Abstract
Our aim was to evaluate the cut-off value and efficiency of using reticulocyte hemoglobin content as a marker to diagnose iron deficiency anemia in Chinese adults. 140 adults who needed bone marrow aspiration for diagnosis at the hematology department of the Peking Union Medical College Hospital were enrolled according to the inclusive and exclusive criteria. Venous blood samples were collected to detect complete blood count, including hemoglobin, reticulocyte hemoglobin content, hematocrit, mean cellular volume, corpuscular hemoglobin concentration, hemoglobin content, free erythrocyte protoporphyrin; iron indexes of serum ferritin, serum transferrin receptor, and unsaturated iron-binding capacity; and inflammation markers of C-reactive protein and α-acid glycoprotein. Bone marrow samples were obtained for the bone marrow iron staining, which was used as the standard for the evaluation of iron status in this study. Subjects were divided into three groups according to hemoglobin levels and bone marrow iron staining results: the IDA (iron deficiency anemia) group, the NIDA (non-iron deficiency anemia) group, and the control group. The differences of the above-mentioned indexes were compared among the three groups and the effect of inflammation was also considered. The cut-off value of reticulocyte hemoglobin content was determined by receiver operation curves. The IDA group (n = 56) had significantly lower reticulocyte hemoglobin content, mean cellular volume, corpuscular hemoglobin concentration, hemoglobin content, and serum ferritin; and higher free erythrocyte protoporphyrin, unsaturated iron-binding capacity, and serum transferrin receptor (p < 0.05) compared with the NIDA group (n = 38) and control group (n = 46). Hematocrit, serum ferritin, and unsaturated iron-binding capacity were significantly affected by inflammation while reticulocyte hemoglobin content and other parameters were not. The cut-off value of reticulocyte hemoglobin content for diagnosing iron deficiency anemia was 27.2 pg, with a sensitivity of 87.5% and a specificity of 92.9%. The cut-off values for mean cellular volume, serum ferritin, and serum transferrin receptor were 76.6, 12.9, and 4.89 mg/L, respectively. Reticulocyte hemoglobin content had the largest area under the curve of 0.929, while those for mean cellular volume, serum ferritin, serum transferrin receptor were 0.922, 0.887, and 0.900, respectively. Reticulocyte hemoglobin content has a high sensitivity and specificity in the diagnosis of iron deficiency anemia, and its comprehensive diagnostic efficacy is better than other traditional indicators—such as serum ferritin and serum transferrin receptor.
Highlights
Anemia remains a highly prevalent global health problem, which affects 43% of children younger than five years old, 38% of pregnant women, and 29% of non-pregnant women worldwide [1].Iron deficiency is the most common etiology globally [2]
A variety of tests are used for evaluating anemia, and at present the most reliable method is a bone marrow biopsy with Prussian blue staining
Bone marrow samples were obtained for the bone marrow iron staining. 140 eligible subjects were divided into three groups according to Hb levels and bone marrow iron staining results: (1) The Iron deficiency anemia (IDA) group: bone marrow iron staining showed negative, Hb < 110 g/L and Hb < 120 g/L; (2) The NIDA
Summary
Anemia remains a highly prevalent global health problem, which affects 43% of children younger than five years old, 38% of pregnant women, and 29% of non-pregnant women worldwide [1]. Iron deficiency is the most common etiology globally [2]. Iron deficiency anemia (IDA) can lead to developmental delays, behavioral disturbances, perinatal complications, and the impairment of learning ability and cognitive function [3,4], and early detection of IDA is essential in helping to prevent various complications and for improving patient quality of life [5]. A variety of tests are used for evaluating anemia, and at present the most reliable method is a bone marrow biopsy with Prussian blue staining. The drawbacks of bone marrow examination—cumbersome, expensive, and traumatic—make it unsuitable for routine use. The sensitivity and specificity to many indicators, such as serum ferritin (SF) and serum transferrin receptor (sTfR), are far from satisfactory [5,6]
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