Prognostic value of reticulocyte hemoglobin content to diagnose iron deficiency in 6–24-month-old children

Abstract

Objective. The aim of our study was to evaluate the prognostic value of reticulocyte hemoglobin content for diagnosis of iron deficiency in 6-24-month-old children.Material and methods. Children aged 6 to 24 months were consulted for suspected iron deficiency in the outpatient department in 2006-2007. Criteria for inclusion into the study were normal birth time and weight, no infection during the last two weeks before blood sampling (Creactive protein <5 mg/L), no iron supplements 1 month before the study. Red blood cell, reticulocyte indices and biochemical tests were analyzed. A total of 180 children were enrolled in our study. Iron deficiency was diagnosed when at least two of four parameters (ferritin, transferrin, transferrin saturation, and soluble transferrin receptors) reflected iron deficiency.Results. According to our criteria of iron deficiency, patients were divided into two groups: 116 had iron deficiency and 64 had normal iron stores. The iron deficiency group had significantly lower hemoglobin, mean corpuscular hemoglobin, mean corpuscular volume, reticulocyte hemoglobin content, ferritin, soluble transferrin receptors, iron and higher red cell distribution width, transferrin, and transferrin saturation (P<0.05) compared with the normal iron store group. Reticulocyte hemoglobin content, ferritin, and transferrin saturation had the highest sensitivity and specificity (76.6% and 78.4%, 81.3% and 81.9%, 85.9% and 87.9%, respectively).Conclusion. Reticulocyte hemoglobin content is comparable test with ferritin and transferrin saturation and can be used to detect iron deficiency in 6-24-month-old children.

Reference intervals for reticulocyte hemoglobin content in healthy infants

“…Our observed lower reference levels (-2 SD) at 4 and 12 months of 25.6 and 24.9 pg/L respectively, corresponds well to the cut off level of 25 pg/L commonly used to diagnose ID in older children (33). Ret-He or its equivalent CHr has shown promise in the identification of children with ID solely on the basis of hematological parameters, (11) as well as a potential predictive tool as an early indicator of ID in infants (12,13) even though its use as a single biomarker has been challenged (9) In our correlation analysis, Ret-He was strongly correlated to sTfR at all ages, while there were varying correlations to MCV, Ferritin and TS as well as Hb. This might reflect that these indicators describe different stages of iron metabolism.…”

“…In this setting, reticulocyte hemoglobin content (Ret-He) has emerged as a relatively new iron status marker. In some previous studies, it has even shown promising qualities as a biomarker of early ID (11,12). Two methods for analysis of Ret-He are available; the CHr (mean cellular hemoglobin content of reticulocytes) parameter provided by the ADVIA 120 and 2120 (Bayer Diagnostics, Tarrytown, NY) and the Ret-He (reticulocyte hemoglobin equivalent) available on analyzers from the Sysmex Corporation, Kobe, Japan (XE 2100, XE 5000 and the XN series), respectively, and show very good level agreement (13).…”

Commentary: Iron deficiency and hair loss

“…All 3 performed well, but it should be noted that the study controlled at least partially for inflammation as it excluded children with recent infection or CRP greater than 5 mg/L. 45 Another study of 237 children found that RHC was the most accurate marker for iron deficiency, a cutoff value 25 pg providing a sensitivity of 94% and specificity of 80%. 46 RHC has also been used to assess iron status in patients on hemodialysis, where measurements of ferritin and transferrin saturation can be unreliable.…”

Peran Reticulocyte Hemoglobin Content (Ret-He) dalam Mendeteksi Defisiensi Besi pada Anak

“…Penelusuran abstrak dan judul. 16 juga memiliki nilai sensitivitas dan spesifisitas yang hampir sama meskipun usia subyek dalam studi ini sangat bebeda, akan tetapi nilai batas RET-He yang digunakan hampir serupa yaitu ≤ 29 pg dan ≤ 28,55 pg.…”

“…Sensitivitas dan spesifisitas RET-He dengan nilai batas ≤ 27,5 pg pada usia 9-12 bulan sebesar 83% dan 72%. 10 Nilai ini hampir serupa dengan nilai sensitivitas dan spesifisitas dalam 3 studi yang ditelaah diatas, kecuali studi Kiudelienė dkk, 16 memiliki sensitivitas dan spesifisitas lebih rendah karena menggunakan nilai batas RET-He yang lebih tinggi yaitu ≤28,55 pg.…”