The validity of reticulocyte hemoglobin content and percentage of hypochromic red blood cells for screening iron-deficiency anemia among patients with end-stage renal disease: a retrospective analysis

Loan Thi Anh Tran,Nhan Hieu Dinh,Suzanne Monivong Cheanh Beaupha

doi:10.1186/s12882-020-01796-8

Loan Thi Anh Tran, Nhan Hieu Dinh + Show 1 more

Open Access

https://doi.org/10.1186/s12882-020-01796-8

Copy DOI

Abstract

BackgroundEarly detection of iron-deficiency anemia (IDA) can enhance the efficiency and effectiveness of clinical treatment and quality of life for end-stage renal disease (ESRD) patients. This study aimed to evaluate the validity of CHr and %Hypo in screening IDA among ESRD patients and compare their performance with screening IDA among non-ESRD patients.MethodA retrospective analysis of 312 participants was conducted at Cho Ray Hospital, Vietnam, including healthy control participants and ESRD patients. Receiver operator characteristics curves and the area under the curve (AUC) of models were used to evaluate the performance of CHr, %Hypo. Optimal cut-off values were determined using Youden’s index.ResultsDetecting IDA in ESRD patients is more complicated, as the screening performance of CHr and %Hypo in predicting IDA among ESRD patients were lower than non ESRD group, but still reasonable with AUC = 0.748 (95% CI: 0.656–0.840, power = 0.997) and 0.740 (95% CI: 0.647–0.833, power = 0.996), respectively. Cut-off values of CHr < 31.5 pg and %Hypo> 10.0 pg are recommended to obtain optimal screening ability for Vietnamese ESRD patients.ConclusionCHr and %Hypo appears to be useful tools for screening IDA among both non ESRD and ESRD patients. The low cost and accessible of the two markers encourage their utility as effective screening tools in clinical practice.

Highlights

Detection of iron-deficiency anemia (IDA) can enhance the efficiency and effectiveness of clinical treatment and quality of life for end-stage renal disease (ESRD) patients
Detecting IDA in ESRD patients is more complicated, as the screening performance of Reticulocyte hemoglobin content (CHr) and %Percentage of hypochromic red blood cells (Hypo) in predicting IDA among ESRD patients were lower than non ESRD group, but still reasonable with area under the curve (AUC) = 0.748 and 0.740, respectively
Storage of iron in bone marrow is the current gold standard to examine iron status [5]. Obtaining this index requires bone marrow biopsy, an invasive procedure which is impossible to apply in routine practice, indicating iron often rely on indirect indices such as serum concentrations of iron, ferritin, or transferrin saturation (TSAT) [6]

Summary

Introduction

Detection of iron-deficiency anemia (IDA) can enhance the efficiency and effectiveness of clinical treatment and quality of life for end-stage renal disease (ESRD) patients. Storage of iron in bone marrow is the current gold standard to examine iron status [5] Obtaining this index requires bone marrow biopsy, an invasive procedure which is impossible to apply in routine practice, indicating iron often rely on indirect indices such as serum concentrations of iron, ferritin, or transferrin saturation (TSAT) [6]. They are the most familiar to physicians had been widely used, concerns had been raised that these markers do not ensure correlation with bone marrow iron stores or hemoglobin response to iron [7]. In resource-limited developing countries, ferritin and TSAT are not available in all facilities, especially small hospitals and community health center

Objectives

Methods

Results

Discussion

Conclusion