Using Reticulocyte Hemoglobin Equivalent as a Marker for Iron Deficiency and Responsiveness to Iron Therapy

Abstract

Objective: To assess the accuracy of a simplified approach for the diagnosis of iron deficiency anemia (IDA) based on the complete blood cell count (CBC) and reticulocyte analysis. Patients and Methods: Five hundred fifty-six consecutive, nonselected patients referred for diagnosis and/or treatment of anemia were included in this diagnostic study to compare the performance of reticulocyte hemoglobin equivalent (RET-He) versus traditional biochemical markers for diagnosis and treatment of IDA. Complete blood count, serum ferritin, iron, and transferrin saturation were performed as clinically indicated. Reticulocyte hemoglobin equivalent was measured with a Sysmex XN-450 analyzer on the residual CBC sample. The study period was from September 20, 2017, through and including November 15, 2018. Results: Patients (N¼556) were studied at baseline, of whom 150 were subsequently treated with intravenous iron. Receiver operating characteristic analysis yielded an RET-He cut-off of 30.7 pg to identify IDA (area under curve, 0.733; 95% CI, 0.692 to 0.775), with 68.2% sensitivity and 69.7% specificity. Patients (n¼240) were seen at follow-up, with 57 treated and 183 not treated with intravenous iron. Responsiveness was defined as a hemoglobin increase of 1.0 g: a combination of RET-He <28.5 pg and hemoglobin value <10.3 g/dL had 84% sensitivity and 78% specificity as response predictor (area under the curve, 0.749; 95% CI, 0.622 to 0.875). Conclusion: Data from CBC and RET-He can identify patients with IDA, determine need for and responsiveness to intravenous iron, and reduce time for therapeutic decisions. Limitations of this study are uncontrolled design, its single-site and retrospective nature, and that it requires prospective validation.

Reticulocyte haemoglobin equivalent (RET-He) as an early marker of responsiveness to oral iron supplementation

“…On the other hand, the main disadvantage of this indicator is that two blood specimens are required to assess the change in RET-He over 1 week. Conversely, baseline RET-He alone was not a strong predictor of haemoglobin response, which has also been previously confirmed in a study of individuals receiving intravenous iron (rather than oral iron) 7…”

“…Strengths of this study include that the analyses were based on a robust randomised controlled clinical trial that used a standard dose of iron (60 mg elemental iron) to elicit a haemoglobin response after 12 weeks of supplementation, a duration of supplementation commonly proposed in WHO guidelines for treatment and prevention of iron deficiency in women 16. One-week change in RET-He was assessed as the reticulocyte index that is optimal for assessing the early responsiveness to iron therapy 7. We used a threshold of 10 g/L to define a haemoglobin response after 12 weeks of iron supplementation as this is what has been suggested globally13; however, we acknowledge that smaller increases may also be clinically meaningful and more women would have elicited a haemoglobin response if a lower threshold was chosen, which may have influenced our findings.…”

“…Reticulocyte count or haemoglobin content can now be easily and efficiently performed on automated haematology analysers that include the option of measurement (eg, reticulocyte haemoglobin equivalent (RET-He) measured on Sysmex analysers or reticulocyte haemoglobin content measured on Bayer analysers) and, therefore, have strong potential as novel biomarkers to diagnose iron deficiency or indicate responsiveness to iron therapy 5–7. An additional advantage is that reticulocyte haemoglobin indices are less influenced by inflammation, which is a common problem with measurement and interpretation of ferritin concentration, a marker of iron stores 8…”

Diagnosis of Iron Deficiency Anemia in Thai Female Adolescents Using Reticulocyte Hemoglobin Equivalent

“…(9) Related studies have demonstrated the applications of Ret-He in IDA and various clinical settings. (10)(11)(12)(13)(14)(15)(16) Notably, Ret-He provided speedy results to indicate iron status and was not affected by other chronic diseases. Therefore, Ret-He is convenient in the diagnosis and follow-up treatment of IDA among infants, pregnant women, and patients with chronic renal failure.…”

Ներերակայի՞ն, Թե՞ Ներքին Ընդունում. Ո՞րն Ընտրել: Երկաթպակասորդային Սակավարյունության Բուժման Նորագույն Մոտեցումները

“…Սովորաբար երկաթը նշանակվում է մինչև ֆերիտինի և տրանսֆերինի հագեցվածության ցուցանիշների նորմալացումը: Որոշ պացիենտներ (օրինակ` ստամոքսաղիքային տելեանգիէկտազիաներից պարբերաբար արյունահոսող) կարող են ունենալ միջինից բարձր երկաթի պաշարների կարիք: Այն դեպքերում, երբ ֆերիտինի և տրանսֆերինի հագեցվածության ցուցանիշները հակասում են միմյանց, առավելությունը պետք է տալ տրանսֆերինի հագեցվածությանը, քանի որ ֆերիտինը, լինելով սուր փուլի սպիտակուց, մեծապես կախված է զուգորդող քրոնիկական հիվանդությունների առկայությունից: Մոնիթորինգի և երկաթի նկատմամբ պատասխանի գնահատման համար կարևոր ցուցանիշ է նաև ռետիկուլոցիտար հոմոգլոբինը (CHr), որի նշանակությունը դեռևս հետազոտման փուլում է [11]:…”