The reticulocyte hemoglobin equivalent as a screening marker for iron deficiency and iron deficiency anemia in children

  • Background: Iron deficiency (ID) is one of the most common nutritional deficiencies in children worldwide and may result in iron deficiency anemia (IDA). The reticulocyte hemoglobin equivalent (Ret-He) provides information about the current availability of iron in erythropoiesis. This study aims to examine the validation of Ret-He as a screening marker for ID and IDA in children. Methods: Blood samples were retrospectively obtained from medical records. Anemia was defined according to the definition provided by the World Health Organization (WHO) for children. ID was defined by transferrin saturation (TSAT) < 20% and ferritin < 100 ng/mL. Children were classified into four groups: IDA, non-anemia iron deficiency (NAID), control and others. Results: Out of 970 children, 332 (34.2%) had NAID and 278 (28.7%) presented with IDA. Analysis revealed that Ret-He significantly correlates with ferritin (rho = 0.41; p < 0.001), TSAT (rho = 0.66; p < 0.001) and soluble transferrin receptor (sTfR) (rho = −0.72; p < 0.001). For ROC analysis, the area under the curve (AUC) was 0.771 for Ret-He detecting ID and 0.845 for detecting IDA. The cut-off value for Ret-He to diagnose ID was 33.5 pg (sensitivity 90.7%; specificity 35.8%) and 31.6 pg (sensitivity 90.6%; specificity 50.4%) to diagnose IDA. Conclusions: The present study demonstrates Ret-He to be a screening marker for ID and IDA in children. Furthermore, Ret-He can be used as a single screening parameter for ID and IDA in children without considering other iron parameters. Economically, the use of Ret-He is highly relevant, as it can save one blood tube per patient and additional costs.

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Author:Vanessa NeefORCiDGND, Elke Schmitt, Peter BaderORCiDGND, Frank Zierfuß, Gudrun Hintereder, Andrea U. SteinbickerORCiDGND, Kai ZacharowskiORCiDGND, Florian PiekarskiORCiDGND
Parent Title (English):Journal of Clinical Medicine
Place of publication:Basel
Document Type:Article
Date of Publication (online):2021/08/09
Date of first Publication:2021/08/09
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2021/10/14
Tag:anemia; children; iron deficiency; reticulocyte hemoglobin equivalent
Issue:16, art. 3506
Page Number:12
First Page:1
Last Page:12
A.U.S. is supported by the German Research Foundation (Deutsche Forschungs-gemeinschaft) grant STE 1895/9-1 and Innovative Medical Research (Innovative Medizinische Forschung) grant IMF 211901 of the Medical Faculty, University of Muenster, Muenster, Germany. A.U.S. is also sponsored by a research grant from Pharmacosmos, Denmark, to perform a single-centre prospective trial on preoperative anemia treatment. K.Z. received grants from B. Braun Melsungen, CSL Behring, Fresenius Kabi and Vifor Pharma for the implementation of Frankfurt’s Patient Blood Management program and honoraria for scientific lectures from B. Braun Melsungen, Vifor Pharma, Ferring, CSL Behring and Pharmacosmos. F.P. received honoraria from Pharmacosmos for scientific lectures. All other authors declare no competing interest.
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0