Table 2. Hematological parameters after 30 days intervention Fe three times daily Fe- once daily Hemogram (n = 3! (n = 3!

" #ean ($%! #ean ($%! Hemoglobin (g&dl! '2.3 ('.3(! ' .'2 ().'0! 0. Hematocrit (*(! 33.33 (3.)3! 33.(2 (2.*3! 0.)0 +,- (million&mm3! (. ( (0.(*! (.30 (0.(0! 0.3 #-. (0! )3. ) (3.2 ! )3. ((.3*! 0.*)

#-H (**! 2)2( (2. 2! 23.*3 ('.3(! 0.* #-H- (g&dl! 3).3* (2.(0! 33.*3 ('. 0! 0.*' +%/ (3(! ' .00 (0.3(! '(.33 ('20! 0.03 #ent0er inde1 '2.(2 (2.2'! '2.'2 ('.*2! 0.(' no3 inde1 2().3' (('.33! 2(0. 0 (3*.((! 02* 4ll children received the same total dose of mg&l5g&

day. 6nly *) children completed the st7dy8 i.e. () in 3 times daily dosage and 0 in once a day dosage. There 3ere no significant differences in se18 age8 body 3eight8 hemoglobin level and other hematological parameter bet3een the t3o gro7ps at the start of the st7dy (Table '!. 4fter 30 days of intervention8 there 3as no significant difference in hemoglobin increase bet3een the t3o gro7ps (Table 2!. %isc7ssion Hemoglobin or hematocrit (pac9ed cell vol7me! assessment is not diagnostic for :%48 beca7se of their

lo3 sensitivity. Ho3ever8 both meas7rements are relatively cheap and are still 7sed as a common screen for :%4.; :%4 cannot be detected from hemoglobin and hematocrit in the early stages of :%4. These meas7rements are 7sed to determine the degree of anemia.'<= 4ssessment of hemoglobin level and hematocrit is not specific for iron deficiency.; The peripheral pict7re blood smear in patients 3ith sho3s hypochromia microcytic. $er7m ferritin level is the best diagnostic test for :%4 as it has the best sensitivity and specificity. $er7m ferritin levels in children 3ith :%4 are less than '2 p.g&>8 ho3ever this meas7rement is relatively e1pensive.'<?; #-. is 7sed to determine microcytic8 normocytic8 or macrocytic red blood cells. :n a previo7s st7dy on infants aged '2 months old8 it 3as fo7nd that there 3as an increase of +%/ (@ '(A! 3ith sensitivity of '00A and specificity of B2A. $ince the specificity is relatively lo38 meas7rement of +%/ alone cannot be 7sed for screeningC it sho7ld be combined 3ith #-. meas7rements to determine the variant of anemia. '0 4n increased +%/ val7e 3ith a decreased #-. are characteristic for iron defic iency.'3 6ne of the methods 7sed to differentiate :%4 from minor thalassemia is assessment of #ent0er inde1 (#-. & +,-!C a #ent0er inde1 of @ '3 is indicative

for :%4 3hile 5 '3 is indicative for minor thalassemia8 3ith a specificity of B2A. +%DE&F inde1 is defined as #-. & +,- 1 +%/. 4 val7e of @ 220 is diagnostic of :%4 3hile 5226 indicates thalassemia8 3ith a specificity of *2AG The meas7rement of +%DE1F can be 7sef7l diagnosis of thalassemia8 3hich is commonly fo7nd in so7th east 4sia8 4frica and #editeranialiH These meas7rement is relatively simple and can be done in laboratory 3ith limited facilities.) +esponse to iron therapy can also help in determining :%48 3ith an increase in hemoglobin level of : IJ g d7ring 3 - ( 3ee9s of iron therapy 3ith 3-2 mg elemental iron&9g&day. :ron therapy can be given orally or parenterally. 6ral ferro7s s7lfate is an easy method that is cheap and has good res7lts. $ide effects of oral iron therapy are more common in ad7lts compared to infants and children. :n small n7mbers of children8 oral Fe can ca7se na7sea8 abdominal pain and diarrhea8 therefore it is s7ggested to ta9e it in divided dose t3ice or three times daily.23 The best form of Fe is the ferroK from8 3hich can be easily absorbed compared to ferriK.L?L T3enty eight percent of children 3ith :-:b levels of ''.0-''.( g&dl sho3ed a therape7tic response to iron 3ith hemoglobin increasing to ' .0 g&dl or more. '2 :f hemoglobin and hematocrit is in the lo3est level8

it is considered anemia if giving response to iron. :..o3er val7e of #-. and & or #-:-' are associated 3ith iron deficiency anemia8; 3ith the e1ception of anemia ca7sed by infection8 chronic infection8 maMor thalassemia and lead poisoning.; T3ice 3ee9ly dosages of oral iron are eN7ally efficacio7s as daily dosages in improving Hb level in preschool children 3ith lo3 iron stat7s. '* Or7s9e $- et al fo7nd that iron s7pplementation Or7s9e $- et al fo7nd that iron s7pplementation that 3as given reg7larly t3ice 3ee9ly gave good and significant res7lts compared to iron s7pplements given every day8 especially in increasing hemoglobin levels.= Ho3ever8 %esai et al fo7nd that iron s7pplementation given reg7larly every day sho3ed significant increase in hemoglobin levels compared to that given reg7larly t3ice 3ee9ly. :n this st7dy increased hemoglobin level 3as detected after 2 K '2 3ee9s of intervention.= Ps7ally8 oral iron therapy as ferro7s s7lfate tablets is prescribed beca7se the cost is lo3. :n children less than 2 years old syr7p is given beca7se it is simpler to administer and had fe3er gastrointestinal side effects. . /e gave ferro7s s7lfate in caps7les 3ith the same taste and color for the s7bMects. /e fo7nd mild side effects8 s7ch as mild diarrhea after the first dose in 2 s7bMects ('2A! in the three times daily control gro7p and in )

s7bMects ('(A! in the once daily gro7p. 67r st7dy 7sed simple meas7rements to diagnose :%4 s7ch as levels of Hb8 :-:t8 #-.8 +%/8 and the #ent0er inde1 and the +%/ inde1. These methods 3ere selected as they are relatively cheap and can be done in laboratories 3ith limited facilities. /e fo7nd significant increases in hemoglobin levels after 30 days of iron therapy. /e contin7ed iron therapy for an additional t3o months to replenish iron store. :n concl7sion8 o7r st7dy sho3ed that ferro7s s7lfate that is given once daily gives the same increase in hemoglobin levels as ferro7s s7lfate given three times daily 3ith same dose per day *-'2 year old children. +eferences '. +aspati H8 +eniarti >8 $7sanah $. 4nemia deQsiensi hesi. :nR "ermono ,8 $7taryo8 Pgrasena :%S8 DL(TUindiast7ti V8 4hd7lsalam #8 editors. ,797 aMar hematologi on9ologi ana9. Wa9artaR," :%4:8 2(E.L C '3. 30R(3. 2. DL(&Ueatheral %W8 O3iat9o3s9i %. Hematologic disorders of children in developing co7ntries. "ediatr -lin Xorth 4m. 2(.DU.L2C(*R ' '(*-2(. 3. 4hd7lsalam #. %iagnosis8 pengobatan dan pencegahan anemia defisiensi hesi pada hayi dan ana9. :nR Triasih +8 editor. 4nemia defisiensi hesi. Yogaya9artaR .D:V%::(4IFa97ltas Oedo9teran PS#8 2-E.L C p. -2(.

(. %irMen Oesmas %ep9es +:. $it7asi gi0i ter9ini dan pee nangg7langan masalah gi0i di :ndonesia. Za9artaR %ep9es +:C 2[.FDU.L. . $oedMatmi9o8 $e9artini +. 4nemia pada ana9 se9olah di '' pmpinsi di :ndonesia. Za9artaR :%4:C 2-E.L3. 2. $ch3art0 V. :ron deficiency anemia. :nR ,ehrman +V8 Oliegman +#8 Wenson H,8 editors. Xelson te1tboo9 of pediatrics.')TL ed. "hiladelphiaR /T , $a7nders8 2(.D.T(C '3. '2'(-2. ). $andoval -8 Zayabose $8 Vden 4X. Trends in diagnosis and management of iron deficiency d7ring infancy and early childhood. Hematol 6ncol -lin Xorth 4m. 2(.D.T(C 'BR '(23 3B. B. /ill 4#. :ron metabolism8 siderohlastic anemia8 and iron overload. :nR >illeyman W$8 Hann :#8 ,l anchette .$8 editors. l9diatric hematology. 2U= ed. >ondonR -h7rchill >ivingstone8 2\.D.UDF.LC p .'0 -22. *. Jlotltin $8 4rth7r "8 4nt3i OY8 Ye7ng S. +andomi0ed controlled trial of single vers7s 3otimes daily ferro7s s7lfate drops for treatment of anemia. "ediatrics. 200'C'0BR2'3-2. '0. /7 4-8 >esperance >8 ,ernstein H. $creening for iron deQciency. "ediatr +ev. 2(.D.UDU.=823R')'o). ''. Halterman W$8 Oac0oro3slti Z#8 4ndre3 4-8 47inger "8 $0ilagyi "S. :ron deficiency and cognitive achievement among school aged children and adolescent in the Pnited $tates. "ediatrics. 2(E.L'Cl6)R '3B'2.

'2. 4ndre3s X-. %isorders of iron metabolism. X Vngl Z #ed. '***C3('Rl*B2o'** . '3. :r3in ZW8 :(irchnerWT. 4nemia in children. 4m Fam "hysician. E.DU.L'C2(R'3)*-B2. '(. 6slti F4. :ron deficiency in infancy and childhood. X Vngl W .D:ed.l**3C32*R'*0o3. ' . ,ritish -ol7mbia #edical 4ssociation S7idelines and "rotocols 4dvisory -ommittee. :nvestigation and manao gment of iron deQciencyR revised 2-D.T(. 4vailable fromR 333. healthR emces bc .ca.Tmsp..Tprotog7ides8.Tgps8.TirondeQ pdf '2. 6s9i F4. X7tritional anemias. :nR /al9er D.48 DY&Uat9ins Z,8 editors. X7trition in pediatrics basic science and clinical application. 2TL ed. TorontoR >ittle ,ro3n8 '**0C p.'0) 22. '). %allman "+8 Yip +8 6s9i F4. :ron deficiency and related n7tritional anemias. :nR Xathan %-8 6slti F48 editors. :Qmatology of infancy and childhood. (TL ed. "hiladelphiaR $a7nders8 '**3C p. ('3-(2. 'B. Sibson +$. "rinciples of n7tritional assessment. Xe3 Yor9R 61ford 7niversity press8l**0C p. 3(*3)2. '*. $ch7ltin9 /:$8 Sross +8 Sli3it09i8 Oaryadi %8#at7lessi " Vffect of daily vs t3ice 3ee9ly iron s7pplementation in :ndonesia preschool children 3ith lo3 iron stat7s. 4m W-lin X7tr.'** C2'R''lo . 20. Or7s9e $S8 +7ben 4+8 ,re3ster %+. 4n iron treatment trial