Comparison of erythrocyte and reticulocyte indices for the diagnosis of iron deficiency
Abstract
Background: Te increased prevalence of iron defciency anemia represents a global public health issue which can be reduced by early diagnosis of pre-iron defcient states. Clinical utility of biochemical indices for iron defciency diagnosis is limited due to the influence of inflammation. Erythrocyte and reticulocyte indices, reticulocyte hemoglobin content, and percentage of hypochromic red cells have been extensively used in diagnosing different iron-defcient conditions. Te aim of our study was to compare the utility of erythrocyte and reticulocyte indices provided by different hematology analyzers for the diagnosis of iron defciency.
Methods: 186 people, 25 patients with iron defciency anemia, 103 patients with chronic kidney disease, and 58 healthy donors were included in our study. Teir whole blood samples were analyzed using two different automated analyzers, XN-1000, Sysmex and Advia 120, Siemens Bayer Diagnostics, to compare reticulocyte and erythrocyte indices.
Results: Linear correlation between indices for hemoglobin reticulocyte content (Ret-He and CHr) has been confrmed while correlation between both erythrocyte indices (Hypo-He and %HYPO) can be described by 2nd degree polynomial. Cut-off value for the diagnosis of iron defciency for Ret-He was established at < 28.2 pg and for Hypo-He at > 1.6 % and showed high diagnostic sensitivity (RetHe = 76 %; Hypo-He = 72 %) and specifcity (100 %).
Conclusions: Reticulocyte indices Ret-He and CHr are directly comparable and can be used for latent iron defciency evaluation. Although erythrocyte indices Hypo-He and %HYPO are not exchangeable, both can be used for long-term iron defciency evaluation. Additionally, we determined reference intervals for Hypo-He and Ret-He.
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References
Camaschella C. Iron-defciency anemia. N Engl J Med. 2015;372(2):1832–43.
Teurl I, Aigner E, Teurl M, Nairz M, Seifert M, Schroll A, et al. Regulation of iron homeostasis in anemia of chronic disease and iron defciency anemia: Diagnostic and therapeutic implications. Control. 2009;113(21):5277–86.
Aapro M, Österborg A, Gascón P, Ludwig H, Beguin Y. Prevalence and management of cancer-related anaemia, iron defciency and the specifc role of I.V. iron. Ann Oncol. 2012;23(8):1954–62.
Tomas DW, Hinchliffe RF, Briggs C, Macdougall IC, Littlewood T, Cavill I. Guideline for the laboratory diagnosis of functional iron defciency. Br J Haematol. 2013;161(5):639–48.
Bahrainwala J, Berns JS. Diagnosis of Iron-Defciency Anemia in Chronic Kidney Disease. Semin Nephrol. 2016;36(2):94–8.
Nairz M, Teurl I, Wolf D, Weiss G. Iron defciency or anemia of inflammation?: Differential diagnosis and mechanisms of anemia of inflammation. Wien Med Wochenschr 2016;166(13–14):411-23.
Urrechaga E, Borque L, Escanero JF. Biomarkers of hypochromia: Te contemporary assessment of iron status and erythropoiesis. Biomed Res Int. 2013;2013:603786.
Ratcliffe LE, Tomas W, Glen J, Padhi S, Pordes BA, Wonderling D. Diagnosis and management of iron defciency in CKD: A summary of the NICE guideline recommendations and their rationale. Am J Kidney Dis 2016;67(4):548–58.
Urrechaga E, Borque L, Escanero JF. Te role of automated measurement of red cell subpopulations on the Sysmex XE 5000 analyzer in the differential diagnosis of microcytic anemia. Int J Lab Hematol. 2011;33(1):30–6.
Urrechaga E, Borque L, Escanero JF. Erythrocyte and reticulocyte parameters in iron defciency and thalassemia. J Clin Lab Anal. 2011;25(3):223–8.
Buttarello M. Laboratory diagnosis of anemia: are the old and new red cell parameters useful in classifcation and treatment, how? Int J Lab Hematol. 2016;38 suppl 1:123–32.
Preložnik-Zupan I, Lenart K. Klinični pomen novih metod (količina hemoglobina v retikulocitih in hipokromni eritrociti) za oceno pomanjkanja železa v telesu. Zdrav Vestn 2004(6);73:499-502.
Piva E, Brugnara C, Spolaore F, Plebani M. Clinical Utility of Reticulocyte Parameters. Clin Lab Med. 2015;35(1):133–63.
National Institute for Health and Care Excellence (NICE) UK. Chronic kidney disease: managing anaemia. NICE Guide, Published: 3 June 2015. [cited 2016 Dec 19]. Available from: https://www.nice.org.uk/guidance/ng8.
Brugnara C, Schiller B, Moran J. Reticulocyte hemoglobin equivalent (Ret He) and assessment of iron-defcient states. Clin Lab Haematol. 2006;28(5):303–8.
Buttarello M, Temporin V, Ceravolo R, Farina G, Bulian P. Te New Reticulocyte Parameter (RET-Y) of the Sysmex XE 2100: Its Use in the Diagnosis and Monitoring of Posttreatment Sideropenic Anemia. Am J Clin Pathol. 2004;121(4):489–95.
Miwa N, Akiba T, Kimata N, Hamaguchi Y, Arakawa Y, Tamura T, et al. Usefulness of measuring reticulocyte hemoglobin equivalent in the management of haemodialysis patients with iron defciency. Int J Lab Hematol. 2010;32(2):248–55.
Tomas L, Franck S, Messinger M, Linssen J, Tomé M, Tomas C. Reticulocyte hemoglobin measurement – Comparison of two methods in the diagnosis of iron-restricted erythropoiesis. Clin Chem Lab Med. 2005;43(11):1193–202.
Urrechaga E, Borque L, Escanero JF. Potential utility of the new sysmex XE 5000 red blood cell extended parameters in the study of disorders of iron metabolism. Clin Chem Lab Med. 2009;47(11):1411–16.
Buttarello M, Pajola R, Novello E, Rebeschini M, Cantaro S, Oliosi F, et al. Diagnosis of iron def ciency in patients undergoing hemodialysis. Am J Clin Pathol.2010;133(6):949–54.
Pekelharing JM, Hauss O, de Jonge R, Lokhoff J, Sodikromo J, Spaans M, et al. Haematology reference intervals for establishedand novel parameters in healthy adults. Diagnostic perspectives (Sysmex). 2013. Available from: http://www.sysmex.se/fleadmin/media/f100/Diagnostic_Perspectives/Pekelharing_DiagPersp_Vol1_1-11.pdf.
Peerschke EIB, Pessin MS, Maslak P. Using the hemoglobin content of reticulocytes (RET-He) to evaluate anemia in patients with cancer. Am J Clin Pathol.2014;142(4):506–12.
Maconi M, Cavalca L, Danise P, Cardarelli F, Brini M. Erythrocyte and reticulocyte indices in iron defciency in chronic kidney disease: comparison of two methods. Scand J Clin Lab Invest. 2009;69(3):365–70.
Buttarello M, Pajola R, Novello E, Mezzapelle G, Plebani M. Evaluation of the hypochromic erythrocyte and reticulocyte hemoglobin content provided by the Sysmex XE-5000 analyzer in diagnosis of iron defciency erythropoiesis. Clin Chem Lab Med. 2016;54(12):1939–45.
Urrechaga E, Borque L, Escanero JF. Erythrocyte and reticulocyte indices in the assessment of erythropoiesis activity and iron availability. Int J Lab Hematol. 2013;35(2):144–9.
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