Reticulocyte Hemoglobin Equivalent Research Articles

Diagnostic Utility of Reticulocyte Hemoglobin Equivalent Parameter in the Evaluation of Microcytic Hypochromic Anemia – Our Experience from Northeast India

Background: Reticulocytes are red blood cell precursors with an average lifespan of 1–2 days. Reticulocyte hemoglobin equivalent (Ret-He) is an early marker of iron deficiency (ID) erythropoiesis and reflects real-time information regarding the synthesis of young erythrocytes in the bone marrow. The objective of this study is to determine the diagnostic utility of Ret-He in patients having microcytic hypochromic anemia in comparison with serum ferritin and iron studies. Objectives: The objective of this study is to determine the diagnostic utility of the Ret-He parameter in patients having microcytic hypochromic anemia in comparison with the serum ferritin, iron studies and its role in routine hematological screening for nutritional deficiency anemia like ID. Design and Settings: The design involves observational study. Materials and Methods: A hospital-based observational study was carried out in a referral hospital. Hematological parameters were processed using Sysmex XN1000 (Sysmex Corporation, Kobe, Japan) analyzer and were compared with Serum iron studies using biochemistry analyzer (VITROS® 250 Chemistry System) from 201 participants who presented with microcytic hypochromic anemia. Main Outcome and Measures: Relationship of Ret-He parameter and its diagnostic utility for screening of iron-deficient states. Sample Size: The sample size was 201. Results: When serum ferritin is taken as “the gold standard” to detect ID, with Ret-He cutoff of 27.15 pg/cell, we found a statistically significant positive correlation between Ret-He and serum ferritin (P < 0.001). We found a sensitivity of 57.37% and specificity of 75.95% with area under the curve of 0.681, positive predictive value of 100%, negative predictive value of 3.8%, and accuracy of 62.19% for Ret-He in detecting ID anemia (IDA). Also found a statistically significant negative correlation between Ret-He and total iron binding capacity (P < 0.001). There was no statistical correlation between Ret-He and serum iron levels in our study. Conclusions: The present study suggests Ret-He is one of the better and more reliable hematological parameters indicating ID and, when used along with biochemical parameters like serum ferritin, can give valuable inputs in a better screening and diagnosis of IDA; hence proper treatment is possible. Limitations: The multicentric study is required to standardize Ret-He reference values, and follow-up to therapy of the subjects was not done. Additional hemoglobin variant analysis data would have been favorable to the study.

Reticulocyte Hemoglobin Equivalent (Ret-He) as a Potential Diagnostic Marker of Iron Deficiency Anemia among Bangladeshi Adults.

Miah MMZ, Pramanik MEA, Rafi MA, et al. Reticulocyte Hemoglobin Equivalent (Ret-He) as a Potential Diagnostic Marker of Iron Deficiency Anemia among Bangladeshi Adults. Euroasian J Hepato-Gastroenterol 2023;13(2):128-132.

Accuracy of Reticulocyte Hemoglobin for Diagnosing Iron Deficiency in Very Preterm Infants: A Population-Based Cohort Study

Background: Preterm born infants are at an increased risk of developing iron deficiency (ID) despite preventative iron supplementation, which can lead to long-term negative neurodevelopmental and behavioral outcomes. Serum ferritin (SF) is the commonly used test for diagnosing ID. However, SF is influenced by infection and inflammation, making it an unreliable marker in such situations. An alternative, reticulocyte hemoglobin equivalent (Ret-He), measures the iron content in newly produced red blood cells, providing an immediate assessment of iron availability. Unlike SF, Ret-He tests are automated, can be performed on the same blood sample as a complete blood count, and is not influenced by infection or inflammation like SF. However, there is limited literature on the reliability of Ret-He as an ID marker in very preterm infants (VPI) during their first year of life. This study aims to evaluate the diagnostic accuracy of Ret-He as an ID indicator in VPI at 4-6 months of corrected age (CA) compared to SF levels. Objective: To investigate the accuracy of Ret-He in detecting ID in VPI at 4-6 months CA Methods: A retrospective population-based cohort study was conducted using a population-based Provincial Perinatal Follow-Up (PFUP) database on all live VPIs born in Nova Scotia between 2012 and 2018. Infants with hematological disorders, chromosomal abnormalities, or major congenital anomalies were excluded. Prophylactic iron supplementation (2-3 mg/kg/day) starting at 2-4 weeks of chronological age was a standard of care for all included infants. Iron supplementation was recommended until 9-12 months CA. All infants underwent SF and CBC testing at either 4- or 6-months CA to assess iron stores and guide supplementation. In 2012, Ret-He was added as an additional marker of ID for clinical decision-making. Two definitions of ID were used. Definition one defined ID as SF level <20 mcg/L. Definition two defined ID as SF level <20 mcg/L at 4 months and <12 mcg/L at 6 months CA. Receiver operating characteristic curves were performed and the areas under the curves (AUC) were calculated to assess the accuracy of Ret-He in classifying patients with ID. The optimal cut-off point for Ret-He was determined using Youden's index, from which sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. The Spearman correlation coefficient was calculated between SF and Ret-He. Statistical significance was set at a two-sided P value of < 0.05. Results: A total of 156 patients were included. Under definition one, 62 (39.7%) met the criteria for ID. Under definition two, 39 (25.0%) patients had ID. Baseline characteristics are provided in Table 1. The Spearman correlation coefficient between SF and Ret-He was 0.23 (p=0.004). Under definition one, the AUC of Ret-He for diagnosing ID was 0.64 (p=0.002) and 0.69 (p<0.001) under definition two (Figure 1). The optimal cut-off value for Ret-He in ID diagnosis was 29.4 pg irrespective of the definition. Sensitivity, specificity, PPV, and NPV for both definitions are reported in Table 1. Conclusion: Regardless of the ID definition used, the AUCs indicated a weak discriminatory ability of Ret-He for ID diagnosis. The study indicated a weak positive relationship between SF and Ret-He. Ret-He's low diagnostic accuracy in this study is comparable to other studies involving healthy pediatric populations but lower than studies involving children with chronic health conditions. Clinicians should use caution when relying on Ret-He alone to diagnose ID in VPI. Further research is needed to determine the optimal diagnostic approach for identifying ID in VPI as well as explore the clinical utility of Ret-He in combination with other ID biomarkers such as SF and transferrin saturation.

Reticulocyte hemoglobin equivalent as a marker to assess iron deficiency: A large pediatric tertiary care hospital study.

Detection of iron deficiency (ID) remains challenging. We aimed to evaluate the performance of reticulocyte hemoglobin equivalent (Ret-He) as a potential diagnostic marker to assess ID and iron deficiency anemia (IDA) in a large pediatric cohort. A total of 3158 patients (aged 15 days to 19 years with a median age of 8.5 years; 60.2% female) were retrospectively studied. Statistical analysis was performed (a) to evaluate relationship of Ret-He with other relevant complete blood count and iron panel parameters; (b) to compare the levels of Ret-He in ID and IDA groups to a control group; and (c) to assess sensitivity and specificity of Ret-He in ID, IDA, and anemia without ID groups. Ret-He values were significantly positively correlated to ferritin and transferrin saturation (TSAT). The median Ret-He was significantly lower in ID. A Ret-He cutoff of ≤30.0 pg distinguished cases of ID from the control group with a sensitivity of 90.2%, specificity of 59.5%, and area under curve (AUC) of 0.88. Ret-He showed better diagnostic performance in the IDA group and acceptable performance for ID without anemia. The sensitivity, specificity, and AUC were 90.1%, 80.9%, and 0.93 for IDA at cutoff value of ≤27.4 pg, and 80.8%, 51.1%, and 0.70 for ID without anemia at cutoff value of ≤30.8 pg, respectively. Our large pediatric tertiary care hospital study demonstrates that Ret-He is a reliable marker to help confirm IDA in pediatric population. However, further studies are needed for its use to capture the early stages of ID.

Relationship between Iron Metabolic Parameters and Platelet Counts in Blood Donors

To investigate the correlation of iron metabolic parameters with platelet counts in blood donors. A total of 400 blood donors who met requirements of apheresis platelet donation were collected, and their hematological parameters were analyzed. The donors were divided into low ferritin group and normal group, the differences of hematological parameters between the two groups were compared, and the correlation of iron metabolic parameters and routine hematology parameters with platelet counts were analyzed. Whether male or female, low ferritin group had higher platelet counts than normal group (P < 0.01). Among the iron metabolic parameters, the platelet counts was negatively correlated with serum ferritin (SF), serum iron (SI), and transferrin saturation (TSAT) (r =-0.162, r =-0.153, r =-0.256), and positively correlated with total iron binding capacity (TIBC) and unsaturated iron binding capacity (UIBC) (r =0.219, r =0.294) in female blood donors. Platelet counts was also negatively correlated with SF, SI and TSAT (r =-0.188, r =-0.148, r =-0.224) and positively correlated with UIBC (r =0.220) in male blood donors. Among the routine hematology parameters, platelet counts was negatively correlated with mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and reticulocyte hemoglobin equivalent (Ret-He) in female blood donors (r =-0.236, r =-0.267, r =-0.213, r =-0.284). Platelet counts was also negatively correlated with MCH, MCHC and Ret-He in male blood donors (r =-0.184, r =-0.221, r =-0.209). In blood donors with low C-reactive protein level, the lower the iron store capacity, the lower the iron utilization, and the platelet counts tends to rise.

A-139 Investigating the Utility of Reticulocyte Hemoglobin Equivalent for Diagnosis of Iron Deficiency Anemia

Abstract Background Iron deficiency anemia (IDA) is one of the most common leading global health problems, which could cause extreme fatigue, chest pain, headache, and even neurodevelopment deterioration in children. Traditionally, assessing serum ferritin, transferrin, and iron are the tools to diagnose IDA. However, a high false-positive rate of these conventional biomarkers might be observed due to inflammation, infection, or malignancy. Reticulocyte hemoglobin equivalent (RET-He) is a new parameter that reflects the recent functional availability of iron for erythropoiesis, with the advantage of real-time results as part of automated reticulocyte analysis. The present study, therefore, aimed to investigate the utility of RET-He for the diagnosis of patients with IDA. Methods This retrospective study collected laboratory data from patients with both serum ferritin and reticulocyte results from January 2022 through December 2022, and excluded the high white blood cell count (WBC &amp;gt; 9380 cells/μL) and high C-reaction protein (CRP &amp;gt; 0.5 mg/dL). RET-He was measured by Sysmex XN-10 or XN-20 automated hematology analyzer (Sysmex, Kobe, Japan). Serum ferritin was measured by Roche Cobas e801 (Roche Diagnostics, Mannheim, Germany). Iron and total iron binding capacity (TIBC) were measured by Roche Cobas c702 (Roche Diagnostics, Mannheim, Germany). Anemia was defined as hemoglobin concentration &amp;lt;13 g/dL for men and &amp;lt; 12 g/dL for women. Iron deficiency was defined as serum ferritin &amp;lt;15 μg/L. Student T-tests and Pearson correlation were performed, and P-values less than 0.05 were considered statistically significant. Statistical analyses were performed with SPSS software (Version 22.0). Results A total of 2208 patient data were enrolled in this study and were classified into the IDA, iron deficiency, anemia, and control groups according to ferritin level and hemoglobin concentration. The RET-He were 20.6, 27.7, 30.4, and 32.3 pg in the IDA, iron deficiency, anemia, and control groups, respectively. The IDA group showed significantly lower RET-He levels than the control group (P &amp;lt; 0.001). By Pearson correlation analysis, the RET-He showed a weak positive correlation with ferritin and hemoglobin (r = 0.236, 0.274), moderate positive correlation with iron (r = 0.354), and moderate negative correlation with TIBC (r = −0.369). In addition, the average turn-around time (received-reported) of RET-He was 16.4 min, which was shorter than other biochemical markers such as ferritin, iron, and TIBC (57.7, 34.2, 34.4 min). Conclusion The RET-He could be an assessment of the iron actually used for the biosynthesis of hemoglobin and as a useful and rapid tool for diagnosing and monitoring iron deficiency anemia.

Reticulocyte Hemoglobin Equivalent as an Early Predictor of Iron Deficiency Anemia in Cancer Patients

Reticulocyte Hemoglobin Equivalent as an Early Predictor of Iron Deficiency Anemia in Cancer Patients

Importance of the reticulocyte hemoglobin equivalent in the exclusion of latent iron deficiency.

Iron deficiency is an underdiagnosed public health problem, especially in developing countries, that can conceal serious underlying illnesses. Early diagnosis and treatment of latent iron deficiency (LID) is crucial. Reticulocyte hemoglobin equivalent (RET-He), was reported to be a cost-effective tool that reflects the iron availability at erythropoiesis. The aims of this study were to evaluate the RET-He in the exclusion of LID. Transversal study was carried out in the laboratory of clinical biology of Ben Arous regional hospital, it included volunteers in apparently good health. We performed a complete blood count and a serum ferritin assay. Participants with normal hemoglobin were divided into two groups: Control group G1: normal ferritin (≥15ng/mL)/LID group G2: low ferritin (<15ng/mL). We compared the blood count parameters of the two groups. We selected 108 participants (G1: 88 (81.5%), G2: 20 (18.5%)), mean age =36 years, gender-ratio =0.92. We noted, in G2, significantly lower rates for hemoglobin Hb (p <0.001), hematocrit (p <0.001), mean corpuscular hemoglobin MCH (p =0.026), reticulocyte count (p =0.039) and RET-He (p <0.001) and significantly higher rate for RDW/CV (p =0.009). RET-He averages were 29.1pg in G2 and 31.1pg in G1. In multivariate analysis, only RET-He showed a significant difference between the two groups. Area under the curve was 0.872, the cutoff =30.9 (sensitivity 100%, specificity 61%, PPV 37%, NPV 100%). RET-He is an accessible and affordable parameter of the iron status, with an excellent NPV. It would be interesting to evaluate our results on a larger sample to define reference values in our population.

Analysis of Erythrocyte Indices and Reticulocyte Hemoglobin Equivalent in Iron Deficiency Anemia on Treatment

Assessment of treatment response is needed in the management of iron deficiency anemia (IDA). This study aims to analyze erythrocyte indices (MCH, MCV, MCHC) and Ret-He as indicators of IDA diagnosis and treatment response. A prospective cohort study in children ages 2-18 years old in orphanages throughout Makassar. Grouped into normal group and therapy group, consisting of IDA and iron deficiency groups. Elemental iron therapy 3mg/kg/day was given. Levels of MCV (fl), MCH (pg), MCHC (g/dL), and Ret-He (pg) were measured before and on the 8th day of therapy. The normality test of numerical variable data used the Kolmogorov-Smirnov test. The statistical test used the Mann-Whitney test, Wilcoxon Signed Rank test, and the Kruskal-Wallis test. Diagnostic value and cut-off determination using ROC curve analysis. Test results were significant if p&lt;0.05. The sample consisted of 40 subjects each in both normal and therapy groups. The therapy group was divided into 7 IDA and 33 iron deficiency. ROC IDA curve on MCV obtained a cut-off of 76 fl, a sensitivity of 100%, a specificity of 95%, NPP of 77.8%, NPN of 100%, MCH obtained a cut-off of 25 pg, a sensitivity of 100%, 97.5% specificity of 97.5%, NPP of 87.5%, NPN of 100%, Ret-He obtained cut-off 29 pg, sensitivity of 100%, specificity of 95%, NPP of 77.5%, NPN of 100%. MCV levels increased by 7.3% (p&lt;0.05) while Ret-He increased by 19.6% (p&lt;0.05) after therapy. The ROC curve coordinate on IDA showed that cut-off levels of MCV 76 fl, MCH 25 pg, and Ret-He 29 pg provided optimal sensitivity and specificity. Increasing MCV after therapy described increasing levels in erythrocyte and hematocrit synthesis. Increasing Ret-He after therapy described improving erythropoiesis quality. MCV, MCH, and Ret-He as indicators of diagnosing IDA. MCV and Ret-He monitor the success of IDA treatment response.

Analysis of Reticulocyte Hemoglobin Equivalent in Routine and Non-Routine Blood Donors in Makassar

Blood donation often causes the depletion of iron stores in the body resulting in anemia. One of the markers to assess the hemoglobin content in reticulocytes is Ret-He. This study aims to analyze Ret-He in routine and non-routine blood donors. This was a cross-sectional study using primary data from routine and non-routine blood donors at the Blood Transfusion Technical Implementation Unit of South Sulawesi Province from June 2021 to September 2021. The study population was blood donors who met the donor selection requirements. The research samples were blood donors who qualified as routine and non-routine blood donors. For a total of 66 blood donors, namely 33 routine blood donors and 33 non-routine blood donors, the mean Ret-He of routine blood donors (33.6 pg) was lower than that of non-routine blood donors (35 pg). The Mann-Whitney test showed a significant difference between routine and non-routine blood donors (p=0.008). Ret-He levels in routine blood donors were significantly lower than in non-routine blood donors. This is because routine blood donors donate blood more frequently and regularly, affecting the iron reserves in the donor's body. The study showed that the Ret-He level of routine blood donors was lower than that of non-routine blood donors but was still within the normal values of Ret-He (normal value: 30.2 pg - 36.7 pg). Ret-He levels in routine blood donors were lower than non-routine blood donors but were still within the normal range.

The association of hepcidin, reticulocyte hemoglobin equivalent and anemia-related indicators on anemia in chronic kidney disease.

Hepcidin is an essential regulator of iron homeostasis in chronic kidney disease (CKD) anemia, reticulocyte hemoglobin equivalent (RET-He) can be used to evaluate the availability of iron for erythropoiesis. Previous research has found that hepcidin indirectly regulates RET-He. This study aimed to investigate the association of hepcidin, RET-He and anemia-related indicators on anemia in chronic kidney disease. A total of 230 individuals were recruited, including 40 CKD3-4 patients, 70 CKD5 patients without renal replacement therapy, 50 peritoneal dialysis patients, and 70 hemodialysis patients. The serum levels of hemoglobin (Hb), reticulocyte, RET-He, serum iron, serum creatinine, serum ferritin, total iron binding capacity, hepcidin-25, high sensitivity C-reactive protein, transferrin, erythropoietin, intrinsic factor antibody, soluble transferrin receptor and interleukins-6 (IL-6) were measured. Hepcidin-25 was positively associated with IL-6, and negatively with total iron binding capacity, intrinsic factor antibody, and transferrin. Reticulocyte Hb equivalent was associated positively with Hb, serum ferritin, serum iron, transferrin saturation, and negatively with serum creatinine, reticulocyte, IL-6, STfR. Hepcidin-25 was not associated with RET-He, while IL-6 was independently associated with hepcidin-25 and RET-He, suggesting that hepcidin has no effffect on the iron dynamics of reticulocytes in CKD, may be related to IL-6, indicate a likelihood of a threshold for stimulation of hepcidin-25 expression by IL-6 in order to indirectly regulates RET-He.

Comparison of Reticulocyte Hemoglobin Equivalent Levels between Low and Normal Birth Weight Newborns

Low Birth Weight (LBW) newborns face a risk of iron deficiency. Iron deficiency hinders growth, and motoric, and cognitive development. Newborns with LBW sometimes suffer from inflammation, which affects the commonly used iron measurements. Reticulocyte hemoglobin equivalent (Ret-He) is considered a potential tool to measure iron profile because it measures functional iron, and it is not affected by inflammation. This study compared the Ret-He in LBW and normal birth weight newborns. This cross-sectional study was done retrospectively by observing and comparing the hematology data of newborns from November to December 2019. The difference in Ret-He level was assessed using a non-parametric test. Out of 70 newborns, 26 were normal and 44 were LBW. The proportion of LBW newborns with anemia was higher than the proportion of normal ones (29.6% vs 7.7%, p=0.03). The median value of Ret-He in LBW was lower compared to normal birth weight (32.6 vs 33.3 pg, p=0.09), however, the values were still within the normal limits. Five from 70 of these newborns' Ret-He levels were under the reference range (7.14%). There was found that CRP levels were higher in LBW newborns than normal ones (5.6% vs 5%, p=0.98). There was a positive correlation between Ret-He and the birth weight of the newborns (r= 0.34, p =&lt;0.01). There was no significant difference in Ret-He levels of LBW compared to normal babies. Further research is needed with a larger sample size to better assess the association of Ret-He and iron profiles in newborns.

Correlation of reticulocyte hemoglobin equivalent (RET-HE) and serum ferritin with hemoglobin levels in hospitalized children with iron deficiency anemia

Correlation of reticulocyte hemoglobin equivalent (RET-HE) and serum ferritin with hemoglobin levels in hospitalized children with iron deficiency anemia

Reticulocyte Hemoglobin Equivalent has Comparable Predictive Accuracy as Conventional Serum Iron Indices for Predicting Iron Deficiency and Anemia in a Nonhuman Primate model of Infantile Iron Deficiency

BackgroundInfantile iron deficiency (ID) causes anemia and compromises neurodevelopment. Current screening relies on hemoglobin (Hgb) determination at 1 year of age, which lacks sensitivity and specificity for timely detection of infantile ID. Low reticulocyte Hgb equivalent (RET-He) indicates ID, but its predictive accuracy relative to conventional serum iron indices is unknown. ObjectivesThe objective was to compare diagnostic accuracies of iron indices, red blood cell (RBC) indices, and RET-He for predicting the risk of ID and IDA in a nonhuman primate model of infantile ID. MethodsSerum iron, total iron binding capacity, unsaturated iron binding capacity, transferrin saturation (TSAT), Hgb, RET-He, and other RBC indices were determined at 2 wk and 2, 4, and 6 mo in breastfed male and female rhesus infants (N = 54). The diagnostic accuracies of RET-He, iron, and RBC indices for predicting the development of ID (TSAT < 20%) and IDA (Hgb < 10 g/dL + TSAT < 20%) were determined using t tests, area under the receiver operating characteristic curve (AUC) analysis, and multiple regression models. ResultsTwenty-three (42.6%) infants developed ID and 16 (29.6%) progressed to IDA. All 4 iron indices and RET-He, but not Hgb or RBC indices, predicted future risk of ID and IDA (P < 0.001). The predictive accuracy of RET-He (AUC = 0.78, SE = 0.07; P = 0.003) for IDA was comparable to that of the iron indices (AUC = 0.77–0.83, SE = 0.07; P ≤ 0.002). A RET-He threshold of 25.5 pg strongly correlated with TSAT < 20% and correctly predicted IDA in 10 of 16 infants (sensitivity: 62.5%) and falsely predicted possibility of IDA in only 4 of 38 unaffected infants (specificity: 89.5%). ConclusionsRET-He is a biomarker of impending ID/IDA in rhesus infants and can be used as a hematological parameter to screen for infantile ID.

285P Reticulocyte hemoglobin equivalent as an early predictor of iron deficiency anemia in cancer patients

Reticulocyte hemoglobin equivalent (RET-He) measures the amount of hemoglobin in the reticulocytes and indicates red cell hemoglobinization, reflecting the quality of the newly produced reticulocytes. It is a useful parameter which allows the diagnosis of IDA before it manifests clinically in a patient and also for treatment follow-up. Therefore, the ability to assess iron deficiency, as part of automated CBC/reticulocyte analysis, may significantly enhance patient management. Etiology of CRA is multifactorial, and is due to myelosuppression secondary to chemotherapy, bone marrow failure, chronic inflammation, and/or iron deficiency.

Reticulocyte Hemoglobin-Equivalent Potentially Detects, Diagnoses and Discriminates between Stages of Iron Deficiency with High Sensitivity and Specificity.

Background: Iron deficiency anemia (IDA) is a global health problem affecting the quality of life of more than 2 billion individuals. The current practice guidelines diagnose and monitor IDA via conventional hematological and iron biomarkers, which take several months before they are corrected under an iron-treatment plan. Reticulocyte hemoglobin equivalent (Ret-He) is used as a marker in most new hematology analyzers to assess iron incorporation into erythrocyte hemoglobin directly. This study aims to examine the efficacy of Ret-He as a marker for iron deficiency (ID) and IDA and investigate whether Ret-He is sensitive to iron therapy. Methods: Two blood samples were drawn from 182 participants for CBC and iron profile measurements. Follow-up samples were drawn from participants with a confirmed diagnosis of ID and/or IDA. Results: Ret-He levels were lower in the ID and IDA groups compared to the control (p < 0.0001), and lower in the IDA group compared to the ID group (p < 0.0001). Ret-He was correlated with ferritin at ID level (<30.0 mg/mL; r = 0.39) and severe IDA (<13.0 ng/mL; p-value < 0.01, r = 0.57). Cut-off values of <28.25 pg for ID and <21.55 pg for IDA showed a higher specificity and sensitivity (ID; AUC: 0.99, sensitivity: 92.73%, specificity: 97.87%) and (IDA; AUC: 0.94, sensitivity: 90.63%, specificity: 92.31%). Finally, Ret-He successfully reflected the iron therapy (p < 0.001) when compared to hemoglobin (Hb) (p = 0.1). Conclusions: Ret-He is a potential marker for detecting and diagnosing different stages of ID with high validity and is very sensitive in reflecting the iron incorporation in a short time.

DIAGNOSIS OF IRON DEFICIENCY ANEMIA IN THAI FEMALE ADOLESCENTS USING RETICULOCYTE HEMOGLOBIN EQUIVALENT

Background: Female adolescents aged 10 to 19 years are at remarkable risk of iron deficiency anemia (IDA). Reticulocyte hemoglobin equivalent (Ret-He) is an initial indicator of iron incorporation in red blood cells (RBCs) hemoglobin and reflects the iron functional availability in the RBCs.&#x0D; Objective: This study aimed to assess the diagnostic performance of Ret-He to identify IDA and determine a specific cut-off value for Thai female adolescents.&#x0D; Methods: Blood samples of 191 Thai female adolescents, ages ranging from 12 to 18 years, were included. Patients underwent complete blood count, reticulocyte count, Ret-He, serum iron (SI), total iron-binding capacity (TIBC), and transferrin saturation (TSAT). The correlation of Ret-He with other parameters and the diagnostic performance to identify IDA were evaluated.&#x0D; Results: Among 191 patients, 89 and 102 were defined as IDA and non-IDA groups. Ret-He value in the IDA group was significantly lower than that in the non-IDA group (p&lt;0.001). Strong positive correlations were observed between Ret-He and RBC indices and SI and TSAT (p&lt;0.001). A Ret-He value of ≤27.0 pg could distinguish IDA from non-IDA with a sensitivity of 91.2% and a specificity of 100.0% (area under the curve, AUC of 0.99, 95% CI: 0.98-0.99; p&lt;0.001).&#x0D; Conclusion: This study confirmed that Ret-He is a cost-effective parameter representing an advantage over other traditional iron markers. A specific Ret-He cut-off value of ≤27.0 pg is suitable for distinguishing IDA from non-IDA with excellent diagnostic performance among Thai female adolescents.

CORRELATION BETWEEN RETICULOCYTE HEMOGLOBIN EQUIVALENT AND IRON STATUS IN PEDIATRIC CHRONIC KIDNEY DISEASE

Background: Anemia is a major complication of pediatric chronic kidney disease (CKD). Iron deficiency is one of the most common causes of anemia. Conventional markers of iron deficiency anemia, transferrin saturation (TSAT) and serum ferritin could be interfered with various factors. in CKD. Reticulocyte hemoglobin equivalent (Ret-He) is useful for assessing iron status among these patients.&#x0D; Methods: A descriptive cross-sectional study enrolling children with CKD stage 3 and above was conducted between April and November 2021. Demographic information was also collected. Correlation of Ret-He, anemia indices and markers of iron status were analyzed.&#x0D; Results: Among 50 participants, we found moderate positive correlations between Hb and Ret-He (r=0.518; p &lt;0.001), Hct and Ret-He (r=0.403; p=0.004), and MCHC and Ret-He (r=0.667; p&lt;0.001); a modest negative correlation between RDW and Ret-He (r=-0.616; p&lt;0.001) and strong correlations between MCV and Ret-He (r=0.747; p&lt;0.001) including MCH and Ret-He (r=0.865; p&lt;0.001). No correlations between TSAT and Ret-He, serum ferritin and Ret-He, TSAT and Hb, or TSAT and Hct were observed. In addition, weak negative correlations between serum ferritin and Hb (r=-0.307; p=0.032) and between serum ferritin and Hct (r=-0.305; p=0.033) were detected. The median RetHe was 28.42 ± 3.37 pg. Twenty-seven participants (54%) met the criteria for iron deficiency anemia (cut-off value &lt;29 pg) of which 2 (4%) had absolute iron deficiency and 9 (18%) had functional iron deficiency defined by conventional markers.&#x0D; Conclusion: Ret-He is a relevant marker of iron status among pediatric patients with CKD and correlates well with anemia indices which could help identify more patients with iron deficiency.

Clinical utility of reticulocyte hemoglobin equivalent in patients with heart failure

Anemia and iron deficiency (ID) are common in patients with heart failure (HF) and intravenous (IV) administration of iron to patients hospitalized for decompensated HF with ID improves outcome. The diagnosis of ID in routine practice is based on serum ferritin and transferrin saturation (TSAT) but both have limitations; alternatives should be considered. Reticulocyte hemoglobin equivalent (Ret-He) reflects iron content in reticulocytes but its clinical utility in patients with HF remains uncertain. We prospectively enrolled 142 patients hospitalized for decompensated HF. Sixty five percent had ID as defined in current international guidelines. Ret-He was directly correlated with serum iron and ferritin concentrations and with TSAT. There was a poor relationship between quartile of Ret-He and HF hospitalization or death but increases or decreases in Ret-He between admission and discharge were associated with a worse outcome. The clinical utility of Ret-He for identifying ID and predicting response to IV iron and prognosis for patients with HF requires further investigation.

Reticulocyte hemoglobin equivalent as a diagnostic parameter of iron deficiency anemia in infants age 1-4 months

IntroductionIron deficiency anemia (IDA) is still a major global health problem. The prevalence was highest among children under five years, 39.7%, with the most contributing cause being dietary iron deficiency (ID). Reticulocyte hemoglobin equivalent (Ret-He) assesses the amount of hemoglobin in reticulocytes. Ret-He is an easy, inexpensive, and applicable diagnostic parameter of iron deficiency. This study aims to determine the role of Ret-He as a diagnostic parameter of ID and IDA in infants 1-4 months old.Material and methodsThe study was conducted prospectively at 10 Community Health Centers in Banjarbaru, South Kalimantan, from August 2020 to August 2021. Total 403 infants aged 1, 2, 3, and 4 months met the inclusion and exclusion criteria. Venous blood samples were checked for Ret-He, complete blood count, and peripheral blood smears.ResultsThe incidence of ID and IDA in infants 1-4 months were 10,9% and 58,6%. Ret-He cut-off values for iron deficiency and IDA at 1, 2, 3 and 4 months were 22,25 pg, 20,3 pg, 19,05 pg and 17,55 pg; with sensitivity 7,8%, 2,5%, 7,4%, 8,2%; specificity 94,4%, 95,0%, 96,9%, 98,1%; positive predictive value 85,7%, 66,7%, 83,3%, 80,0%, and negative predictive value 18,1%, 19,6%, 33,0%, 53,6%.ConclusionsRet-He can detect iron deficiency and IDA in 1-4 months baby with high specificity and positive predictive value.