Usefulness of Reticulocyte Parameters for Diagnosis of Hereditary Spherocytosis in Children

Abstract

Innovations in laboratory equipment have enabled a widening of the spectrum of hematological parameters obtained from single measurements of peripheral blood samples, including reticulocyte parameters. The usefulness of reticulocytes indices to confirm the diagnosis of pediatric anemia was analyzed in this study. The study group consisted of 163 children, aged 1 month-17 years, with anemia. Complete blood count extended with an analysis of reticulocyte parameters were measured using a Beckman Coulter LH 750. The mean sphered corpuscular volume (MSCV) in the group of children with hereditary spherocytosis (HS) was 66.71 ± 8.45 fL, whereas in other anemic patients MSCV was 87.76 ± 11.22 fL, < 0.0001. In HS children the average mean corpuscular volume of red blood cells was higher than the MSCV value, while an inverse correlation was observed in the group of children with other anemias, < 0.0001. A significant difference was found between the ratio of absolute reticulocyte count and IRF fraction (Ret#/IRF)-0.6 ± 0.28 in the HS group and 0.23 ± 0.16 in the non-HS group, respectively. Our results suggest that analysis of reticulocyte parameters is useful in the diagnosis of anemia and should be included in the routine CBC analysis in anemic children.

Utility of Reticulocyte Parameters for the Diagnosis of Hereditary Spherocytosis

“…Similar observations were made by Ciepiela O et al 8 in their study in which the RBC size factor was found to be low in patients with HS. Since the calculation of Rsf is based MSCV is another parameter which has been studied by few authors and have been proved to have high sensitivity and specificity in screening of HS.…”

“…From the different reticulocyte parameters which were analyzed, area under the curve was calculated for IRF, MRV and Retic#/IRF which was 0.867, 0.865 and 0.931 respectively. Ciepiela O et al, 8 in their study derived AUC for MRV which was 0.963 with a sensitivity of 87.66% and specificity of 94.12%., at a cut off value of 91.15fl. AUC for reticulocyte parameters were also calculated by Lazarova E et al The AUC for MRV, IRF and Retic#/IRF were 0.98, 0.50 and 0.95 respectively from which they derived cut off values of <96.7, >0.19 and >1.5 respectively.…”

Old and new insights into the diagnosis of hereditary spherocytosis

“…Low MSCV has been demonstrated to be a sensitive parameter for HS detection (20). When expressed as delta MSCV, i.e., the difference between MCV and MSCV (MCV-MSCV), this measurement has even higher discriminatory value for the detection of HS, which is confirmed by increased delta MSCV (19,(21)(22)(23).…”

“…Patients with HS present a high reticulocyte count with a low immature reticulocyte fraction (IRF). These less mature reticulocytes are recognized as cells with higher RNA levels (21). Mullier et al showed that mild cases of HS have a Ret/IRF ratio higher than 19, while severe cases of HS have a Ret/IRF ratio higher than 7.7 (15).…”

“…Persijn et al proposed that the threshold for the MicroR value be decreased from ≥3.5% to ≥2.6% to discriminate between HS and non-HS subjects, which would significantly increase the sensitivity of the test (26). A low mean reticulocyte volume (MRV) has also been shown to be a good parameter to distinguish between HS and non-HS subjects; however, it has a lower sensitivity and specificity than other reticulocyte indices (20,21,27). Combining some new parameters into diagnostic algorithms, like MCV-MSCV >10 with MRV-MSCV <25, obtains results with satisfactory sensitivity and specificity (28) ( Table 1).…”