Evaluation of reticulocyte hemoglobin for assessment of anemia in rheumatological disorders

Abstract

Objective: The aim of this study was to evaluate the role of reticulocyte hemoglobin (Ret He) estimation in subtyping of anemia and to find the correlation of Ret He with the severity of anemia. Methods:Ninety-four patients with rheumatic diseases with anemia were enrolled.Blood samples were taken to determine various parameters. Patients were divided into three groups: iron deficiency anemia, anemia of chronic disease with iron deficiency and anemia of chronic disease depending on the iron status and inflammatory markers. Analysis of variance and Pearson correlation coefficient were used. Receiver operating characteristic analysis was used to evaluate the accuracy of the parameters in differentiating anemia. Results: Statistically significant differences among groups were seen with regard to parameters such as erythrocyte sedimentation rate, C-reactive protein, serum ferritin, total iron binding capacity, transferrin saturation, transferrin receptor protein, soluble transferrin receptor/log ferritin and Ret He. Ret He correlates with the subtype of anemia in patients with rheumatic disorders but it does not correlate with the severity of anemia. Soluble transferrin receptor/log ferritin, Ret He and serum ferritin values were the best parameters to differentiate between various groups. Ret He (pg) values of <24, 24-26.5 and >26.5, while serum ferritin levels (µg/L) of <35, 35-178 and >178 were highly sensitive and specific for iron deficiency anemia, anemia of chronic disease with iron deficiency and anemia of chronic disease groups, respectively. Conclusion: In cost constraints settings, a simple investigation like Ret He alone or with serum ferritin can help us to diagnose and differentiate between the different types of anemia accompanying rheumatological disorders without doing other serum iron studies and expensive tests like transferrin receptor protein which are not readily available. K E Y W O R D S assessment of anemia, log ferritin, Ret He, soluble transferrin receptor

Reticulocyte hemoglobin content: a simple parameter for detection of iron deficiency anemia in children with chronic liver disease

“…There was no significant difference in hemoglobin values between both our patients' groups; however, Ret Hb was significantly lower among patients with IDA. This is in consistency with Singh et al [15] in 2019 who evaluated the role of Ret Hb in classification of anemia among patients with rheumatological diseases in adults. Singh reported a significant difference in Ret Hb being lower among patients with IDA than patients with anemia of chronic disease.…”

“…Other studies reported a variable range of cutoff values from 27.5 to 34 pg with range of sensitivity from 74.3 to 90% and specificity from 60 to 75% among patients with different chronic inflammatory disorders [6,8,10,14]. We think that our different cutoff values for Ret Hb could be due to lack of comparing our results to bone marrow iron as the "gold standard" [15] as well as the high prevalence of chronic inflammation in our study population.…”

Reticulocyte Hemoglobin Equivalent: Diagnostic Performance in Assessment of Iron Deficiency in Patients with Hypothyroidism

“…In cases where iron deficiency was present before developments of frank anemia, Ret-He at cutoff 31.7 pg had 91% sensitivity and 70% specificity. A study conducted by Singh et al [26] [27] calculated receiver operating characteristic (ROC) curve for Ret-He in iron deficient patients which revealed area under the curve of 0.818 (p < 0.0001), which is slightly lower than our study. Our study showed area under curve of 0.93. eir cutoff for diagnosing iron deficiency anemia was slightly higher than our results.…”

Clinical utility of reticulocyte haemoglobin in the assessment of iron deficiency and iron deficiency anaemia in the paediatric population

“…3,5,7,8,11,12 In patients with chronic inflammation due to non-renal diseases, there is no gold standard for the diagnosis of ID or severe-ID. 15,16 Our study identified a group of patients with chronic disease/inflammation with discrepant results that have normal or elevated ferritin with a low Ret-He. These results would indicate ID in a cohort of patients that previously would not have received this diagnosis and suggests that Ret-He may be able to identify ID in patients with chronic disease and inflammation in non-renal patients.…”

“…4,9,17,19,20,22 Ret-He has been reviewed multiple times in adult and paediatric renal disease on chronic dialysis with limited studies on patients with rheumatologic disorders and inflammatory bowel disease. 10,12,15,16,23 Ret-He is not affected by inflammation, allowing it to be used in the assessment of ID and severe-ID in patients with chronic disease. Ret-He has been recommended for the assessment of iron status in paediatric patients receiving haemodialysis in the National Institute for Health and Care Excellence guidelines.…”