9/16/2019 Asia Pacific Journal of Pediatric and Child Health

Ref Number = PITIKA-ASPR0260

IRON DEFICIENCY ANEMIA AS A RISK FACTOR FOR STROKE IN CHILDREN: A SYSTEMATIC LITERATURE
REVIEW
Fakhri Muhammad1, Diadra Annisa1, Shofa N Luthfiyani1, Murti Andriastuti2

Objective: Iron deficiency anemia (IDA) is prevalent among Indonesian children under 5 years old, with the
estimated prevalence of 40-45%. Various reports have suggested an association between IDA and stroke in children.
Stroke in children can result in devastating sequelae, such as seizure disorder, cognitive impairment, and
developmental delay. A systematic review was conducted to highlight the high burden of IDA, which may cause
stroke in children.
Method: We searched PubMed, EbscoHost, Cochrane Library, Google Scholar, ProQuest, SCOPUS, Wiley, SAGE Journal,
and Science Direct for relevant articles. Studies examining stroke in children aged 0-18 years with IDA were
included regardless of publication year. Research not conducted in humans and written in languages other than
English were excluded. Studies were peer-reviewed by four independent researchers and qualitative analysis of
data was conducted.
Results: Out of 87 records, 12 studies met the inclusion criteria. On full-text review, two studies were
excluded. One study was excluded because IDA diagnosis was not based on iron profile; while another was due to
full-text unavailability. Out of 10 studies, 1 retrospective cohort study, 2 case-control studies, 2
retrospective descriptive studies, and 7 case reports were analyzed. Case-control studies indicated that IDA was
3.8 times more likely to happen in children with stroke compared to healthy subjects. Thrombocytosis seen in IDA
has been proposed as the cause of pediatric stroke. Cerebral venous sinus thrombosis, arterial ischemic stroke,
and intracerebral hemorrhage were reported as the types of stroke which occurred in children with IDA. Lethargy,
hemiparesis, and seizures were the most common presentations.
Conclusion: IDA remains a problem in children worldwide and in Indonesia. It is a risk factor for stroke in
children, which causes disabilities, affects long-term quality of life, and increases mortality and morbidity.
Children with IDA and stroke may become burdens in their families and in the society. Therefore prevention, early
detection, and prompt treatment of IDA must be prioritized.

Keywords: Iron deficiency anemia, Stroke

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