Abstract
Abstract Objectives This study investigated the diagnostic power of reticulocyte hemoglobin equivalent (Ret-He) in the differential diagnosis of hypochromic microcytic anemia to differentiate iron deficiency anemia (IDA) and thalassemia trait (TT) based on the traditionally used erythrocyte index and formulas. Methods Twenty-six children with iron deficiency (ID), 26 with IDA, 33 with β-TT, 41 healthy children were assessed. Complete blood count parameters, Ret-He, immature reticulocyte fraction (IRF), low-fluorescence ratio (LFR), Mentzer’s indexes (MI) were evaluated. The diagnostic power of Ret-He in distinguishing between IDA and β-TT was investigated using ROC analysis. Results Ret-He levels were (median(Q1-Q3)) 20.6(19.7–21.5) pg in β-TT, 16.1(13.1–20) pg in IDA, 29.7(27.2–30.7) pg in ID, 30.5(29.8–31.7) pg in healthy controls. Based on ROC analysis, diagnostic power for distinguishing between IDA and β-TT was determined as RBC>MI>Ret-He>RDW>LFR>IRF. The highest sensitivity and specificity for differential diagnosis was obtained when the Ret-He cut-off value was 18.2pg. The AUC (95%CI) value was calculated as 0.765(0.637–0.866), and a statistically significant difference was found between groups (p<0.0006). Conclusions In patients with hypochromic microcytic anemia, Ret-He≤18.2pg combined with RBC≤5.3x106/L and MI>10.42 can be safely used to distinguish IDA from β-TT. In particular, patients with low Ret-He who don’t respond to iron therapy should be examined for β-TT.
Highlights
Anemia is a significant health problem that affects approximately a third of the world’s population and has negative effects on maternal and child mortality rates, physical performance
This study investigated the diagnostic power of reticulocyte hemoglobin equivalent (Ret-He) in the differential diagnosis of hypochromic microcytic anemia to differentiate iron deficiency anemia (IDA) and thalassemia trait (TT) based on the traditionally used erythrocyte index and formulas
In patients with hypochromic anemia, Hb, red blood cells (RBCs), serum iron, transferrin saturation, and ferritin were significantly lower; red blood cell distribution width (RDW) and total iron-binding capacity (TIBC) were significantly higher; and Mentzer’s indexes (MI) was significantly lower in the IDA group than in the β-thalassemia trait (β-TT) group (p
Summary
Anemia is a significant health problem that affects approximately a third of the world’s population and has negative effects on maternal and child mortality rates, physical performance. Iron deficiency (ID) is responsible for anemia in approximately half of the world’s population. The most common cause of ıron deficiency anemia (IDA) is nutritional deficiency [1], and it is characterized by hypochromia and microcytosis [2]. ID and IDA are more common during child growth and menstruation in adolescent girls. Poor socioeconomic status, and previous infections are factors contributing to IDA development [3]. In infancy, IDA is associated with poor neurodevelopment. Cognitive and behavioral performances may not be fully improved even with iron supplementation in severe cases of IDA [7]
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