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

Abstract

Background Iron deficiency anemia is common among patients with chronic liver disease. Reticulocyte hemoglobin is a marker for iron availability in the bone marrow that is not affected by inflammation. Objective The aim of this study is to detect the diagnostic value of reticulocyte hemoglobin (Ret-Hb) in diagnosis of iron deficiency anemia among children with chronic liver disease. Methods This is a cross-sectional study that included thirty-three children with chronic liver disease (CLD) and Hb < 11 g/dL, MCV < 77 fl, regularly attending the Pediatric Hepatology Clinic, Cairo University Children Hospitals. Patients underwent full history taking, and full iron profile and reticulocyte Hb were done. Results The median age of our patients was 5.9 years with a median age of onset of CLD was 1.6 years. The mean reticulocytic Hb was 25.52 ± 4.53 pg (N: 28–36 pg). Mean serum ferritin was 89 ± 16.55 ng/ml (N: 7–140 ng/ml). There was a statistically positive significant linear correlation between S-ferritin and Ret. Hb, r = +0.433, p = 0.012. ROC curve analysis of reticulocytic Hb, at cutoff ≤ 29.3 pg for diagnosis of iron deficiency anemia in children with CLD, had an AUC of 0.824 with a sensitivity of 92.59% and a specificity of 83.33%, with p = 0.012. Conclusion Reticulocyte Hb is a sensitive and specific marker for detection of iron deficiency anemia in CLD patients. Anemia in CLD was mostly iron deficiency anemia.