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November 5, 2007

SickKids researchers find link between iron-deficiency anemia and stroke in young children

TORONTO – Researchers at The Hospital for Sick Children (SickKids) and the University of Toronto (U of T) have found that previously healthy toddlers who have a stroke are 10 times more likely to have iron-deficiency anemia than otherwise healthy children of this age group. The study also showed that children with iron-deficiency anemia accounted for more than half of all stroke cases in children without an underlying medical illness, which indicates that iron-deficiency anemia is a significant risk factor for stroke in otherwise healthy toddlers. This research is reported in the November issue of the journal Pediatrics.

Iron-deficiency anemia is a common childhood disorder and is caused by a lack of iron in a child's diet. It is particularly prevalent amongst children between one to three years of age who consume large amounts of cow's milk, a food product that does not contain iron. Iron-deficiency anemia occurs when there is not enough iron to produce red blood cells, thereby diminishing the blood's ability to carry oxygen from the lungs to the rest of the body. Until now, long-term effects of the condition in children were thought to be cognitive and motor developmental delay but this is the first time that iron-deficiency anemia has been linked to a life-threatening condition.

“This study shows us that there needs to be greater attention given to early detection of iron-deficiency anemia in young children and that parents and caregivers can play a role in preventing it by ensuring that a variety of iron-rich foods are included in their child's diet,” says Dr. Patricia Parkin, the study's principal investigator, director of the Paediatric Outcomes Research Team, staff paediatrician and associate scientist at SickKids and associate professor at U of T. “Strategies need to be developed to prevent iron-deficiency anemia from occurring and to detect it early so that it can be treated before a life-altering complication like a stroke develops.”

The study examined 56 children between one and three years of age from the Canadian Paediatric Ischemic Stroke Registry, based at SickKids, who were admitted to hospital between 1992 and 2004 with stroke. Fifteen of these children who were previously healthy and had no identifiable risk factors for stroke were considered as case patients. A control group of 143 healthy children in the same age range were also recruited for the study. Researchers found that iron-deficiency anemia was significantly more common among case patients (53 per cent) than control subjects (nine per cent). Researchers were not able to determine the proportion of young children who have iron-deficiency and are at the risk of stroke.

“While we cannot yet determine the cause of the association between iron-deficiency anemia and childhood ischemic stroke, we found that children with stroke were five times more likely to have a high platelet count than children who did not have a stroke, suggesting that it may be a factor,” says Dr. Jonathon Maguire, the study's lead author, a U of T graduate student and a Canadian Institutes of Health Research fellow in the Division of Paediatric Medicine at SickKids.

Although childhood stroke is rare, it occurs in children more frequently than brain tumours, at a rate of three per 100,000 children in Canada annually. This can lead to devastating long-term consequences and occasionally death.

“Our research shows that we may be able to reduce the rate of stroke in children by simply preventing and treating a very common condition, iron-deficiency anemia,” says Dr. Gabrielle deVeber, a member of the study's research team, staff neurologist, director of the Children's Stroke Program and scientist at SickKids and holder of a Stroke Investigator Award from the Heart and Stroke Foundation.

This study was supported by the Danone Institute of Canada, the Heart and Stroke Foundation of Ontario and the Bloorview Children's Hospital Foundation. The Paediatric Outcomes Research Team is supported by a grant from the SickKids Foundation. The mandate of the Paediatric Outcomes Research Team program is to undertake research in common paediatric problems using epidemiologic methods.

SickKids, affiliated with the University of Toronto , is Canada 's most research-intensive children's hospital and the largest centre dedicated to improving children's health in the country. As innovators in child health, SickKids improves the health of children by integrating care, research and teaching. The mission of SickKids is to provide the best in complex and specialized care by creating scientific and clinical advancements, sharing our knowledge and expertise and championing the development of an accessible, comprehensive and sustainable child health system. For more information, please visit www.sickkids.ca. SickKids is committed to healthier children for a better world.

For more information, please contact:

Shelley Romoff
Public Affairs
The Hospital for Sick Children
Phone: 416-813-5046
email: shelley.romoff@sickkids.ca