribution width (RDW)> 14.

METHODS
Six ml of venous blood was drawn from all participants and then separated into two parts: 2 ml were placed in a vacutainer tube containing an ethylenediaminetetraacetic acid (EDTA) for CBC and blood smear measurement, and 4 ml were placed in a serum (plain) tube and centrifuged for 10 minutes after clotting the samples.CBC was done using a Sysmex XN330 hematology autoanalyzer, while the blood smear was done by Leishman stain.On the other hand, the separated serum was divided into two parts; one was used for measuring serum iron and TIBC by COBAS c311 chemistry autoanalyzer system, and the other was kept at -20 in the freezer to determine serum ferritin by COBAS e411, ROCHE diagnostics.

Statistical analysis:
All analyses were performed using Statistical Package for the Social Sciences (SPSS) software (Version 26 for Windows; SPSS Inc., Armonk, NY: IBM Corp).Categorical variables were represented as numbers (n) and percentages (%).Continuous variables were expressed as means ± standard deviation (SD).Independent t-test was used to compare the two groups.The correlation between continuous data was analyzed by Pearson correlation test.The receiver operating characteristics (ROC) curve was used to assess the sensitivity and specificity at various cut-off points.Univariate logistic analysis predicted the most significant variables, and the results of the univariate analysis were input into a multivariate logistic regression model.A P-value<0.05 was considered to be statistically significant.

DISCUSSION
The present study showed that the mean age among anemic children was 5.89 years compared to 6.6 years in the control group, with no statistically significant difference.In addition, the predominance of males over females in both groups.Similarly

LIMITATIONS OF THE STUDY
The main limitations of this analysis are the small sample size and the non-longitudinal assessment of causes and complications.

CONCLUSIONS
We conclude that reactive thrombocytosis is the most common IDA-related platelet abnormality.Platelet activity can be determined indirectly using platelet volume indicators, including MPV, PLCC, and PLCR).The most significant predictors for anemic patients were MPV, PLCC, and PLCR based on the ROC curve.Moreover, the only independent predictors for anemia were MPV and PLCC.So, MPV can be considered a marker that helps diagnose IDA and follow-up, and physicians should pay attention to thinking about IDA as a diagnosis.

RECOMMENDATION
The present study provided evidence of the usefulness of a newly diagnosed MPV as a convenient and sensitive biomarker for predicting IDA patients.