Reticulocyte hemoglobin equivalent to detect thalassemia and thalassemic hemoglobin variants

Abstract

Summary Introduction Thalassemia and iron deficiency may both result in hypochromic microcytic anemia. Hematological algorithms that differentiate the two are mainly established in adult selected diagnostic groups. We aimed at creating an algorithm applicable in the presence of children, hemoglobin variants, and iron deficiency. Methods Our study material constituted blood samples referred during 1 year for routine diagnostics of hemoglobinopathy. We included 443 samples, of which 37% were from children 3 months or older. We found β‐thalassemia trait (n = 100), α‐thalassemia (n = 75), combined α‐/β‐thalassemia (n = 14), hemoglobin variants (n = 42), and no‐hemoglobinopathy (n = 207), of whom 107 had a ferritin at or below 20 μg/L. We included reticulocyte hemoglobin equivalent, ferritin, and erythrocyte count in our algorithm. Results Our algorithm differentiated β‐thalassemia trait from no‐hemoglobinopathy with a sensitivity of 99% at 83% specificity. It performed better than other published algorithms when applied to all patient samples, while equally or moderately better in the 63% adult samples. Our algorithm also detected the clinically significant α‐thalassemias, and most of the combined α‐/β‐thalassemias and thalassemic hemoglobin variants. Conclusion Our algorithm efficiently differentiated thalassemia and thalassemic hemoglobin variants from iron deficiency in children and adults.

Evaluation of the new red cell parameters on Beckman Coulter DxH800 in distinguishing iron deficiency anaemia from thalassaemia trait

“…Our formula is simple to apply and can be generated automatically from the laboratory information system based on the five parameters of the DxH800. In contrast to other proposed algorithm, there is no need to involve biochemical marker of iron status such as serum ferritin [12], and hence, it is more convenient to use in the routine clinical diagnostic laboratory. Moreover, ours is a single formula unlike the HCT, haematocrit; MAF, microcytic anaemia factor; RBC, red blood cell; RSF, red blood cell size factor; SD-C-NERT, standard deviation of conductivity of the nonreticulocyte population; UGC, unghosted cell.…”

Discriminant indices for distinguishing thalassemia and iron deficiency in patients with microcytic anemia: a meta-analysis

“…For example, Mentzer originally published his index with 13 as the cut-off value [3]. Other authors, however, used values between 13 and 14 [20,39,48,62,70], between 14 and 15 [7,34,38,43,55,58,59,65,82,87,93,94,96,101], 15.5 [57], 17 [44,61,92] or even as high as 20 [102], without proper validation. Therefore the effect of a modified cut-off value on an index's performance is difficult to judge and may require further investigations.…”

Reticulocyte Hemoglobin Content During the First Month of Life in Critically Ill Very Low Birth Weight Neonates Differs From Term Infants, Children, and Adults

“…Only human studies of infants, children, and adults with "reticulocyte hemoglobin content," "RET-He," "CHr," "reticulocyte indices," and/or "hematological indices" were included. Ten publications were identified (6,7,10,11,15,(22)(23)(24)(25)(26). To locate additional publications with original RET-He data, the reference section of these ten papers were reviewed by three of the coauthors (RA, DN, and JW).…”