Reticulocyte Hemoglobin Content Research Articles

Reticulocyte hemoglobin content: a new frontier in iron deficiency diagnostics for major surgical patients

BackgroundIron deficiency (ID) is the most common nutritional deficiency among patients undergoing major surgery. Treatment of ID is straightforward, however implementing a comprehensive anemia management strategy within clinical routines is complex. Recently, reticulocyte hemoglobin content (Ret-He) has been evaluated as an early marker for ID diagnosis.MethodIn this retrospective study, 2,966 major surgical patients from two University Hospitals were screened for the presence of ID and the significance of Ret-He in diagnosis ID was evaluated in both non-anemic and anemic patients. According to hemoglobin, ferritin, and transferrin saturation concentrations patients were assigned to a Control group (no anemia, no ID), ID group (no anemia, ID), IDA group (anemia, ID) or Others group (anemia, no ID).ResultsIn total, 2,760 patients were included in analysis: Control (n = 1500; 54.2%), IDA (n = 412; 14.9%), ID (n = 487; 17.6%), and Others (n = 370; 13.4%). Ret-He was significantly decreased in the IDA group compared to ID, Control and Others, respectively (p < 0.001). The ROC curve analysis revealed an AUC of 0.842 (95% CI (0.82–0.87)) at Ret-He cutoff 33.5 pg, by which IDA was discriminated with 69.7% (95% CI (65.3–74.0%)) sensitivity and 85.7% (95% CI (82.3-86.1%)) specificity. Of the 370 patients with anemia of unknown cause (Others group) 131 had Ret-He levels < 33.5 pg. In these patients, the median values for ferritin was 492.0 ng/ml (333.5; 818.5 ng/ml) and transferrin saturation 11.9% (18.0; 23.3%). Logistic regression identified significant predictors of ID, with each decrease in Hb and Ret-He associated with a 19.4% (OR = 0.806; p < 0.001) and 26% (OR = 0.740; p < 0.001) increase in the odds of ID, respectively.ConclusionThis study highlights the potential of Ret-He as a promising alternative marker for diagnosing ID in patients undergoing major surgery, particularly in cases of elevated ferritin levels or non-anemic patients. Ret-He may serve as a valuable tool to prioritize patients for further iron status testing, especially when preoperative time is limited.

To Assess the Relationship Between Reticulocyte Hemoglobin Content and Iron Status in Hemodialysis-Dependent Patients

Objectives: This study aims to evaluate the diagnostic utility of reticulocyte hemoglobin content (RET-He) and its correlation with transferrin saturation (TSAT) and other iron markers for identifying iron deficiency anemia in hemodialysis patients. Methods: The study was conducted at Hematology Department of Shaikh Zayed Hospital in Lahore, from March 2022- April 2023. Total 120 patients with chronic kidney disease on hemodialysis were enrolled in this study. Ferritin was determined by chemiluminescence immunoassay. Flow cytometry and spectrophotometry was performed to determine RET-He and iron status including serum iron and Total iron binding capacity (TIBC). Patients of both genders, aged 18-80 and those on hemodialysis for 3 months or more were selected. Patients excluded were those with bleeding from any site in last three months, received oral or parenteral iron supplementation in one month. Results: In this study, 120 hemodialysis dependent chronic kidney disease patients were enrolled. Among them, 65 (54.2%) were males, while 55 (45.8%) were females; 18 years to 80 years was the age range, with 53.48 ± 13.782 years being mean age. Mean RET-He was 29.439 ± 3.51 pg/cell, while mean serum iron was 68.96 ± 38.63 µg/dl, mean TIBC was 224.41 ± 55.109 µg/dl, serum ferritin mean value being 386.91 ± 357.51 ng/ml and mean TSAT was 31.93 ± 18.52%. Sensitivity (Se) was 56.0%, specificity (Sp) was 74.6%, positive predictive value (PPV) 36.8%, negative predictive value (NPV) 86.6% and accuracy of RET-He in diagnosing Iron deficiency anemia was 70.8% respectively. Conclusion: Reticulocyte hemoglobin content is highly effective in diagnosing iron deficiency anemia in chronic kidney disease patients. Its lower cost compared to traditional markers makes it a valuable tool for clinical practice.

Reticulocyte Haemoglobin Equivalent a Useful Indicator of Iron Deficiency in Patients with Iron Deficiency Anaemia and Anaemia of Chronic Disease

Objective: To find an association between RET-He and iron deficiency (ID) and evaluate its usefulness in detection of iron deficiency in patients with iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD).Study Design: Cross sectional study.Place and Duration: Department of Pathology, Army Medical College (NUMS), Rawalpindi in collaboration with Pak Emirates Military Hospital (PEMH), Rawalpindi.Methodology: A total of 95 participants were selected and divided into three groups control, IDA and ACD after taking informed consent and obtaining ethical approval. Patients were selected according to WHO diagnostic criteria for IDA and ACD and subjected to testing for RET-He by using sysmex XN 3000 which quantifies haemoglobin content of reticulocytes via fluorescent flow cytometry. Blood counts were collected and analyzed by using SPSS version 22.Results: Mean age of total population was 44.62 years and ranged from 16-85 years. Anemia was significant in female population in the IDA group. Mean value of RET-He in CG was 31.35 ± 1.5 4.16pg, in IDA group was 20.6 ± 4.16 and in ACD group was 26.3 ± 4.9 pg. RET-He was significantly low in the IDA group and in ACD it was moderately low. RET-He detected ID in both groups and a significant p-value of ˂0.001 was obtained.Conclusion: RET-He is a useful indicator of ID which is not affected by inflammation and readily detects iron deficiency.

Biological variation and analytical performance specification study of erythrocyte and related parameters

Objective: To study biological variation (BV) and analytical performance specifications (APS) of 15 erythrocyte and related parameters. Methods: Sixty healthy participants from Beijing Hospital were prospectively recruited for the study, from July to December, 2023, including 30 males [aged (41.3±11.9) years] and 30 females [aged (40.3±12.4) years]. The study was designed based on the Biological Variation Data Critical Appraisal Checklist and the characteristics of erythrocyte detection. Whole blood samples were collected 10 times at 2-week intervals during 20 weeks. All samples were tested in duplicate using Mindray BC-7500 hematology analyzer and its accompanying reagents. Within-subject biological variation (CVI) and between-subject biological variation (CVG) were estimated by the nested ANOVA method. The BV data in this study were compared with the BV data of the European Database of Biological Variation. APS, reference change value (RCV) and index of individuality (II) were calculated. Results: The CVI for 15 parameters ranged from 0.49% to 86.46%, and the CVI data for red cell distribution width (RDW)-CV, RDW-SD, reticulocyte (RET) percentage, RET count, reticulocyte hemoglobin content (RHE), medium fluorescence reticulocyte (MFR) and high fluorescence reticulocyte (HFR) were significantly higher in females than in males (all P<0.05). The CVG ranged from 1.27% to 100.79%, and the CVG data for HFR were significantly different between genders (P<0.05). The CVI data for red blood cell (RBC), hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and RHE in this study were lower than those recommended by the European database. The derived indicators of most parameters were influenced by gender. The II values for all parameters were<1.4, where the II values of MCHC and HFR were between 0.6 and 1.4; the II values for the remaining 13 parameters were<0.6. Conclusions: A BV study protocol for erythrocyte parameters is designed. When the reference intervals differ between genders, BV data should be calculated separately and the lower BV data are recommended for calculating APS; the RCV should be set separately for each gender.

Assessment of myeloid response and iron status among Sudanese pediatric ESKD on hemodialysis through reticulocyte parameters and β-globin mRNA expression

BackgroundSudanese children with End-Stage Kidney Disease (ESKD) often show limited improvement in hemoglobin levels despite treatment with recombinant human erythropoietin (rHuEPO). This study aims to assess the response to rHuEPO therapy by analyzing β-globin mRNA expression and reticulocyte parameters. Additionally, it classifies anemia among Sudanese pediatric patients based on iron status, considering age and gender as biological markers for evaluating treatment response.MethodsA prospective observational cohort study was conducted from January 2019 to February 2020 in Khartoum, Sudan, involving 45 anemic children aged 2 to 15 years diagnosed with ESKD. The treatment protocol included rHuEPO injections and maintenance hemodialysis. Laboratory assessments consisted of complete blood count (CBC), absolute reticulocyte count, ferritin, and transferrin measurements. β-globin mRNA expression was quantified using reverse transcription polymerase chain reaction (RT-PCR), and reticulocyte parameters, including Reticulocyte Hemoglobin Content (CHr), percentage of hypochromic reticulocytes (HYPO%), and Immature Reticulocyte Fraction (IRF), were measured via flow cytometry.ResultsSignificant variations in hemoglobin levels were observed across different age groups (p = 0.011). Gender analysis revealed a significant association with IRF, showing a lower IRF in male patients (p = 0.017). However, there were no significant differences in hemoglobin levels between genders (p = 0.999). β-globin mRNA expression showed considerable variability, with a strong positive correlation with hemoglobin levels (r = 0.875, p < 0.0001).ConclusionAge and gender significantly influence treatment responses in children with ESKD, highlighting the need to consider growth physiology in anemia management. This study underscores the variability in β-globin mRNA expression and its association with Flow Cytometry parameters, demonstrating their effectiveness in evaluating iron status and guiding rHuEPO dosage.

Reticulocyte-Hemoglobin Content as Marker for Iron Status in Preterm Neonates

Abstract Background Reticulocyte indices and reticulocyte hemoglobin provide a direct real time measure of hemoglobinization in newly produced erythrocytes, without perturbation by inflammation. It has been a reliable indicator of iron availability for Hb synthesis in children and adults. Aim of the Work To assess the average RET-Hb values in premature neonates soon after birth, to assess its value as marker of iron deficiency (ID) and to correlate these levels with the need for early iron supplement and/or blood transfusion. Patients and Methods This is a prospective observational study conducted at Neonatal Intensive Care Unit (NICU), Ain Shams University Children Hospital from March 2022 till September 2022. Results The study included 22 females (44.0%) and 28 males (56.0%) with mean gestational age of 31.84±1.60 weeks. The mean HGB level on admission was 16.76 ± 2.16 mg/dL, with 24.0% of neonates having an HGB level &amp;lt;15 mg/dL and the mean Ret-HB level for preterm neonates was 31.70 ± 2.68 pg/cell. The median serum ferritin level was 168 (IQR: 125 – 225) ng/mL and ferritin was positively correlated with Ret-Hb. Almost 58% (n = 29) required iron supplements in the first 2-4 weeks of life and 64% of neonates required packed red cell transfusion during their hospitalization. Ret-Hb at a cut off level of ≤ 30.4 pg/cell can predict early enteral iron supplement among the studied group at the cut off level with sensitivity of 52.4%, specificity of 75.9% and with a cut off level &amp;lt; 30.8pg/cell can predict the need for blood transfusion among the studied group with sensitivity of 56.25% and specificity of 83.33%. Conclusion Ret-Hb levels in preterm neonates was significantly correlated with ferritin levels. Ret-Hb could be a reliable marker of iron deficiency and helps in early enteral iron supplement for this age group but normal reference ranges should be standardized.

Red cell size factor is a sensitive index in the early diagnosis of nondigestive tract cancer-related anemia: An observational study.

Cancer-related anemia (CRA) is a common comorbidity in cancer patients, and it can lead to a worse prognosis. The aim of this cross-sectional study is to investigate the clinical value of the red cell size factor (Rsf) in the early diagnosis of nondigestive tract CRA. A total of 231 patients with nondigestive tract solid cancer were included, and they were divided into anemic and nonanemic subjects according to the hemoglobin (Hb) levels. A BC-7500 blood analyzer was used to detect the indices of red blood cell and reticulocyte, and the mean corpuscular volume (MCV), mean reticulocyte volume (MRV), reticulocyte hemoglobin (RHE) content, and reticulocyte production index were observed. Subsequently, the Rsf was calculated. Receiver operating characteristic curve analysis was used to evaluate the identifying power of Rsf for anemia diagnosed by the combination of RHE and reticulocyte production index. The adjusted-multivariate analysis and quartiles were used to assess the relation of reduced Rsf level with the risk and incidence of anemia diagnosed by combining the MCV, MCH, and mean corpuscular hemoglobin concentration (MCHC), respectively. Rsf levels showed no statistical differences between anemia and nonanemia subjects grouped by Hb (P > .05). Rsf has a high correlation with the RHE level (R > 0.900, P < .001), or MCV, mean corpuscular hemoglobin (MCH), and MCHC in anemia patients (r: 0.435-0.802, P < .001). Receiver operating characteristic curves showed that Rsf had the highest overall area under curve of 0.886 (95% confidence interval: 0.845-0.927) in identifying anemia of cancer patients (P < .001). When the optimal cutoff values of Rsf were set at 97.05 fl in males and 94.95 fl in females, the sensitivity and specificity were 0.94 and 0.76, and 0.98 and 0.75, respectively. Being treated as a categorical variable, Rsf had a highest odds ratio value of 30.626 (12.552-74.726; P < .001) for the risk of anemia. The increment of Rsf quartiles was highly associated with the decreased incidence of overall anemia (P trend < 0.001). The study suggests that decreased Rsf level is a potentially powerful predictor of overt anemia in nondigestive tract cancer, and it can be used as a convenient, practical, cost-free, and sensitive index in early diagnosis of nondigestive tract CRA.

Reticulocyte haemoglobin content in the differential diagnosis of iron deficiency anaemia and thalassemia traits in pregnancy

Background: Iron deficiency anaemia (IDA) and thalassemia traits are the common conditions of microcytic hypochromic anaemia in pregnant women. However, the laboratory tests to differentiate them are expensive. The reticulocyte haemoglobin (Ret-Hb) test is relatively cheap. This study aimed to assess whether Ret-Hb can differentiate IDA from thalassemia traits in pregnant patients. Method: This cross-sectional study was conducted in the Bangabandhu Sheikh Mujib Medical University (BSMMU) from March 2023 to February 2024. We recruited pregnant women aged 18 to 40 through antenatal visits in the Obstetrics and Gynecology Department. Microcytic hypochromic anaemia was diagnosed by complete blood counts, IDA by iron profile and thalassemia traits by haemoglobin electrophoresis. Ret-Hb was measured using the flow cytometric method. Ninety pregnant women—30 each with IDA, thalassemia traits and healthy individuals—were enrolled. Result: The mean age was 27 years. The IDA patients had significantly (P&lt;0.001) lower levels of Ret-Hb (mean 18.1, standard deviation 3.2 pg) compared to thalassemia traits (20.8, 2.2 pg) and healthy pregnant women (29.2, 1.9 pg). Using a Ret-Hb cut-off point of 19 pg, the test had 86.7% sensitivity and 53.3% specificity to differentiate thalassemia traits from IDA. Conclusion: Ret-Hb could be considered a diagnostic test to differentiate thalassemia traits from IDA in clinical settings before expensive confirmatory tests are performed.

Utility of reticulocyte haemoglobin content (CHr) in the diagnosis of iron deficiency anaemia in adult females

Utility of reticulocyte haemoglobin content (CHr) in the diagnosis of iron deficiency anaemia in adult females

Efficacy of Reticulocyte Hemoglobin Content and Immature Reticulocyte Fraction in Early Diagnosis of Latent Iron Deficiency in Blood Donors

Efficacy of Reticulocyte Hemoglobin Content and Immature Reticulocyte Fraction in Early Diagnosis of Latent Iron Deficiency in Blood Donors

Iron Indices Mediate but Not Modify Association of Parathyroid Hormone with Erythropoietin Resistance in Hemodialysis Patients

Introduction: Disordered iron balance and abnormal parathyroid hormone (PTH) concentrations, both prevalent in hemodialysis patients, are risk factors of erythropoietin (EPO) resistance. Few studies have evaluated the correlation between iron indices and PTH and the potential role of iron markers on the association of PTH with EPO resistance in hemodialysis population. Methods: In this cross-sectional study of 71 maintenance hemodialysis patients, iron indices including hepcidin, ferritin, reticulocyte hemoglobin content (CHr), and transferrin saturation (TSAT) were examined. EPO responsiveness was measured as EPO resistance index (ERI). Lowess regression curves were performed to explore the correlations of iron indices, PTH, and ERI. The association between PTH and ERI was modeled using linear regressions. Potential role of iron indices on this association was examined using stratified analyses and mediation analyses. Results: The average ERI value was 10.3 ± 5.3 IU w−1 kg−1 (g/dL) −1. ERI was correlated to PTH, hepcidin, CHr, and TSAT (all p < 0.05). Hepcidin and PTH were closely correlated with each other (r = 0.28, p = 0.020). Analysis by PTH categories yielded a total association effect of 2.53 (95% CI: 0.27–4.85, p = 0.027) for high PTH subgroup versus the reference low subgroup. No clinically significant interaction between iron indexes and PTH was identified. Hepcidin appeared to mediate about one-third of the total association between PTH and ERI in hemodialysis population (33.6%, p = 0.025). Conclusion: Iron indices and PTH levels were related to ERI values. Hepcidin appeared to be closely correlated to PTH and partly mediate the association between PTH and ERI in hemodialysis population.

Reticulocyte hemoglobin content: Is it valuable before scheduled orthopedic surgery?

Reticulocyte hemoglobin content: Is it valuable before scheduled orthopedic surgery?

Analysis and Interpretation of Automated Blood Count in the Treatment of Chronic Paracoccidioidomycosis.

Blood count is crucial for assessing bone marrow's cell production and differentiation during infections, gaging disease severity, and monitoring therapeutic responses. The profile of blood count in chronic forms of paracoccidioidomycosis (PCM) has been insufficiently explored. To better understand the changes in hematological cells in different stages of the PCM chronic form, we evaluated the blood count, including immature blood cells in automated equipment, before and during the treatment follow-up of 62 chronic PCM patients. Predominantly male (96.8%) with an average age of 54.3 (standard deviation SD 6.9) years, participants exhibited pre-treatment conditions such as anemia (45.2%), monocytosis (38.7%), and leukocytosis (17.7%), which became less frequent after clinical cure. Anemia was more prevalent in severe cases. Notably, hemoglobin and reticulocyte hemoglobin content increased, while leukocytes, monocytes, neutrophils, immature granulocytes, and platelets decreased. Chronic PCM induced manageable hematological abnormalities, mainly in the red blood series. Monocytosis, indicating monocytes' role in PCM's immune response, was frequent. Post-treatment, especially after achieving clinical cure, significant improvements were observed in various hematological indices, including immature granulocytes and reticulocyte hemoglobin content, underscoring the impact of infection on these parameters.

The Role of Reticulocyte Hemoglobin Content in Diagnosing Iron Deficiency in Childhood Cancer

Abstract Background The prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) in children with cancer is not well studied. The detection of ID and IDA using sensitive laboratory tools may facilitate early diagnosis and treatment in this cohort. In this regard, reticulocyte hemoglobin (Ret-He) content serves as a cost-effective measurement that remains unaffected by inflammation, unlike the ferritin test. Aim The objective of this study is to analyze the role of Ret-He as a diagnostic tool to identify functional and absolute ID and IDA in children with cancer. Methods We conducted a cross-sectional study in children aged 0 to 18 years. Blood samples were collected to compare Ret-He values with iron status, reflected by hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), serum iron (SI), total iron binding capacity (TIBC), and ferritin and transferrin saturation. The overall discriminative power of Ret-He in detecting ID and IDA was assessed using receiver operating characteristic analysis. Results Of the 135 children included in the study, 58 (43.0%) had anemia. Among them, 20 (14.8%) had IDA (8 [5.9%] absolute and 12 [8.9%] functional), while 25 (18.5%) had ID (16 [11.9%] absolute and 9 [6.7%] functional). The Ret-He value was significantly related to iron status (p ≤ 0.002). Ret-He was also shown to have a significant correlation with the abovementioned hematological parameters (p = 0.000), except TIBC. Multivariate analysis revealed a significant relationship between Hb (p = 0.051), MCH (p = 0.000), and MCHC (p = 0.001) and Ret-He. Ret-He values of 33.7, 32.7, 32.4 and 28.6 pg were established as optimal cut-off values to identify functional ID, absolute ID, functional IDA, and absolute IDA, respectively. Conclusion Ret-He is a reliable diagnostic tool for absolute and functional IDA in children with cancer.

The mean reticulocyte volume is a valuable index in early diagnosis of cancer-related anemia.

Cancer-related anemia (CRA) is a functional iron deficient anemia, and the early diagnosis will improve the prognosis of the patients. This prospective study aimed to investigate the utility of mean reticulocyte volume (MRV) in the early diagnosis of CRA. A total of 284 first-diagnosed cancer patients were enrolled, and the subjects were assigned anemia and non-anemia groups by hemoglobin (Hb) concentrations. The mature RBC and reticulocyte indices were detected with BC-7500 blood analyzer, and the MRV, reticulocyte hemoglobin (RHE) content, and reticulocyte production index (RPI) were obtained. ROC curves were constructed in identifying anemia diagnosed by the combination of RHE and RPI. An adjusted multivariate analyse and quartiles were used to assess the associations of MRV with early CRA diagnosed by combining RBC indices (MCV, MCH and MCHC), respectively. No statistical differences were observed in MCV, RHE and MRV levels between anemia and non-anemia subjects (p>0.05). MRV exhibited a complete or high correlation with the RHE levels (r=1.000, p<0.001), or MCV, MCH, and MCHC in anemia patients (R: 0.575-0.820, p<0.001). ROC curves analyse indicated a highest area under curve of 0.829 (95% CI [0.762-0.895]) and 0.884 (95% CI [0.831-0.936]) for MRV in identifying anemia in male and female patients, respectively (p<0.001). When the optimal cutoff values of MRV were set at 100.95 fl in males and 98.35 fl in females, the sensitivity and specificity were 1.00 and 0.68, and 1.00 and 0.73, respectively. The regression analyse showed that, when being as a categorical variable, MRV showed an odds ratio of 19.111 (95% CI [6.985-52.288]; p<0.001) for the incidence of CRA. The incidence of overall anemia demonstrated a more significant decrease trend along with the increase of MRV quartiles (p-trend < 0.001). This study revealed that the MRV can be used as a convenient and sensitive index in early diagnosis of cancer-related anemia, and decreased MRV level may be the powerful predictor of overt anemia in cancer patients.

Reticulocyte hemoglobin content associated with the risk of iron deficiency anemia

Background/ObjectiveReticulocyte hemoglobin content (MCHr) was recognized as a rapid and reliable marker for investigating iron deficiency (ID). We hypothesized that MCHr was associated with the risk of iron deficiency anemia in adults. MethodsThis is a dual-center case-control study. A total of 806 patients and healthy individuals were recruited from Ruijin Hospital and Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine between January 2021 and December 2021. The participants were categorized into iron deficiency anemia (IDA) group (n = 302), non-IDA group (n = 366), and healthy control group (n = 138). According to the MCHr level, the participants were divided into two groups, i.e. normal MCHr (≥25 pg) and decreased MCHr (<25 pg) group. Multivariate logistic regression analysis and adjusted subgroup analysis were conducted to estimate the relative risk between MCHr and IDA, with confounding factors including age, sex, hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), Hematocrit (HCT), serum iron (Fe), ferritin (Ferrit), and total iron binding capacity (TIBC). ResultsCompared with the non-IDA, the MCHr level with IDA decreased significantly. ROC curve analysis showed that MCHr had the largest area under the AUC curve. After comprehensive adjustment for confounding factors, individuals with normal level of MCHr exhibited a decreased risk of IDA (OR = 0.68 [0.60, 0.77], P < 0.01), while the risk of IDA was up to 5 times higher for those with decreased MCHr. ConclusionOur findings supported the hypothesis that MCHr was associated with the risk of IDA in adults and could serve as an indicator of IDA severity. MCHr holds clinical value as an auxiliary diagnostic indicator, providing valuable insights into whether invasive examinations are warranted in the assessment of IDA.

Reticulocyte Hemoglobin Content: Advancing the Frontiers in Iron-deficiency Anemia Diagnosis and Management

Iron-deficiency anemia (IDA) is a global health concern, and its widespread prevalence and multifaceted impact on various populations, particularly in developing countries, underscore the urgency for efficient diagnostic and management strategies. While traditional diagnostic methods such as ferritin and transferrin saturation are fundamental, their limitations in sensitivity and specificity lead to challenges in the early detection and effective management of IDA. This review provides a comprehensive analysis of IDA, focusing on the evolution of diagnostic methods culminating in the utilization of reticulocyte hemoglobin content (CHr) as a critical biomarker. The core of this review is the detailed examination of CHr as a biomarker. Its emergence has been pivotal due to its superior sensitivity and specificity in identifying iron deficiency and monitoring therapy efficacy. The review discusses the comparative advantages of CHr over conventional methods, including its ability to detect IDA at an earlier stage and its utility in varied demographic groups, such as children and pregnant women. Future research directions are proposed, including integration of CHr into routine clinical practice, cost-effectiveness analysis, and technological advancements for enhanced measurement and accessibility. In conclusion, CHr holds significant potential for revolutionizing IDA management, paving the way for more precise and personalized medical interventions, thereby improving patient outcomes in diverse populations.

49 Early pregnancy reticulocyte hemoglobin content as a marker for iron deficiency by BMI category

49 Early pregnancy reticulocyte hemoglobin content as a marker for iron deficiency by BMI category

Report of the International Council for Standardization in Haematology working group for standardization of reticulocyte parameters.

The International Council for Standardization in Haematology convened a working group to assess and propose improvements upon the state of standardization and harmonization of reticulocyte parameters among commercial hematology analyzers. An international group of laboratory hematologists prospectively collected and analyzed clinical samples using locally available IVD commercial hematology analyzers. Eight hundred and fifty-five total samples were collected at 6 sites using 9 distinct analyzer types. Samples were assessed for reticulocyte percent (RET%), immature reticulocyte fraction (IRF), and reticulocyte hemoglobin content (RHC). Method comparison and regression statistics were calculated. These analyses were used to determine whether statistical recalibration offered a potential avenue for increasing comparability between these methods. While methods producing reticulocyte percent were the most comparable in this study, the state of harmonization for the IRF and RHC was reduced with pearson correlation coefficients ranging from 0.955 to 0.77 and 0.927 and 0.680, respectively. Nevertheless, use of parameters from the Passing Bablok regression substantially improved the comparability of the results. In addition, precision data was derived which also demonstrated substantial differences between analyzer systems. While reticulocyte counting is correlated between the automated methods evaluated in this study, the current state of harmonization of other reticulocyte parameters is not as strong. A major challenge in moving this field forward is the need for commutable materials to facilitate comparisons between analyzers not co-located. A potential alternate approach to improve the current state would be instrument re-calibration. However, this is challenging both technically and due to national regulatory frameworks.

Iron Deficiency Prior to Discharge in Very Low Birth Weight Infants: Screening with Reticulocyte Hemoglobin Content.

This study aimed to assess the iron status prior to discharge in very low birth weight (VLBW) infants utilizing reticulocyte hemoglobin content (CHr) and evaluate the impact of delayed cord clamping (DCC) on iron status. This is a retrospective analysis of VLBW infants from two tertiary level of care Neonatal Intensive Care Units. The primary outcome was the proportion of VLBW infants with low CHr (<29 pg) prior to discharge. Hematologic parameters were also compared between infants who received or did not receive DCC. Infants with a positive newborn screen for hemoglobin Bart's were excluded. Among the 315 infants included, 99 infants (31.4%) had low CHr prior to discharge. The median (interquartile range) CHr prior to discharge was 30.8 pg (28.4-39 pg). DCC was performed in 46.7% of infants. Hemoglobin at birth, discharge, and CHr prior to discharge were higher and the need for blood transfusion and the number of infants with low CHr prior to discharge were lower in the DCC group. Approximately 31.4% of VLBW infants had low CHr near the time of discharge suggesting they were iron deficient. DCC improved hematological parameters prior to discharge in VLBW infants. CHr content can be used to guide iron supplementation in VLBW infants to potentially improve their iron status and long-term neurocognitive outcomes. · DCC was associated with an improved hemoglobin and iron status at discharge in VLBW infants.. · CHr is an early and reliable marker for iron deficiency.. · Approximately one in three VLBW infants can be iron deficient at the time of discharge..