Comparative study of new reticulocyte and erythrocyte parameters With serum iron parameters for the early diagnosis of Iron deficiency In pregnant women using Sysmex XN1000.

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. DocuSign Envelope ID: FD9B409CF6B6DB83--023976BC--448B9C56-A-B5BE6FE-A-901B755FE1D37F608E1E3AC XI 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