Evaluation of the Efficiency of the Reticulocyte Hemoglobin Content on Diagnosis for Iron Deficiency Anemia in Chinese Adults

Abstract

Our aim was to evaluate the cut-off value and efficiency of using reticulocyte hemoglobin content as a marker to diagnose iron deficiency anemia in Chinese adults. 140 adults who needed bone marrow aspiration for diagnosis at the hematology department of the Peking Union Medical College Hospital were enrolled according to the inclusive and exclusive criteria. Venous blood samples were collected to detect complete blood count, including hemoglobin, reticulocyte hemoglobin content, hematocrit, mean cellular volume, corpuscular hemoglobin concentration, hemoglobin content, free erythrocyte protoporphyrin; iron indexes of serum ferritin, serum transferrin receptor, and unsaturated iron-binding capacity; and inflammation markers of C-reactive protein and α-acid glycoprotein. Bone marrow samples were obtained for the bone marrow iron staining, which was used as the standard for the evaluation of iron status in this study. Subjects were divided into three groups according to hemoglobin levels and bone marrow iron staining results: the IDA (iron deficiency anemia) group, the NIDA (non-iron deficiency anemia) group, and the control group. The differences of the above-mentioned indexes were compared among the three groups and the effect of inflammation was also considered. The cut-off value of reticulocyte hemoglobin content was determined by receiver operation curves. The IDA group (n = 56) had significantly lower reticulocyte hemoglobin content, mean cellular volume, corpuscular hemoglobin concentration, hemoglobin content, and serum ferritin; and higher free erythrocyte protoporphyrin, unsaturated iron-binding capacity, and serum transferrin receptor (p < 0.05) compared with the NIDA group (n = 38) and control group (n = 46). Hematocrit, serum ferritin, and unsaturated iron-binding capacity were significantly affected by inflammation while reticulocyte hemoglobin content and other parameters were not. The cut-off value of reticulocyte hemoglobin content for diagnosing iron deficiency anemia was 27.2 pg, with a sensitivity of 87.5% and a specificity of 92.9%. The cut-off values for mean cellular volume, serum ferritin, and serum transferrin receptor were 76.6, 12.9, and 4.89 mg/L, respectively. Reticulocyte hemoglobin content had the largest area under the curve of 0.929, while those for mean cellular volume, serum ferritin, serum transferrin receptor were 0.922, 0.887, and 0.900, respectively. Reticulocyte hemoglobin content has a high sensitivity and specificity in the diagnosis of iron deficiency anemia, and its comprehensive diagnostic efficacy is better than other traditional indicators—such as serum ferritin and serum transferrin receptor.

Prognostic evaluation of colorectal cancer using three new comprehensive indexes related to infection, anemia and coagulation derived from peripheral blood

“…Peripheral blood test is commonly used in clinical practice. Blood routine test (BRT), as one of the most basic peripheral blood biochemical tests, can quickly and accurately detect the values of blood components such as white blood cells (WBC), lymphocytes (LY), red blood cells (RBC), hemoglobin (HGB) and platelets (PLT), as well as other related indicators, in order to effectively indicate abnormalities of infection, anemia and cruor [7][8][9] . In recent years, a wide variety of blood indicators with different changes were concerned and discussed in the study of malignant tumor diseases including CRC: Qian W, et al reported that the post-/pre-treatment MPV (Mean Platelet Volume) ratio were prognostic factors for OS in resectable CRCs [10] ; Preoperative neutrophil-lymphocyte ratio (NLR) and red blood cell distribution width (RDW), especially the independent prediction of NLR, were confirmed as effective biomarkers for clinical diagnosis and prognosis evaluation of esophageal cancers [11] ; In patients with pathologic stage I non-small cell lung cancer undergoing surgical resection, high LY and PLT count from peripheral blood could provide poor prognostic value independently [12] ; Even the ratios between indicators were developed into new indexes, which had fairly good prognostic significance, including NLR, Platelet-to-Lymphocyte Ratio (PLR), Lymphocyte-to-Monocyte ratio (LMR).…”

Utility of reticulocyte hemoglobin in diagnosing latent iron deficiency and iron deficiency anemia

“…7,8 They also found that CHr has a high sensitivity and specificity in the diagnosis of IDA, and its comprehensive diagnostic efficacy is better than other traditional indicators such as Transferrin Saturation and sTfR. 9 CHr is much more cost efficient compared to doing current diagnostic panel; as it can be obtained as part of the complete blood count in most of the modern-day analysers, at no extra cost or additional blood sample. CHr can also be used to evaluate response to Iron therapy at the earliest in comparison to other hematological parameters.…”

Utility of Novel Hypochromia and Microcythemia Markers in Classifying Hematological and Iron Status in Male Athletes

“…In recent years, new indices of red blood cells have emerged in parallel with technological developments, including both erythrocytes and maturing cells (i.e., reticulocytes). These new parameters, measured simultaneously with basic blood morphology, are helpful in assessing iron status in healthy subjects [10,11,12,13,14,15] and patients with various disorders [2,16,17]. Due to the short life span of reticulocytes (i.e., 24–48 h), markers of maturing red blood cells offer some diagnostic value in assessing subclinical ID [2,18,19].…”