Reference intervals for reticulocyte hemoglobin content in healthy infants

Löfving, Anders; Domellöf, Magnus; Hellström‐Westas, Lena; Andersson, Ola

doi:10.1038/s41390-018-0046-4

Cited by 25 publications

(20 citation statements)

References 37 publications

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“…9,10 Conventional iron biomarkers are also affected by acute-phase responses, 8,12 and influenced by diurnal variation and dietary intake. 12,13 Due to these diagnostic difficulties, an alternative marker is sought.…”

Section: Introductionmentioning

confidence: 99%

“…Bone marrow iron staining, the gold standard method for diagnosing iron deficiency, is invasive [8][9][10][11] and subjective. 9,10 Conventional iron biomarkers are also affected by acute-phase responses, 8,12 and influenced by diurnal variation and dietary intake. 12,13 Due to these diagnostic difficulties, an alternative marker is sought.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic performance of reticulocyte hemoglobin equivalent in assessing the iron status

Chinudomwong

Binyasing

Trongsakul

et al. 2020

Clinical Laboratory Analysis

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Background: Measurement of reticulocyte hemoglobin equivalent (RET-He) is rapid, convenient, and cost-effective. Yet, researches on its performance in diagnosing iron deficiency with concurrent inflammation are limited. Hence, this study investigated RET-He value in various states, including inflammation, and evaluated its diagnostic performance in iron status assessment.Methods: Retrospectively, 953 clinical data and laboratory results-complete blood count, reticulocyte count, RET-He, and serum ferritin-were reviewed. Patients on iron therapy were excluded. Iron status was defined by serum ferritin as the reference method. RET-He among populations was investigated. Its diagnostic performance and optimal cutoff were determined by ROC analysis.Results: Three population groups were classified: healthy control, iron deficiency anemia (IDA), and non-ID anemia. Significantly, RET-He value in IDA was lower than that of healthy control, anemia of inflammation, and chronic kidney disease (P < .0001).Low RET-He was also observed in IDA with concomitant inflammation despite normal-to-high serum ferritin levels. No significant difference was observed between RET-He values in pure IDA and thalassemia (P = .57). ROC curve analysis revealed AUC of 0.876 (P < .0001) at cutoff 30 pg, by which IDA was discriminated with 74.2% sensitivity and 97.4% specificity. Applying cutoff ≤30 pg, IDA can be diagnosed with 96% sensitivity, 97.4% specificity, 80% PPV, and 99.6% NPV. Hence, RET-He >30 pg signifies a non-IDA state. Conclusion:In addition to convenience and cost-effectiveness, RET-He cutoff >30 pg can be potentially used to exclude IDA due to its excellent diagnostic sensitivity and specificity.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic performance of reticulocyte hemoglobin equivalent in assessing the iron status

Chinudomwong

Binyasing

Trongsakul

et al. 2020

Clinical Laboratory Analysis

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“…In term newborns, mean hemoglobin values decreased approximately 5 g/dL between birth and 28 days of life and the mean platelet count increased 140 3 10 3 /lL by 90 days of life. 17 Lofving et al 21 reported that RET-He decreases after birth and levels off at 4 months. Neutrophil counts are low at delivery, but increase after birth, with a peak value between 6 and 14 HOL, then decreasing and leveling off at approximately 72 hours.…”

Section: Discussion Factors That Can Affect Cbc Reference Intervalsmentioning

confidence: 99%

Defining Normal Healthy Term Newborn Automated Hematologic Reference Intervals at 24 Hours of Life

Ianni

McDaniel

Savilo

et al. 2020

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Automated analyzers have advanced the field of clinical hematology, mandating updated complete blood count (CBC) reference intervals (RIs) to be clinically useful. Contemporary newborn CBC RI publications are mostly retrospective, which some authors have cited as one of their cardinal limitations and recommended future prospective studies. Objective.— To prospectively establish accurate hematologic RIs for normal healthy term newborns at 24 hours of life given the limitations of the current medical literature. Design.— This prospective study was conducted at an academic tertiary care center, and hematology samples were collected from 120 participants deemed to be normal healthy term newborns. Distributions were assessed for normality and tested for outliers. Reference intervals were values between the 2.5th percentile and 97.5th percentile. Results.— The novel RIs obtained for this study population are as follows: absolute immature granulocyte count, 80/μL to 1700/μL; immature granulocyte percentage, 0.6% to 6.1%; reticulocyte hemoglobin equivalent, 31.7 to 38.4 pg; immature reticulocyte fraction, 35.9% to 52.8%; immature platelet count, 4.73 × 103/μL to 19.72 × 103/μL; and immature platelet fraction, 1.7% to 9.8%. Conclusions.— This prospective study has defined hematologic RIs for this newborn population, including new advanced clinical parameters from the Sysmex XN-1000 Automated Hematology Analyzer. These RIs are proposed as the new standard and can serve as a strong foundation for continued research to further explore their value in diagnosing and managing morbidities such as sepsis, anemia, and thrombocytopenia.

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“…17 Broad reference interval widths do have implications in clinical practice as these may reduce diagnostic power and even small to modest overestimation may result in higher false negative rates. 33 Of note is that reference intervals specifically for Ret-He, using data from the County Hospital of Halland cohort, have already been previously published, 28 but with different reference interval methodology (a parametric approach). Since these calculations are less robust to population skewness, we did further analyses and harmonised calculations with the other RBC biomarkers.…”

Section: Original Researchmentioning

confidence: 99%

Haemoglobin and red blood cell reference intervals during infancy

et al. 2021

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ObjectivesThere is a need for updated haematological reference data in infancy. This study aimed to define intervals for haemoglobin and red blood cell biomarkers based on data from a large cohort of longitudinally followed Swedish infants.DesignLongitudinal cohort study.SettingTwo Swedish study centres.ParticipantsThree community-based populations including 442 presumably healthy infants born at term and with umbilical cord clamping delayed to 30 s or more after birth.MethodsBlood samples were collected from umbilical cord blood (a), at 48–118 hours (b), at 4 months (c) and at 12 months (d). Reference intervals as the 2.5th and 97.5th percentiles were calculated in coherence with Clinical and Laboratory Standards Institute guidelines.ResultsReference intervals for haemoglobin (g/L) were: (a) 116–189, (b) 147–218, (c) 99–130, (d) 104–134, and for mean cell volume (fL): (a) 97–118, (b) 91–107, (c) 71–85, (d) 70–83. Reference intervals for erythrocyte counts, reticulocyte counts, reticulocyte haemoglobin, mean cell haemoglobin and mean cell haemoglobin concentration were also estimated. According to the WHO definition of anaemia, a haemoglobin value less than 110 g/L, 16% of this presumably healthy cohort could be classified as anaemic at 12 months.ConclusionWe found mainly narrower reference intervals compared with previously published studies. The reference intervals for each parameter varied according to the infants’ age, demonstrating the necessity of age definitions when presenting infant reference intervals. The discrepancy with the WHO classification for anaemia at 12 months, despite favourable conditions in infancy, needs future investigation.

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Reference intervals for reticulocyte hemoglobin content in healthy infants

Abstract: This longitudinal study presents Ret-He reference intervals based on non-anemic and non-iron-deficient infants and constitutes a step towards standardizing Ret-He as a pre-anemia biomarker of iron deficiency in children.

Cited by 25 publications

References 37 publications

Diagnostic performance of reticulocyte hemoglobin equivalent in assessing the iron status

Diagnostic performance of reticulocyte hemoglobin equivalent in assessing the iron status

Defining Normal Healthy Term Newborn Automated Hematologic Reference Intervals at 24 Hours of Life

Haemoglobin and red blood cell reference intervals during infancy

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