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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 30  |  Issue : 1  |  Page : 209-212

Study of iron deficiency anemia in children with febrile seizures


1 Department of Pediatric, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
2 Department of Biochemistry, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt

Date of Submission09-Nov-2015
Date of Acceptance20-Dec-2015
Date of Web Publication25-Jul-2017

Correspondence Address:
Zeinab M. M. Barseem
Department of Pediatric, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia 32511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_456_15

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  Abstract 


Objective
Our aim was to study the prevalence of iron deficiency anemia (IDA) in children with febrile seizures (FS).
Background
FS are the most common type of seizures in children. The relationship between IDA and FS has been examined in several studies with conflicting results.
Patients and methods
This prospective, case–control study was conducted on 60 children aged 6 months to 5 years who attended the Outpatient Clinics and Emergency Department of Ashmoon Hospital and Menoufia University Hospitals during the period from December 2014 to June 2015. The children were categorized into two groups: case and control groups. The case group included 40 patients and the control group included 20 children. Hemoglobin (Hb), hematocrit, mean corpuscular volume, mean corpuscular Hb, mean corpuscular Hb concentration, serum iron, serum ferritin, total iron-binding capacity, and transferring saturation were assessed for the two groups.
Results
A total of 21 (52.5%) children in the case group had IDA compared with four (20%) in the control group, which was statistically significant (P < 0.05).
Conclusion
Based on the result of this study, iron deficiency could be an important risk factor for development of febrile convulsion. Evaluation of iron status is encouraged to be performed in children with FS.

Keywords: anemia, febrile, iron, seizures


How to cite this article:
El-Shafie AM, Abou El-Nour ESS, El-Hawy MA, Barseem ZM. Study of iron deficiency anemia in children with febrile seizures. Menoufia Med J 2017;30:209-12

How to cite this URL:
El-Shafie AM, Abou El-Nour ESS, El-Hawy MA, Barseem ZM. Study of iron deficiency anemia in children with febrile seizures. Menoufia Med J [serial online] 2017 [cited 2019 Aug 18];30:209-12. Available from: http://www.mmj.eg.net/text.asp?2017/30/1/209/211503




  Introduction Top


Febrile seizure (FS) is the most common type of childhood seizure, which occurs in 2–5% of neurologically healthy children. FS is defined as a seizure associated with a febrile illness in the absence of central nervous system (CNS) infections or acute electrolyte abnormalities in 6–60-month-old children without previous afebrile seizures. FS is further classified as simple and complex types. Complex FS is defined as a seizure lasting more than 15 min, and recurring within 24 h or focal seizure [1].

Iron deficiency is one of the most frequent micronutrient deficiencies and affects at least one-third of the population of the world. Anemia is the most common clinical manifestation of iron deficiency, but other organs and systems may also be affected. Cognitive dysfunction, psychomotor retardation, behavioral impairments, pica, breath-holding spells, restless leg syndrome, and thrombosis could be associated with iron deficiency. Effect of iron deficiency in the developing brain and mechanisms such as altered development of hippocampus neurons, impairment of energy metabolism, delayed maturation of myelin, slowed visual and auditory evoked potentials, and alterations in synaptic neurotransmitter systems including norepinephrine, dopamine, glutamate, γ-amino butyric acid, and serotonin may be responsible for these symptoms [2],[3]. On the other hand, fever may aggravate negative effects of iron deficiency on the brain [4].

The relationship between iron deficiency anemia (IDA) and FS has been evaluated in several studies with conflicting results [5].

The aim of this case–control study was to evaluate the relation of IDA with first FS.


  Patients and Methods Top


This prospective case–control study was conducted on 60 children aged 6 months to 5 years who attended the Outpatient Clinics and Emergency Department of Ashmoon Hospital and Menoufia University Hospitals during the period from December 2014 to June 2015.

The children were categorized into two groups:

  1. The case group: It included 40 children with first attack of FS
  2. The control group: It included 20 febrile children but without seizures at the same age.


After admission, all children were thoroughly examined to exclude children with a previous history of epilepsy, developmental delay, neurological deficit, and CNS infection. Information on age, sex, body temperature upon admission, cause of fever, duration between initiation of fever and convulsion, family history of febrile convulsion, and details of the seizure history including duration, frequency, and type of seizure (simple or complex) were recorded for all cases and controls. Tonic clonic or tonic seizures lasting for less than 15 min without focal signs with a short postictal period were defined as simple, whereas seizures of more than 15 min duration occurring more than once in 24 h or focal features were considered complex.

Diagnostic criteria for simple FS included seizures associated with fever and the seizures were generalized, short duration (<15 min), no recurrence of seizures within 24 h, child is otherwise neurologically healthy and without any neurological abnormality before and after the episode of seizures.

Exclusion criteria

Following were the exclusion criteria: atypical FS, afebrile seizures, any signs of CNS infection, any chronic neurodevelopment problems, previous diagnosis of other hematological problems, bleeding or coagulation disorders, hematological malignancy, on iron supplementation, and any serious illness.

Blood investigations carried out to diagnose iron deficiency included hemoglobin (Hb) level, hematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) (all of these measurements were automated using Sysmex KS-800, Kassel, Germany), serum ferritin level (SF) (measurement was automated using VIDAS, Henri-Bourassa West, Canada), serum iron level (SI), total iron-binding capacity (TIBC) (automated using Pictus 700, Budapest, Hungary), and transferring saturation of children.

Iron deficiency was diagnosed by hematological investigations of Hb less than 11 g/dl, Hct less than 33%, MCV less than 74 fl, MCH less than 24 pg, MCHC less than 32% [6], SI less than 50 μg/dl [7], SF less than 12 μg/dl [8], TIBC more than 400 μg/dl [9], and transferring saturation less than 15% [8].

Statistical analysis

Data were entered and analyzed using the statistical package for the social science (SPSS). Nominal data were expressed as frequency and percentage. Numerical data were expressed as mean ± SD and were compared using Student's t-test. P values of less than 0.05% were considered significant, and P values of less than 0.01% were considered highly significant.


  Results Top


Of the 60 children studied, 40 with FS were enrolled in the case group and 20 were considered as controls.

IDA was more frequent in children with FS and this difference was statistically significant (P < 0.05%; [Table 1]).
Table 1 Prevelance of iron deficiency anemia among cases and controls

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A comparison between laboratory characteristics of complete blood count in the two groups indicated no significant difference between the studied groups regarding red blood cell (RBC) count in millions, MCHC. On the other hand, there was a significant difference between the studied groups regarding Hb, MCV, and MCH, which were lower in the case group than in the control group (P < 0.05%), and also there was a highly significant difference between the studied groups regarding Hct, which was lower in the case group than in the control group (P < 0.01%; [Table 2]).
Table 2 Mean levels of hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration among cases with febrile seizures and controls

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A comparison between laboratory characteristics of iron profile in both groups indicated that there was a significant difference between the studied groups regarding the level of SI, TIBC, and transferrin saturation, of which the levels of SI and transferrin saturation were lower in the case group than in the control group, but the level of TIBC was higher in the case group than in the control group (P < 0.05%); moreover, there was a highly significant difference between the studied groups regarding the level of SF, which was lower in the case group than in the control group (P < 0.01%; [Table 3]).
Table 3 Serum iron, serum ferritin, total iron-binding capacity, and transferrin saturation among cases with febrile seizures and controls

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  Discussion Top


FS occur in 2–4% of all children with a recurrence rate of 30–40%. Age for peak incidence of FS is 14–18 months, which overlaps with that of IDA, which is from 6 to 24 months [10],[11].

Iron deficiency is the most common micronutrient deficiency worldwide, and is a preventable and treatable condition [12]. Iron is needed for brain energy metabolism, for metabolism of neurotransmitters, and for myelination. Thus, iron deficiency may alter the seizure threshold of a child [13],[14]. Iron deficiency is postulated as a risk factor for FS in children and is an easily correctable condition [15],[16]. We, therefore, studied the association between iron deficiency and simple FS.

In our study we found that IDA was more prevalent in the case group than in the control group, and the difference was a statistically significant (P < 0.05%).

This was in agreement with Pisacane et al. [17], who compared the levels of Hb, MCV, and SI among controls and patients with FS, and reported that iron deficiency was significantly more frequent among cases than controls.

Kumari et al. [18] performed a study on 308 children aged 6 months to 3 years old and found 63.6% of the case group suffered from iron deficiency in comparison with 24.7% of the control group. They concluded that iron deficiency was an important risk factor in simple febrile convulsion.

In a study by Vaswani et al. [19], 68% of the cases were iron deficient compared with 30% of the controls.

In 2009, Hartfield et al. [20], from the University of Alberta, Canada, reported in a retrospective study that children with FS were twice as likely to have iron deficiency as those with febrile illness alone.

In our study, we measured iron status components SI, SF, RBC, Hb, HCT, MCV, MCH, MCHC, TIBC, and transferrin saturation) among cases and controls. In the present study, we found no significant differences in RBC and MCHC between cases and controls; however, there was a significant difference between the studied groups regarding Hb, MCV, MCH, SI, TIBC, and transferrin saturation, and also there was a highly significant difference between the studied groups regarding Hct and SF, which were lower in the case group than in the control group.

Naveed-ur-Rehman and Billo [21] showed that SF levels were significantly lower in children with FS compared with controls, and suggested that children with iron deficiency are more prone to FS.

Daoud et al. [22] reported that the mean level of ferritin in cases with first FS is significantly lower than that in a reference group, but the mean levels of Hb, MCV, and MCH were lower in children with first FS than in children in a control group, although the differences were not significant.

In contrast, Kobrinsky et al. [23], in a case–control study with 25 cases and 26 controls, showed that anemia raises the threshold for focal febrile convulsions and iron deficiency may protect against the development of febrile convulsions.

Momen and Hakimzadeh [24] reported no relationship between IDA and first febrile convulsion in children younger than 5 years of age in Iran.

In another study in Iran, Bidabadi and Mashouf [25] reported that IDA was less frequent among patients with FS than among controls, and found no protective effect of iron deficiency against febrile convulsions.


  Conclusion Top


It may be stated that iron deficiency is a risk factor for FS and interventional studies should be designed to verify this hypothesis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Pisacane A, Sansone R, Impagliazzo N, Coppola A, Rolando P, D'Apuzzo A, et al. Iron deficiency anemia and febrile convulsions: case–control study in children under 2 years. BMJ 1996; 313:343  Back to cited text no. 17
    
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Hartfield DS, Tan J, Yager JY, Rosychuk RJ, Spandy D, Haines C, Craig WR The association between iron deficiency and febrile seizures in childhood. Clin Pediatr (Phila) 2009; 48:420–428.  Back to cited text no. 20
    
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Naveed-ur-Rehman1, Billoo AG. Association between iron deficiency anemia and febrile seizures. J Coll Physicians Surg Pak 2005; 15:338–340.  Back to cited text no. 21
    
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Daoud AS, Batieha A, Abu-Ekteish F, Gharaibeh N, Ajlouni S, Hijazi S. Iron status: a possible risk factor for the first febrile seizure. Epilepsia 2002; 43:740–743.  Back to cited text no. 22
    
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Momen AA, Hakimzadeh M. Case–control study of the relationship between anemia and febrile convulsion in children between 9 months and 5 years of age. J Ahwaz University Med Sci 2003; 1:50–54.  Back to cited text no. 24
    
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