Background

Laboratory evaluation is commonly integrated into evaluation of children with suspected physical abuse to identify occult injury and potential mimics of abuse, including hemophagocytic lymphohistiocytosis (HLH). We evaluated the utility of ferritin in laboratory screening panels for physical abuse.

Objective(s)

To determine if hyperferritinemia is a useful screening marker of HLH in physical abuse diagnostic evaluations.

Participants and setting

Children being evaluated for physical abuse at a quaternary pediatric referral and level one trauma center in Houston, Texas.

Methods

We conducted a 12-year (2003 – 2015) retrospective descriptive analysis of all ferritin values obtained as part of routine screening panels for physical child abuse. Medical records were abstracted for patients with ferritin > 500 ng/mL.

Results

2954 ferritin levels were obtained in 3091 encounters for suspected physical abuse (median age 6.5 months, interquartile range 2.3–23.5 months). Elevated ferritin was found in 82/2954 (2.8 %); no child evaluated for physical abuse was found to have HLH (95 % CI: 0–4.5%). The child abuse team was consulted in 48/82 (58.5 %) of cases, with the final impression being physical abuse in 33/48 (68.8 %).

Conclusions

We found no instances where HLH was identified by institutional screening panels. The inclusion of ferritin in the screening panel was not beneficial. The presence of hyperferritinemia should not cast medical or legal doubt on physical abuse diagnoses when there is a high index of clinical suspicion. Novel hypotheses from case reports and case series should be studied more rigorously before affecting system change.

中文翻译：

---

在虐待儿童评估中筛查噬血细胞淋巴组织细胞增生症：十二年的数据

背景

实验室评估通常与疑似身体虐待儿童的评估相结合，以识别隐匿性损伤和潜在的虐待行为，包括噬血细胞性淋巴组织细胞增生症 (HLH)。我们评估了铁蛋白在实验室身体虐待筛查小组中的效用。

目标

确定高铁蛋白血症是否是身体虐待诊断评估中 HLH 的有用筛选标志物。

参与者和设置

儿童在德克萨斯州休斯顿的四级儿科转诊和一级创伤中心接受身体虐待评估。

方法

我们对所有铁蛋白值进行了为期 12 年（2003 年至 2015 年）的回顾性描述性分析，这些铁蛋白值作为身体虐待的常规筛查小组的一部分。提取铁蛋白 > 500 ng/mL 患者的医疗记录。

结果

在 3091 次疑似身体虐待（中位年龄 6.5 个月，四分位距 2.3-23.5 个月）的遭遇中获得了 2954 次铁蛋白水平。在 82/2954 (2.8 %) 中发现铁蛋白升高；没有发现因身体虐待而评估的儿童患有 HLH（95% CI：0-4.5%）。在 48/82 (58.5%) 的案件中咨询了虐待儿童小组，33/48 (68.8%) 的最终印象是身体虐待。

结论

我们没有发现机构筛查小组发现 HLH 的情况。在筛选小组中加入铁蛋白是没有好处的。当临床怀疑指数很高时，高铁蛋白血症的存在不应对身体虐待的诊断产生医学或法律上的怀疑。在影响系统变化之前，应该更严格地研究来自案例报告和案例系列的新假设。