Measurement of reticulocyte and red blood cell indices in patients with iron deficiency anemia and β-thalassemia minor

Abstract

New parameters correlated with the hemoglobin content in reticulocytes (RET-Y) and in red blood cells (RBC-Y) have been suggested as helpful in diagnosing iron deficiency anemia. We have studied RET-Y and RBC-Y indices in two groups of patients with microcytosis to verify if these parameters could be used to differentiate iron deficiency anemia from beta-thalassemia minor. Blood samples from 33 iron-deficient patients, 25 beta-thalassemic minor patients and 50 normal individuals were analyzed on a Sysmex XE-2100 instrument. A significant difference was observed in reticulocyte counting and immature reticulocyte fraction between iron deficiency anemia and beta-thalassemia minor groups, but not in RBC-X and RET-Y parameters. Reticulocyte counting was higher in beta-thalassemia minor and the immature reticulocyte fraction was higher in severe iron deficiency anemia. The ratio RET-Y/mean cell volume was tested and was significantly different when beta-thalassemia minor was compared with mild and severe iron deficiency anemia, and showed better performance than the Mentzer ratio and the Green and King function. A great overlap of RET-Y and RBC-Y individual values was observed in both groups of microcytic anemias; we conclude that these new indices may be used with caution as indicative of iron deficiency, mainly in populations where beta-thalassemia minor is frequent.

Anaemia in patients with cancer: role of inflammatory activity on iron metabolism and severity of anaemia

“…Anaemia of chronic disease, the most common form of anaemia in cancer patients, is typically a hypoproliferative anaemia consequent to the iron-restricted erythropoiesis due to a diversion of iron traffic from the circulation to store sites. Our results showing RET-Y values lower in IDA and ACD groups than in NoA and ARC indicate the impaired offer of iron to erythropoiesis, as previously reported [15].…”

“…Values of Hb £ 11.2-12.0 g/dl in females and £ 13.0-13.5 g/dl in males have been used as indicative of anaemia in those patients [13,14]. The World Health Organization defines anaemia as Hb < 10.9 g/dl [15]. We adopted the haemoglobin value lower than 12 g/dl as indicative of anaemia [11,12].…”

Erythrocyte and reticulocyte parameters in iron deficiency and thalassemia

“…This can be explained by the fact that erythropoietin levels in b thalassemia minor are significantly lower than in IDA with the same degree of anemia (32). A possible explanation could be that adjustment of capillary circulation owing to life-long anemia would lead to diminished hypoxic stimulus and, consequently, to the secretion of erythropoietin concentrations lower than theoretically expected (16).…”

“…Erythrocyte hemoglobin equivalent (RBC He) and reticulocyte hemoglobin equivalent (Ret He) are parameters reported by this instrument. The role of Ret He and RBC He in thalassemia detection has been evaluated (16)(17)(18).…”

Reticulocyte parameters of delta beta thalassaemia trait, beta thalassaemia trait and iron deficiency anaemia

“…ΔCHr can be calculated as the difference between measured CHr and the CHr expected for the corresponding MCVr (ΔCHr=CHr−CHr-e). Sysmex analysers (Sysmex, Kobe, Japan) provide a parameter called reticulocyte haemoglobin equivalent (Ret He, also known as RET-Y), similar but not identical to CHr, that has also been evaluated in β-TT and IDA 1 11 12 14 16. Whereas Noronha and Grotto11 and Bartels et al 12 found no significant differences between both pathologies, other authors reported differences between β-TT and mild14 or all types of IDA,1 and Sudmann et al 16 evaluated an efficient and easy-to-calculate algorithm, including Ret He, RBC and ferritin to discriminate between β-TT and IDA.…”