Abstract:
Introduction
Iron deficiency (ID) is the most common anemia in pregnancy. It is one of the
major causes of morbidity in pregnancy. Hemoglobin (Hb) estimation is the routine
investigation employed in the antenatal screening where 11g/dl is taken as a cut-off
for making a diagnosis of anemia. Different Iron studies like Serum iron, transferrin,
and transferrin saturation are the additional investigation parameters, currently being
used in the diagnostic algorithm of IDA. Serum iron, transferrin saturation shows
diurnal variations and serum ferritin values show false increase in the presence of
infection or inflammation.With the advancement of technology, new reticulocyte and
erythrocyte parameters such as Ret-He, %Micro-R and %Hypo-He are available on
automated hematology analyzers for the assessment of iron status. These parameters
are simple and cost-effective alternative to serum biochemical tests, and are not
influenced by infection or inflammation. The added advantage being the ability to
obtain these parameters on the same sample used for complete blood count (CBC)
analysis.
Aims and Objectives
To compare the utility of Ret-He, %Micro- R, and %Hypo-He with serum iron
parameters and ferritin levels in the diagnosis of latent IDA in first-trimester pregnant
women.
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Materials and Methods
A hospital-based prospective cross-sectional study was conducted on blood
samples of nonanemic pregnant women of first trimester presenting to the antenatal
clinic(ANC) for the first time in the Department of Obstetrics and Gynecology(OBG)
were sent to the Hematology section of the Department of Pathology of BLDE
(Deemed to be University), Shri B. M. Patil Medical College, Vijayapura.
Study period: 1st November 2018 to 30th May 2020
Results
Among the 280 cases included in the study 151cases were ID and 129 were
non-ID. Comparison of the new reticulocyte parameter Ret-He and the new
erythrocyte parameters %Micro-R and % Hypo-he with Serum Ferritin showed that
the sensitivity and specificity of Ret He was similar to Serum Ferritin. At the optimal
cut-off value of 32.25, the sensitivity and specificity was 98.0% and 97.0%
respectively. The AUC for Ret-He (0.999, 95% CI 0.998-1.000) indicates that Ret-He
is the best discriminator of ID with a p value <0.001. %Micro-R at a cut-off of 1.55
showed sensitivity and specificity of 76.9% and 69.9% respectively and was
statistically significant. % Hypo-He did not show statistically significant difference
between ID and N-ID
Conclusion
Ret-he can be used as an alternative hematological investigation to the
traditionally used biochemical parameters such as serum ferritin for the early
diagnosis of ID in pregnant women as it is cost effective and can be done along with
hematological investigation such as CBC
