Assessment of Serum Ferritin and Red Blood Cell Indices in Children with Severe Acute Malnutrition in a Tertiary Care Hospital in Jharkhand

BACKGROUND: Severe acute malnutrition (SAM) significantly contributes to childhood mortality and disrupts hematological functions. While iron deficiency is a common comorbidity, its diagnosis is often confounded by systemic inflammation (SI), which can affect traditional iron markers such as serum ferritin (SF). OBJECTIVE: The objective of this study was to evaluate SF levels and red blood cell (RBC) indices - including mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), MCH concentration (MCHC), and red cell distribution width (RDW) - in children with SAM. METHODOLOGY: This hospital-based cross-sectional study was conducted in a tertiary care hospital in Jharkhand over 12 months. One hundred and forty children aged 6-59 months old who met the World Health Organisation criteria for SAM were enrolled. Clinical evaluation and anthropometric measurements were recorded, followed by laboratory investigations for hemoglobin (Hb), RBC indices, and SF. Children with chronic illnesses, congenital anomalies, or recent blood transfusions were excluded. Data were analyzed using SPSS version 20.0. RESULTS: The mean age was 19.66 ± 12.38 months, with a male predominance. Anemia was nearly universal in 137 (97.9%), predominantly microcytic hypochromic. Mean Hb and RBC counts were significantly lower in complicated SAM (P < 0.001), although no significant differences were observed in MCV, MCH, MCHC, or RDW between complicated and uncomplicated groups. Mean SF was significantly higher in complicated SAM compared to uncomplicated SAM (P < 0.001). CONCLUSION: Red cell indices consistently reflect nutritional deficits in SAM. However, in complicated cases, SF acts as an acute-phase reactant, masking iron deficiency due to SI. Clinicians should utilize a combination of adjusted ferritin thresholds and RBC indices for accurate assessment.