Screening Healthy Infants for Iron Deficiency Using Reticulocyte Hemoglobin Content

Ullrich, Christina; Wu, Ann Chen; Armsby, C. C.; Rieber, Sarah; Wingerter, Sarah; Brugnara, Carlo; Shapiro, David E.; Bernstein, Henry H.

doi:10.1001/jama.294.8.924

Cited by 161 publications

(149 citation statements)

References 39 publications

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“…Our study shows that retHe is superior to this panel of tests in the detection of iron deficiency as early as its latent stage. This is in accordance with previous reports [13][14][15][16], which showed that determination of the reticulocyte hemoglobin content may allow realtime evaluation of iron deficiency and concluded that it is to be used as a marker of iron deficiency. Failure of RetHe to predict the prelatent stage of iron deficiency can be overcomed by a close look at the RDW CV % which is significantly increased compared to normal controls (p<0.0005).…”

Section: Discussionsupporting

confidence: 93%

Early Diagnosis of Iron Deficiency in School Children: A Qatari Experience

Madi¹

2015

J Hematol Thrombo Dis

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Objective: Iron deficiency still remains the most common nutritional deficiency throughout the world and is the leading cause of anaemia in children. Early recognition of iron deficiency, even before the development of anaemia is crucial to prevent the systemic complications of this disease.Methods: Ninety-seven school children between 5 and 16 years were stratified into prelatent iron deficiency (10 cases), latent iron deficiency (14 cases), overt iron deficiency anemia (13 cases), and controls (60 cases). All hemograms were performed on the same day of collection using the same Sysmex XE-2100 analyzer with reticulocyte indices included. Biochemical markers such serum iron, total iron binding capacity and percent saturation (calculated) in addition to serum ferritin and serum transferrin receptors were simultaneously measured. Data analysis was done using ANOVA test, generalized linear regression, and ROC curve. Results:Our study indicates that a panel based on hematologic parameters including reticulocyte hemoglobin at a cut off of ≤27 and ≤25.6, serum transferrin receptors at a cut off >0.48 and >0.68, red cell distribution width at a cut off >13.8 and >16.8 may provide an alternative to the traditional biochemical panels for the diagnosis of latent iron deficiency and overt iron deficiency anemia respectively. Conclusion:Whenever iron deficiency is thought of, a hemogram including reticulocyte hemoglobin and serum transferrin receptors would be the adequate diagnostic panel obviating the need for a more extensive one. These parameters should always be interpreted in the clinical context involving dietary habits, social standard as well as family history.

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Section: Discussionsupporting

confidence: 93%

Early Diagnosis of Iron Deficiency in School Children: A Qatari Experience

Madi¹

2015

J Hematol Thrombo Dis

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“…identifying non-anemic iron deficiency defined by ferritin concentration, 28 and in infants, an AUC ROC of 0.85 when iron deficiency was defined by transferrin saturation. 29 We found that serum hepcidin, when compared with the sTfR-F index gold standard, had an AUC ROC of 0.89, and when compared with ferritin, the AUC ROC was 0.87. Hepcidin is, therefore, at least as promising as other recently introduced tests of iron deficiency.…”

Section: S-r Pasricha Et Almentioning

confidence: 71%

Serum hepcidin as a diagnostic test of iron deficiency in premenopausal female blood donors

Pasricha¹,

McQuilten²,

Westerman³

et al. 2011

Haematologica

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BackgroundCurrently used indicators of iron status have limitations. Hepcidin, a key regulator of iron metabolism, is reduced in iron deficiency. We sought to determine the properties of hepcidin as a diagnostic test of iron deficiency. Design and MethodsSera from female, non-anemic, whole blood donors were analyzed for hepcidin (enzymelinked immunosorbent assay), ferritin, soluble transferrin receptor and C-reactive protein. Iron deficiency was defined as (i) serum ferritin less than 15 ng/mL or (ii) soluble transferrin receptor /log(ferritin) index greater than 3.2 if the C-reactive protein concentration was less than 10 mg/L, or greater than 2.2 if the C-reactive protein concentration was greater than 10 mg/L). Receiver operating characteristic curves were plotted to determine the overall utility and identify optimal cut-points of hepcidin as a test of iron deficiency. ResultsIn 261 blood donors the prevalence of iron deficiency defined by ferritin concentration was 59/261 [22.6% (17.5, 27.7)], whereas defined by soluble transferrin receptor/log(ferritin) index it was 53/261 [20. 4% (15.4, 25.2)]. The 95% reference range of hepcidin concentration in the iron-replete population was 8.2-199.7 ng/mL. The area under the receiver operating characteristic curve for hepcidin compared with ferritin concentration less than 15 ng/mL was 0.87 (0.82, 0.92), while that compared with the soluble transferrin receptor /log(ferritin) index was 0.89 (95% CI 0.84, 0.93). For a diagnosis of iron deficiency defined by the soluble transferrin receptor/log(ferritin) index, hepcidin less than 8 ng/mL had a sensitivity of 41.5% and a specificity of 97.6%, while hepcidin less than 18 ng/mL had a sensitivity of 79.2% and a specificity of 85.6%. ConclusionsSerum hepcidin concentration may be a useful indicator of deficient iron stores. Further studies are required to evaluate the role of hepcidin in the diagnosis of iron deficiency in other groups of patients.

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“…Two studies have examined the clinical utility of CHr in pediatric patients (age 9 months to 8 years) with comparison to other markers. The optimal CHr concentration cutoff value for the diagnosis of iron deficiency differed slightly in these two studies at 26.0 and 27.5 pg [11,12]. CHr outperformed ferritin, MCV, MCH, RDW, and Zn protoporphyrin in detecting iron deficiency defined by decreased hemoglobin and transferrin saturations.…”

Section: Applications and Limitationsmentioning

confidence: 86%

Reticulocyte hemoglobin content

2007

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Under normal conditions, reticulocytes are the youngest erythrocytes released from the bone marrow into circulating blood. They mature for 1–3 days within the bone marrow and circulate for 1–2 days before becoming mature erythrocytes. Measurement of cellular hemoglobin concentration has long been reported by automated hematology analyzers as one of the red blood cell indices. The reticulocyte hemoglobin content (CHr or Ret‐He) provides an indirect measure of the functional iron available for new red blood cell production over the previous 3–4 days. Measurement of reticulocyte hemoglobin content in peripheral blood samples is useful for diagnosis of iron deficiency in adults (Mast et al., Blood 2002;99:1489–1491) and children (Brugnara et al., JAMA 1999;281:2225–2230; Ullrich et al., JAMA 2005;294:924–930; Bakr and Sarette, Eur J Pediatr 2006;165:442–445). It provides an early measure of the response to iron therapy increasing within 2–4 days of the initiation of intravenous iron therapy (Brugnara et al., Blood 1994;83:3100–3101). Sequential measurements of reticulocyte hemoglobin content in patients with iron deficiency anemia provide a rapid means for assessing the erythropoietic response to iron replacement therapy (Brugnara et al., Blood 1994;83:3100–3101). It is also an early indicator or iron‐restricted erythropoiesis in patients receiving erythropoietin therapy (Fishbane et al., Kidney Int 1997;52:217–222; Fishbane et al., Kidney Int 2001;60:2406–2411; Mittman et al., Am J Kidney Dis 1997;30:912–922; Tsuchiya et al., Clin Nephrol 2003;59:115–123; Chuang et al., Nephrol Dial Transplant 2003;18:370–377). Thus, reticulocyte hemoglobin content is a recent addition to an expanding list of biomarkers that can be used to differentiate iron deficiency from other causes of anemia. Am. J. Hematol., 2008. © 2007 Wiley‐Liss, Inc.

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Screening Healthy Infants for Iron Deficiency Using Reticulocyte Hemoglobin Content

Cited by 161 publications

References 39 publications

Early Diagnosis of Iron Deficiency in School Children: A Qatari Experience

Early Diagnosis of Iron Deficiency in School Children: A Qatari Experience

Serum hepcidin as a diagnostic test of iron deficiency in premenopausal female blood donors

Reticulocyte hemoglobin content

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