Reticulocyte hemoglobin equivalent as a marker to assess iron deficiency: A large pediatric tertiary care hospital study

Abstract

IntroductionDetection of iron deficiency (ID) remains challenging. We aimed to evaluate the performance of reticulocyte hemoglobin equivalent (Ret‐He) as a potential diagnostic marker to assess ID and iron deficiency anemia (IDA) in a large pediatric cohort.MethodsA total of 3158 patients (aged 15 days to 19 years with a median age of 8.5 years; 60.2% female) were retrospectively studied. Statistical analysis was performed (a) to evaluate relationship of Ret‐He with other relevant complete blood count and iron panel parameters; (b) to compare the levels of Ret‐He in ID and IDA groups to a control group; and (c) to assess sensitivity and specificity of Ret‐He in ID, IDA, and anemia without ID groups.ResultsRet‐He values were significantly positively correlated to ferritin and transferrin saturation (TSAT). The median Ret‐He was significantly lower in ID. A Ret‐He cutoff of ≤30.0 pg distinguished cases of ID from the control group with a sensitivity of 90.2%, specificity of 59.5%, and area under curve (AUC) of 0.88. Ret‐He showed better diagnostic performance in the IDA group and acceptable performance for ID without anemia. The sensitivity, specificity, and AUC were 90.1%, 80.9%, and 0.93 for IDA at cutoff value of ≤27.4 pg, and 80.8%, 51.1%, and 0.70 for ID without anemia at cutoff value of ≤30.8 pg, respectively.ConclusionOur large pediatric tertiary care hospital study demonstrates that Ret‐He is a reliable marker to help confirm IDA in pediatric population. However, further studies are needed for its use to capture the early stages of ID.