Evaluation of Reticulated Haemoglobin (CHr) as a diagnostic parameter in Iron Deficiency Anemia

Abstract

Introduction: Iron deficiency anemia (IDA) is the commonest nutritional deficiency in all parts of the world. In developing countries, the commonest cause is inadequate dietary intake [1]. The red cell indices raise the suspicion of iron deficiency state due to the microcytic, hypochromic changes and the wide red cell distribution width. The iron studies are confirmatory of an iron deficiency state, but are not accurate in the presence of infection, inflammation or malignancy as they are acute phase proteins and are affected in these states making the serum iron studies unreliable under these conditions. The reticulocyte haemoglobin content (CHr) indicates the iron available in the marrow for the production of Hb and are not affected by the above-mentioned situations and therefore has been recommended as a reliable marker of iron status in the body. The value for CHr given in the literature was 25pg [3].
 Objectives: General objective was to evaluate the significance of CHr in the diagnosis of IDA. The Specific objectives were to compare CHr with the other conventional iron parameters including serum iron, serum ferritin, TS and TIBC and evaluate any significance of CHr with RBC indices (MCV, MCH and MCHC) and age.
 Methodology: A retrospective analytical study performed at the Department of Haematology of a Tertiary care hospital in Sri Lanka. Data was obtained from the patient records of those referred to the Haematology department for management of iron deficiency during the period of 9 months commencing from April 2019 to January 2020. Data from 178 adult patients both males and females (16 to 84 years) diagnosed with IDA (S. Ferritin < 20ng/ml) (Hb < 12g/dl in men and Hb <11.5g/dl in women) were randomly selected. In pregnant females the S. Ferritin level considered was <30ng/ml and the Hb level was <11g/dl in the first trimester and 10.5g/dl in the 2nd and third trimester [4]. Blood count and CHr was analyzed using Mindray fully automated analyzer BC 6800, Serum iron and TIBC was measured with Mindray BS 480 and Serum ferritin with Advia Centaur Xp. TS was calculated by dividing serum iron by TIBC and multiplying by 100. A data extraction sheet was used to enter the investigations with the results.
 Statistical Analysis: Data were double entered and were analyzed using Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistical methods were used to calculate the median and the mean ± standard deviation of Hb, serum iron, serum ferritin, TIBC, TS, MCV, MCH, MCHC and CHr. Pearson’s correlation was used to evaluate the correlation between variables. Coefficient of determination (R Sq) was used to a statistical measure of how close the data are to the fitted regression line. P < 0.05 was considered significant.
 Conclusion: Significant positive correlations were observed between the CHr and haematological parameters such as Hb, MCV, MCH, and MCHC and biochemical parameters including serum iron, serum ferritin, and TS (p value < 0.001). Negative correlation was seen between the CHr and TIBC and there was no correlation with age. The mean value of CHr was 22.4 ±4.16pg and median was 22.2 pg.