Background: Stunting remains a critical child health problem worldwide and in Indonesia, where ~20% of children under five are affected (SSGI 2024). Stunting is not only a marker of poor linear growth but also predicts impaired cognitive development, lower educational achievement, and increased long-term morbidity.One key contributor is iron deficiency (ID), among the most common micronutrient deficiencies in low- and middle-income countries (LMICs). Iron is essential for growth, neurodevelopment, and immune function. Chronic ID weakens growth hormone pathways and increases susceptibility to infection, creating a vicious cycle that exacerbates stunting.Accurate detection of ID is therefore crucial. Specific markers such as ferritin (with CRP/AGP adjustment), soluble transferrin receptor (sTfR), or reticulocyte hemoglobin content (CHr) are reliable but costly and rarely available in primary care. In contrast, Complete Blood Count (CBC) tests are widely accessible even at Puskesmas. Parameters such as hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and red cell distribution width (RDW) are inexpensive and routinely reported. The question is whether these indices are sufficiently reliable to detect early ID for use in stunting prevention.Objective: To review recent evidence on the diagnostic value of basic hematology indices in identifying iron deficiency in children and assess their relevance for public health strategies to reduce stunting in LMICs, particularly Indonesia.Method: A narrative mini-review was performed using PubMed, WHO guidelines, and national health reports. Literature from 2010–2024 was reviewed, with emphasis on pediatric studies published since 2018. Keywords included iron deficiency, hemoglobin, MCV, MCH, RDW, ferritin, reticulocyte hemoglobin, stunting, children.Results: Hb remains the most widely used indicator but lacks sensitivity, as it only declines in late-stage ID. MCV and MCH support the diagnosis of microcytic anemia but overlap with thalassemia traits, common in Southeast Asia. RDW is more sensitive; a 2024 adolescent study reported an AUC of ~0.73, with cut-offs of 16–18% improving sensitivity (~90%) and higher cut-offs (20–21%) improving specificity (>90%).CHr/Ret-Hb shows strong diagnostic accuracy, with optimal cut-offs around 21–26 pg yielding sensitivities >80% and specificities ~70–80%, but requires advanced analyzers. Ferritin adjusted for inflammation remains the reference, but is not routinely feasible in primary care. Combining Hb, MCV/MCH, and RDW improves early identification of ID in children.Discussion: The use of basic hematology indices for ID screening has major public health implications. In Indonesia, integrating CBC-based tools into routine growth monitoring at Puskesmas could support earlier intervention, including supplementation and dietary counseling. Challenges include the need for locally validated cut-offs and careful interpretation in areas with high thalassemia prevalence.Conclusion: Stunting continues to threaten child health and development. Simple hematology indices, particularly Hb, MCV/MCH, and RDW, are practical and widely available tools to support early ID detection in children. While not substitutes for ferritin or CHr, they can function as cost-effective first-line screening instruments in LMICs.Incorporating these indices into community child health programs could strengthen stunting prevention and contribute to national and global nutrition targets.
