Utility of reticulocyte haemoglobin content and immature reticulocyte fraction in early diagnosis of latent iron deficiency in whole blood donors

Abstract

Background and Objectives: The present study was planned to assess the clinical utility of reticulocyte haemoglobin content (CHr) and immature reticulocyte fraction (IRF) in the early detection of latent iron deficiency in blood donors. Materials and Methods:The prospective longitudinal observational study was conducted using the purposive sampling method. Written informed consent was obtained and donors were allocated into the first-time (FTD) and regular donor (RD) group. The enrolled blood donors (n = 205 in each group) were followed up for two subsequent whole blood donations. Haemoglobin (Hb), CHr, IRF and serum ferritin values were recorded at enrolment and two follow-ups. Results:The sensitivity of CHr in detecting iron-deficient erythropoiesis (serum ferritin values ≤ 26 μg/dl) was 45% and 56.7%, specificity 96.7%, positive predictive value (PPV) 85.6% and 90.8% and negative predictive value (NPV) 80.1% and 78.7%, respectively in FTD and RD cohorts. The sensitivity of IRF was 45.1% and 44.8%, specificity 93.4% and 97.1%, PPV 74.8% and 90.4% and NPV 79.6% and 74.5%, respectively in both the cohorts.The sensitivity of CHr in detecting absent iron stores (serum ferritin values ≤ 15 μg/ dl) was 66.2% and 74.4%, specificity 92% and 90.6%, PPV 56.7% and 68.7% and NPV 94.5% and 92.8% among FTD and RD cohort, respectively. The sensitivity of IRF was 72.7% and 65.3%, specificity 90.3% and 94.3%, PPV 54.4% and 76% and NPV 95.4% and 90.8%, respectively in both the cohorts. Conclusion:Reticulocyte hemoglobin content and IRF can be used along with complete blood count for early detection of iron deficiency in blood donors using the same blood sample at no extra cost.immature reticulocyte fraction, latent iron deficiency, reticulocyte haemoglobin content Highlights• Reticulocyte hemoglobin content and immature reticulocyte fraction were found to have a high positive predictive value and negative predictive value in detecting iron deficiency in whole blood donors at an early stage.

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

“…Therefore, immature reticulocyte fraction can be used along with complete blood count for early detection of iron deficiency. 13 IRF was initially introduced to monitor the hematopoietic treatment in cases of childhood pancytopenia due to cancer chemotherapy. However, IRF was valuable in making diagnoses of megaloblastic anemia, aplastic anemia, early marrow recovery from suppression, and hemolytic disease.…”

“…The clinical utility of IRF is applied in various circumstances, such as monitoring anemia treatment and diagnosing and monitoring aplastic anemias. 12 , 13 Reticulocyte production index monitors bone marrow response to iron-treated anemia. 14 Uniquely, all erythrocyte indices and reticulocyte parameters can be seen at once automatically on the Sysmex XN-450 Hematology Analyzer.…”

Reference intervals for reticulocyte indices, immature reticulocyte fraction, and the percentage of hypochromic red blood cells in adult large breed dogs using the ADVIA 2120 hematology analyzer

“…deficiency and beta-thalassemia in the investigation of microcytic anemias with IRF values higher in iron-deficiency anemia and to be comparable in performance to the CHr for diagnosis of latent iron deficiency in a group of blood donors. 13,22 It has also been shown to be an early indicator of stem cell engraftment and an earlier indicator of bone marrow recovery in chemotherapy-induced myelosuppression, with changes in IRF preceding changes in the more traditionally monitored absolute neutrophil count (ANC) by 3-7 days. This study is not without limitations, many of which stem from the study population used.…”

“…12 Additionally, the IRF has been identified to have comparable accuracy in identifying irondeficiency anemia compared to the CHr in a population of human blood donors. 13 Two further novel hematology variables in dogs include CHdelta and the percentage of hypochromic red blood cells (%HYPO-RBC). A reference interval using the ADVIA 2120 hematology analyzer has previously been reported for CH-delta based on 122 clinically healthy adult dogs.…”

“…Among these uses, of particular interest is its ability to act as an earlier indicator of bone marrow activity compared to traditionally monitored variables, such as the absolute reticulocyte count – in various clinical settings 12 . Additionally, the IRF has been identified to have comparable accuracy in identifying iron‐deficiency anemia compared to the CHr in a population of human blood donors 13 …”