Role of Reticulocyte Hemoglobin Parameter In Evaluation of Microcytic Hypochromic Anemia.

Abstract

Introduction Reticulocytes are RBC precursors with an average lifespan of 1-2 days. Information regarding its hemoglobin gives a good indication of Iron availability. Ret-He is an early marker of Iron deficiency erythropoiesis and reflects real-time information regarding the synthesis of young erythrocytes in the bone marrow. It provides an initial measure of functional Iron deficiency Objectives To determine the diagnostic utility of Ret-He in patients having Microcytic Hypochromic anemia in comparison with Serum ferritin and Iron studies. Methods A hospital-based observational study was carried out in Shri B. M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka. Hematological parameters like RBC count, Hb, PCV, MCV, MCH, MCHC, RDW, Reticulocyte count, Absolute Reticulocyte Count, RPI, IRF, Ret-He processed in the Sysmex XN1000 (Sysmex Corporation, Kobe, Japan) analyzer were studied and compared with Biochemical parameters of assessing body Iron stores and Iron availability such as TIBC, Serum Iron and Serum Ferritin using Biochemistry analyzer (VITROS® 250 Chemistry System) from 201 subjects, after fulfilling all the inclusion and exclusion criteria's. Observations When S Ferritin is taken as 'the gold standard' to detect ID, after statistical evaluation, we found the cut-off value of Ret-He to detect ID state was DocuSign Envelope ID: 05FE315F7B4D4E62-A-49F6D3-74-E46D04A-9-BB1AD51-F-73226EC4EE8ED783ECCD0E xii 27.15pg/cell, and there was a statistically good correlation between Ret-He and S Ferritin with P <0.001. When the S Ferritin cutoff of <15ng/mL was taken as ID state, we found a Sensitivity of 57.37% and Specificity of 75.95% with AUC of 0.681 for Ret-He. PPV of 100%, NPV of 3.8%, and accuracy of 62.19% for Ret- He was found. When S Ferritin <30ng/mL was taken as ID, which supposedly increases its sensitivity and PPV in detecting ID states; we found a significant increase in sensitivity to 80.42% at the cost of decrease in specificity to 56.52% for Ret-He. In our study, we found that Ret-He was showing significant statistical positive correlation with Hb with P <0.001. There was also a moderate positive correlation which is statistically significant between Ret-He and MCV, MCH, MCHC. A significant statistical positive correlation was found between Ret-He and S Ferritin levels p <0.001 which suggested Ret-He as a comparable hematological parameter. Also found a statistically significant negative correlation between Ret- He and TIBC p<0.001. There was no statistical correlation between Ret-He and S Iron levels in our study which may be attributed various causes. Conclusions The present study suggests Ret-He is one of the better and reliable hematological parameters indicating ID and, when used along with biochemical parameters such as S Ferritin, can give valuable inputs in a better screening of ID states and diagnosis of IDA and hence proper treatment is possible. Keywords: Ret-He, Iron deficiency, Anemia DocuSign Envelope ID: 05FE315F7B4D4E62-A-49F6D3-74-E46D04A-9-BB1AD51-F-73226EC4EE8ED783ECCD0E