The Reticulocyte Hemoglobin Equivalent as a Screening Marker for Iron Deficiency and Iron Deficiency Anemia in Children

Abstract

Background: Iron deficiency (ID) is one of the most common nutritional deficiencies in children worldwide and may result in iron deficiency anemia (IDA). The reticulocyte hemoglobin equivalent (Ret-He) provides information about the current availability of iron in erythropoiesis. This study aims to examine the validation of Ret-He as a screening marker for ID and IDA in children. Methods: Blood samples were retrospectively obtained from medical records. Anemia was defined according to the definition provided by the World Health Organization (WHO) for children. ID was defined by transferrin saturation (TSAT) < 20% and ferritin < 100 ng/mL. Children were classified into four groups: IDA, non-anemia iron deficiency (NAID), control and others. Results: Out of 970 children, 332 (34.2%) had NAID and 278 (28.7%) presented with IDA. Analysis revealed that Ret-He significantly correlates with ferritin (rho = 0.41; p < 0.001), TSAT (rho = 0.66; p < 0.001) and soluble transferrin receptor (sTfR) (rho = −0.72; p < 0.001). For ROC analysis, the area under the curve (AUC) was 0.771 for Ret-He detecting ID and 0.845 for detecting IDA. The cut-off value for Ret-He to diagnose ID was 33.5 pg (sensitivity 90.7%; specificity 35.8%) and 31.6 pg (sensitivity 90.6%; specificity 50.4%) to diagnose IDA. Conclusions: The present study demonstrates Ret-He to be a screening marker for ID and IDA in children. Furthermore, Ret-He can be used as a single screening parameter for ID and IDA in children without considering other iron parameters. Economically, the use of Ret-He is highly relevant, as it can save one blood tube per patient and additional costs.

Iron metabolism and chronic inflammation in IgA nephropathy

“…Soluble transferrin receptor (sTfR) is a fragment of TfR on the cell membrane secreted into the circulation by protease hydrolysis, which can indirectly reflect the cytosolic expression of TfR [ 85 ]. sTfR can reflect iron deficiency in anemia and inflammatory status [ 86 ]. In addition, sTfR is also a strong predictor of heart failure.…”

Reticulocyte Hemoglobin as a Screening Test for Iron Deficiency Anemia: A New Cut-Off

“…The measurement of ret-hemoglobin content is a known direct assessment of the iron incorporation into erythrocyte hemoglobin, so it is a direct estimate of the recent functional availability of such iron in the erythron [ 14 ]. A single biomarker is important to use for the diagnosis of IDA, but the use of a serum marker that can be easily identified as a screening marker is necessary [ 15 , 16 ]. Ret-He has already been suggested to be an additional marker for the screening of IDA [ 15 ].…”

“…A single biomarker is important to use for the diagnosis of IDA, but the use of a serum marker that can be easily identified as a screening marker is necessary [ 15 , 16 ]. Ret-He has already been suggested to be an additional marker for the screening of IDA [ 15 ]. Hence, in this study, we review the role of Ret-Hb in the diagnosis of LID and as a screening parameter for IDA.…”

Prevalence of Iron Deficiency Anemia and Reference Range of Complete Blood Count, Reticulocyte Parameters in Infants Aged 9–11 Months

“…Many studies have shown that Ret-He can show iron deficiency without anemia. 8 , 10 , 11 Therefore, a lower value than the lower limit of the Ret-He reference range according to age indicates that an infant is iron deficient.…”