Evaluation of Hematological Parameters Among Children with Autism in Duhok City

Background and objective: Western studies have linked autism with nutritional deficiencies, particularly those of iron and folate, while such studies are scarce from developing countries. We aimed to assess such deficiencies and their associated hematological abnormalities among Iraqi autistic children. Methods: In this cross-sectional study 100 diagnosed autistic children, visiting the mental health center in Duhok, Iraq in the period (December 2022-June 2023) were recruited. The records of these patients were reviewed and they had blood counts, serum iron, total iron binding capacity, transferrin saturation, ferritin and folate assayed. Patients were labelled as iron deficient if they had serum ferritin<30 ug/L, and/or transferrin saturation<16%. They were further categorized as anemic or non-anemic based on their hemoglobin levels. Results: Patients had a median age of 7 years (range 4-13), included 75% males, and 17% with severe autism. Iron deficiency anemia was documented in 1%, while non-anemic iron deficiency in 41%. Serum ferritin, transferrin saturation, and folate were significantly lower in severe cases (P<0.001, 0.007 and 0.035 respectively). Iron deficiency was significantly more frequent in the severe cases (P<0.001), and among preschool children (P=0.009). Conclusion: Iron deficiency was frequently observed among autistic children, although it was latent in the large majority. Furthermore, iron deficiency and low serum folate were associated with more severe disease.