Abstract No: OP 121
UTILITY OF RETICULOCYTE HEMOGLOBIN
LEVEL IN EARLY IRON DEFICIENCY ANEMIA
INTRODUCTION
Iron deficiency anaemia is the most common type of anaemia
characterized by hypochromia and microcytosis in
erythrocytes, decreased serum ferritin ,serum iron levels and
increased total iron-binding capacity.
Reticulocyte Haemoglobin measures the amount of
haemoglobin in reticulocytes and is an indicator of cell
hemoglobination, reflecting the quality of newly produced
reticulocytes.
Reticulocytes pass into the peripheral blood and turn into
mature erythrocytes within 1-2 days.
Reticulocyte Haemoglobin reflects an earlier measure of
reduced haemoglobin status compared to haemoglobin
Methods
STUDY DESIGN : Prospective study
STUDY POPULATION : 100 Master health checkup patients from January 2023 to
December 2023
INCLUSION CRITERIA: Patients attending master health checkup clinic with normal red
blood cell haemoglobin ( Men Hb – 13g/dl ; Women – 12 g/dl ) and mild iron deficiency
anaemia ( Men Hb – 11-12.9g/dl and Women Hb – 10-11.9g/dl )
EXCLUSION CRITERIA : Moderate and severe iron deficiency anaemia
Patients on iron therapy
Known case of thalassemia, sideroblastic anaemia etc.
Methods..,
2ml of fresh blood sample was collected in Ethylene Diamine
Tetra Acetic Acid Dipotassium salt (K2EDTA) vacutainer for
complete blood count and reticulocyte haemoglobin content
evaluation.
Samples were processed in SYSMEX XN 1000.
Another 2ml of peripheral blood sample collected in red
capped vacutainer were used for analysis of serum ferritin.
Samples collected were analysed in ABBOTT ALINITY
analyser which uses Immunoassay technology.
REFERENCE RANGE
For reticulocyte haemoglobin content reference range used
was 27.5 - 34 picogram,
Levels below 27.5pg was taken as iron deficiency state
For haemoglobin male < 13 g/ dl and female < 12 g / dl for
iron deficiency anaemia
For serum ferritin <25µg / l for iron deficiency state.
Observation
Age wise distribution of cases
50 46
45
40
35
25
30
No. of cases
25
20
15 12
8
10
5 1
1
0
11 to 20 21 to 30 31 to 40 41 to 50 51 to 60 61 to 70
Age group (in years)
Screening for Anaemia based on Hb and Ret-He
Male Female
Anaemia Low Ret-He
11 59
(Male (<27.5pg)
<13gm/dL;
Normal Ret-
Female
0 0
He (>27.5pg)
<12gm/dL)
Haemoglobin
Normal
Low Ret-He
3 20
(Male ≥ (<27.5pg)
13gm/dL;
Normal Ret-
Female
7 0
He (>27.5pg)
≥12gm/dL)
Screening for Anemia based on Hb and Ret-He
Low Ret-He Normal Ret-He
Low Hb 70 0
Normal Hb 23 7
Screening for anaemia – Hb and Ret-He
59
60
50
40
30
20
20
11
7
10 3
0 0 0
0
Low Ret-He (<27.5pg) Normal Ret-He Low Ret-He (<27.5pg) Normal Ret-He
(>27.5pg) (>27.5pg)
Reduced Hb Normal Hb
Male Female
Screening for anemia based on Hb and
S.Ferritin
Screening for anemia based on Hb and S.Ferritin
Male Female
Low S.Ferritin (<25) 16 54
Anemia
(Male <13gm/dL;
Normal S.Ferritin
Female <12gm/dL) 0 0
(>25)
Haemoglobin
Low S.Ferritin (<25) 0 0
Normal
(Male >13gm/dL;
Normal S.Ferritin
Female >12gm/dL) 24 6
(>25)
Diagnosis of anemia from S.Ferritin and Ret-He
Observation Male Female
Anemia(<25µg/dL) 16% 54%
Based on S.Ferritin
Normal (≥25µg/dL) 5% 25%
Anemia(<27.5pg) 18% 75 %
Based on Ret-He
Normal (>27.5pg) 3% 4%
Results/observation
Reticulocyte Haemoglobin diagnosed anaemia in 23 cases
with normal haemoglobin.
Detection of decreased iron stores is more with reticulocyte
haemoglobin as 93%of the study population had decreased
reticulocyte haemoglobin levels.
Only 70% had decreased serum ferritin levels. This indicates
with detection of early iron deficiency is better with
Reticulocyte Haemoglobin estimation.
Discussion
• Reticulocyte haemoglobin content is considered as early
marker of iron deficiency. In our study 100 cases were divided
into control group, iron deficiency anaemia based on
haemoglobin and MCV.
• Reticulocyte haemoglobin and serum ferritin were analysed.
• Control group in our study with normal body iron status by
haemoglobin value, MCV and serum ferritin was found to
have iron deficiency anaemia by Reticulocyte Haemoglobin in
23%.
• Using Reticulocyte Haemoglobin as a diagnostic tool, study
showed Sensitivity of 97.87% and specificity 83.33%.
• The study results supplemented the fact that it detects iron
deficiency in cases with normal haemoglobin
Conclusion
• The study concluded that reticulocyte
haemoglobin content remains superior to other
red cell parameters and serum ferritin in
detecting early stages of iron deficiency in non
anemic group.
Reference
Brugnara C, Zurakowski D, DiCanzio J, Boyd T, Platt O. Reticulocyte
Haemoglobin Content to Diagnose Iron Deficiency in Children.
JAMA. 1999;281(23):2225–2230. doi:10.1001/jama.281.23.2225
Gelaw Y, Woldu B, Melku M. The Role of Reticulocyte Hemoglobin
Content for Diagnosis of Iron Deficiency and Iron Deficiency Anemia,
and Monitoring of Iron Therapy: a Literature Review. Clin Lab. 2019
Dec 1;65(12). doi: 10.7754/Clin.Lab.2019.190315. PMID: 31850722.
