Reticulocyte and erythrocyte hypochromia markers in detection of iron deficiency in adolescent female athletes

Abstract

The aim of this study was to analyse the effectiveness of new haematology parameters related to reticulocytes and mature red blood cells to differentiate pre latent and latent iron deficiency. The study included 219 female athletes (aged 15-20 years) representing volleyball, handball, cycling, canoeing, cross-country skiing, swimming and judo. To assess iron status the concentration of ferritin, soluble transferrin receptor (sTfR), iron and total iron binding capacity (TIBC) were determined in serum. In addition to blood morphology, the mean cellular haemoglobin content in erythrocytes (CH) and reticulocytes (CHr), mean cellular haemoglobin concentration in reticulocytes (CHCMr), the percentage of erythrocytes (HYPOm) and reticulocytes (HYPOr) with decreased cellular haemoglobin concentration, the percentage of erythrocytes (LowCHm) and reticulocytes (LowCHr) with decreased cellular haemoglobin content, and percentage of erythrocytes with decreased volume (MICROm) were determined. Subjects with ferritin <30 ng/ml were classified as having stage I (pre-latent) iron deficiency (ID). The second stage (latent ID) was diagnosed when low ferritin was accompanied by elevated sTfR and/or elevated TIBC values. The frequency of ID (without anaemia symptoms) was high, amounting to 60% (stage I in 45%, stage II in 15% of subjects). In subjects with stage I ID significant changes in haematological variables concerned mainly reticulocytes: CHCMr (p<.001), CHr (p<.05), LowCHr (p<.05), HYPOr (p<.001) in comparison to normal iron stores. In athletes with latent ID, there were also significant changes (p<.001) in many indices of mature red blood cells, i.e. haemoglobin concentration (Hb), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), CH, %LowCHm, as well as %MICROm (p<.01) in relation to the group without iron deficiency. The main finding of this study was that the diminished or exhausted iron stores had already caused changes in reticulocytes, and intensified iron deficiency (stage II) increased changes in both reticulocytes’ and erythrocytes’ hypochromia indices, while microcythaemia symptoms appeared later. This suggests that the markers of hypochromia relating especially to reticulocytes are useful for diagnosis of early ID in athletes with absence of an acute phase reaction.

The Association between Iron and Vitamin D Status in Female Elite Athletes

“…The high frequency of both iron and vitamin D deficiencies observed in the present study are in accordance with many earlier studies concerning physically active subjects [ 10 , 12 , 19 , 21 , 22 , 27 , 43 ]. This confirms that the problem regarding deficiencies in both nutrients in athletes is still present.…”

“…The groups particularly exposed to deficiencies of this mineral are women of reproductive age, children and adolescents [ 2 , 16 , 17 ]. Results from many studies indicate that athletes are also at high risk for iron deficiency [ 18 , 19 , 20 ], and this applies especially to physically active women [ 19 , 21 , 22 ].…”

Role of Reticulocyte Parameters in Anemia of First Trimester Pregnancy: A Single Center Observational Study

“…4,5 Recently, different reticulocyte parameters are being studied in the diagnosis of IDA in various age groups but their analysis exclusively in pregnancy is rarely reported. 6,7 The major advantage of these reticulocyte parameters is that it can be evaluated easily with recent automated hematology analyzers using routine blood samples. The feasibility and the ease of use of reticulocyte parameters may also prove beneficial in evaluation of IDA in pregnancy.…”

Utility of Novel Hypochromia and Microcythemia Markers in Classifying Hematological and Iron Status in Male Athletes

“…Since rigorous physical exercise may also stimulate inflammation [1,4], this parameter could add value in diagnosing iron status in athletic populations. To date, few studies have examined the utility of CHr as an assessment tool in sport [25,26,27]. The most commonly accepted CHr cut-off value for anemia is 28 pg [12,13,20], but no standardized threshold exists that would allow a robust diagnosis of this condition.…”

“…Because reticulocyte parameters exhibit only minor changes under physical training [26], other indices of maturing red blood cells could have diagnostic utility in sport. Our recent study demonstrated visible changes in many reticulocyte indices among female athletes already at a very early stage of ID [25]. Furthermore, other novel indicators of mature red blood cells are emerging as reliable tests for detecting ID before overt anemia is present, in both athletic [25,26] and non-athletic cohorts [19,23], although their reference intervals have not been established.…”