Reticulocyte hemoglobin equivalent in differential diagnosis of iron deficiency, iron deficiency anemia and β thalassemia trait in children

Abstract

Objectives: This study investigated the diagnostic power of reticulocyte hemoglobin equivalent (Ret-He) in the differential diagnosis of hypochromic microcytic anemia to differentiate iron deficiency anemia (IDA) and thalassemia trait (TT) based on the traditionally used erythrocyte index and formulas. Methods: Twenty-six children with iron deficiency (ID), 26 with IDA, 33 with β-TT, 41 healthy children were assessed. Complete blood count parameters, Ret-He, immature reticulocyte fraction (IRF), low-fluorescence ratio (LFR), Mentzer's indexes (MI) were evaluated. The diagnostic power of Ret-He in distinguishing between IDA and β-TT was investigated using ROC analysis. Results: Ret-He levels were (median(Q1-Q3)) 20.6(19.7-21.5) pg in β-TT, 16.1(13.1-20) pg in IDA, 29.7(27.2-30.7) pg in ID, 30.5(29.8-31.7) pg in healthy controls. Based on ROC analysis, diagnostic power for distinguishing between IDAand β-TTwas determined as RBC>MI>Ret-He>RDW>LFR>IRF. The highest sensitivity and specificity for differential diagnosis was obtained when the Ret-He cut-off value was 18.2pg. The AUC (95%CI) value was calculated as 0.765(0.637-0.866), and a statistically significant difference was found between groups (p<0.0006). Conclusions: In patients with hypochromic microcytic anemia, Ret-He≤18.2pg combined with RBC≤5.3x106/L and MI>10.42 can be safely used to distinguish IDA from β-TT. In particular, patients with low Ret-He who don't respond to iron therapy should be examined for β-TT.