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Rudzki J, Polewka M, Agopsowicz P, Nowak A, Porada M, Czempik PF. Current approach to the management of preoperative iron deficiency anemia in colorectal cancer patients: a review of literature. POLISH JOURNAL OF SURGERY 2024; 96:67-74. [PMID: 39138992 DOI: 10.5604/01.3001.0054.5124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
<b>Introduction:</b> The prevalence of preoperative anemia is the highest in the group of colorectal cancer (CRC) patients and may reach over 75%. The prevalence of anemia in CRC patients increases even further following surgery. Approximately 75-80% of anemic CRC patients present with absolute or functional iron deficiency (ID). Preoperative anemia constitutes an independent risk factor for allogeneic blood transfusion (ABT), postoperative complications, prolonged length of hospital stay, and increased mortality. ABT is itself associated with increased morbidity and mortality.<b>Aim:</b> The aim of this review article was to present the pathophysiology and the current approach to the diagnostics and treatment of preoperative iron deficiency anemia (IDA) in CRC patients.<b>Material and methods:</b> Extensive search of medical literature databases was performed (Pubmed, Embase). The key words that were used were as follows: CRC, colorectal surgery, ID, IDA, intravenous iron, Patient Blood Management (PBM).<b>Results:</b> There are several laboratory parameters that can be used for IDA diagnosis, however, the simplest and most cost- -effective is reticulocyte hemoglobin equivalent (RET-He). Pathophysiologic features of IDA in CRC patients favor treatment with intravenous, as opposed to oral, iron formulations. Applying PBM strategies minimizes the exposure to ABT.<b>Conclusions:</b> Preoperative IDA is highly prevalent among CRC patients. Preoperative anemia is an independent risk factor for ABT, increased morbidity and mortality, as well as prolonged hospital length of stay. The same negative consequences are associated with ABT. Therefore, preoperative IDA in CRC patients needs to be screened for, diagnosed, and treated before surgery. Effective treatment of preoperative IDA in CRC patients is with intravenous iron formulations. ABT should be the treatment of last resort due to the risk of negative clinical consequences, including an increased rate of cancer recurrence.
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Affiliation(s)
- Jakub Rudzki
- Students' Scientific Society, Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Mikołaj Polewka
- Students' Scientific Society, Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Paulina Agopsowicz
- Students' Scientific Society, Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Anna Nowak
- Students' Scientific Society, Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Michał Porada
- Students' Scientific Society, Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Piotr F Czempik
- Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland, Transfusion Committee, University Clinical Center of Medical University of Silesia in Katowice, Katowice, Poland
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Bani-Ahmad MA, Abu Tayyem NE. The Modulation of Euglycemic Endocrine and Exocrine Pancreatic Secretions in Iron Deficiency. Med Princ Pract 2024; 33:260-268. [PMID: 38479367 PMCID: PMC11175607 DOI: 10.1159/000538335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 03/10/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVES The contribution of pancreatic secretions in iron metabolism has been elucidated, but the clinical outcomes of iron deficiency on pancreatic function are debatable. This study aimed to investigate the modulation of euglycemic endocrine and exocrine pancreatic excretions in response to variations in iron availability. SUBJECTS AND METHODS Serum levels of insulin, glucagon, insulin-to-glucagon ratio (IGR), and amylase were determined in 170 adult subjects with variable levels of serum iron. RESULTS Control (n = 46) and iron-deficient (n = 124) subjects had significant differences (p < 0.001) in their average levels of insulin (68.7 ± 0.5 vs. 100.0 ± 2.0 pmol/dL), glucagon (17.9 ± 0.6 vs. 10.8 ± 0.8 pmol/dL), IGR (4.0 ± 0.1 vs. 19.5 ± 2.1), and amylase (29.7 ± 0.9 vs. 17.5 ± 0.2). The upregulation of serum insulin levels increases proportionally and gradually to the extent of iron deficiency as compared to an abrupt downregulation of serum levels of glucagon and amylase. A significant association was observed between serum iron and IGR (r = -0.645, p < 0.001) and amylase levels (r = 0.653, p < 0.001). The receiver operating characteristic curve analysis defines an excellent predictivity of the reduced serum iron level to discriminate subjects with upregulated IGR and amylase levels with area under curves of 0.938 and 0.905, respectively. CONCLUSION Iron deficiency is associated with an adaptive modulation of euglycemic endocrine and exocrine secretions that is consistent with a status of insulin resistance.
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Affiliation(s)
- Mohammad A Bani-Ahmad
- Department of Medical Laboratory Science, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Noor E Abu Tayyem
- Department of Medical Laboratory Science, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
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Huang JH, Li RH, Tsai LC. Dual nature of ferritin for hematologic, liver functional, and metabolic parameters in older diabetic patients. Sci Rep 2023; 13:20207. [PMID: 37980447 PMCID: PMC10657432 DOI: 10.1038/s41598-023-47678-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/16/2023] [Indexed: 11/20/2023] Open
Abstract
This study explored the association between ferritin with hematologic, liver functional, and metabolic parameters in older diabetic patients. A total of 210 diabetic patients aged 65 or older were classified into four groups according to the reference range of serum ferritin. Demographic variables and health-related lifestyle factors were obtained through the utilization of a standardized questionnaire. Anthropometric measures, blood pressure, hematology test, and biochemical assessment were also performed. Among all patients, 29.5% had anemia. The percentage of anemia in groups low ferritin (< 40 μg/L), lower side within the reference range (40-120 μg/L), higher side within the reference range (121-200 μg/L), and high ferritin levels (> 200 μg/L) were 50.0, 27.7, 20.5, and 24.2% (P = 0.025), respectively. Low ferritin levels had a higher risk of anemia and a high red blood cell distribution width (RDW). High ferritin levels were associated with a higher risk of high glutamate pyruvate transaminase, obesity, high fasting blood glucose (FBG), and high postprandial blood glucose. The higher side within the reference range of ferritin also showed a higher risk of high FBG and high glycated hemoglobin. Nevertheless, there was no significant association between ferritin and inflammation marker, serum lipids or blood pressure. Overall, ferritin demonstrates a dual nature in older diabetic patients: low ferritin levels are linked to anemia or elevated RDW, while high levels are linked to obesity, increased liver enzymes, and worse glycemia control.
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Affiliation(s)
- Jui-Hua Huang
- Department of Golden-Ager Industry Management, Chaoyang University of Technology, Taichung, 413, Taiwan
| | - Ren-Hau Li
- Department of Psychology, Chung Shan Medical University, Taichung, 402, Taiwan
| | - Leih-Ching Tsai
- Division of Endocrine and Metabolism, Department of Internal Medicine, Erlin-Branch, Changhua Christian Hospital, Changhua, Taiwan.
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Chung SJ, Lim HS, Lee MY, Lee YT, Yoon KJ, Park CH. Sex-Specific Associations between Serum Ferritin and Osteosarcopenic Obesity in Adults Aged over 50 Years. Nutrients 2022; 14:nu14194023. [PMID: 36235680 PMCID: PMC9570979 DOI: 10.3390/nu14194023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
We investigated the sex-specific association between ferritin and adverse body composition in adults aged over 50 years in a population-based cohort. A total of 25,546 participants (16,912 women; 8634 men) were stratified into three groups by the tertiles of ferritin. The number of adverse body compositions was categorized as 0 (without osteopenia/osteoporosis, low muscle mass, or obesity), 1 (having one of the components), 2 (two), and 3 (all three; osteosarcopenic obesity). As ferritin tertile increased, the prevalence of one, two, or three simultaneous adverse body compositions increased, significant only in women (p < 0.0001), not in men (p = 0.125). Among women, the prevalence of osteosarcopenic obesity gradually increased from 1.7% in the lowest, to 2.2% in the middle, and 2.5% in the highest tertile. Using multivariate-adjusted analysis, women in the higher tertile had an increased likelihood of having multiple adverse body compositions compared with those in the lowest tertile. Women in the highest tertile had a 1.52 times increased risk of osteosarcopenic obesity than those in the lowest tertile. A high ferritin level was associated with an increased risk of having multiple adverse body compositions, especially for osteosarcopenic obesity in women aged >50 years, suggesting its potential use for detecting osteosarcopenic obesity.
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Affiliation(s)
- Sung-Joon Chung
- Department of Physical and Rehabilitation Medicine, Kyunghee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea
- Department of Medicine, Graduate School, Kyunghee University, Seoul 02447, Korea
| | - Han Sol Lim
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea
| | - Mi-Yeon Lee
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea
| | - Yong-Taek Lee
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea
| | - Kyung Jae Yoon
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06355, Korea
| | - Chul-Hyun Park
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea
- Correspondence: ; Tel.: +82-2-2001-2284
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Iron Depletion in Systemic and Muscle Compartments Defines a Specific Phenotype of Severe COPD in Female and Male Patients: Implications in Exercise Tolerance. Nutrients 2022; 14:nu14193929. [PMID: 36235581 PMCID: PMC9571884 DOI: 10.3390/nu14193929] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 11/23/2022] Open
Abstract
We hypothesized that iron content and regulatory factors, which may be involved in exercise tolerance, are differentially expressed in systemic and muscle compartments in iron deficient severe chronic obstructive pulmonary disease (COPD) patients. In the vastus lateralis and blood of severe COPD patients with/without iron depletion, iron content and regulators, exercise capacity, and muscle function were evaluated in 40 severe COPD patients: non-iron deficiency (NID) and iron deficiency (ID) (20 patients/group). In ID compared to NID patients, exercise capacity, muscle iron and ferritin content, serum transferrin saturation, hepcidin-25, and hemojuvelin decreased, while serum transferrin and soluble transferrin receptor and muscle IRP-1 and IRP-2 increased. Among all COPD, a significant positive correlation was detected between FEV1 and serum transferrin saturation. In ID patients, significant positive correlations were detected between serum ferritin, hepcidin, and muscle iron content and exercise tolerance and between muscle IRP-2 and serum ferritin and hepcidin levels. In ID severe COPD patients, iron content and its regulators are differentially expressed. A potential crosstalk between systemic and muscle compartments was observed in the ID patients. Lung function and exercise capacity were associated with several markers of iron metabolism regulation. Iron status should be included in the overall assessment of COPD patients given its implications in their exercise performance.
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Elmore C, Ellis J. Screening, Treatment, and Monitoring of Iron Deficiency Anemia in Pregnancy and Postpartum. J Midwifery Womens Health 2022; 67:321-331. [PMID: 35642737 DOI: 10.1111/jmwh.13370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/29/2022]
Abstract
Iron deficiency anemia is the most prevalent form of anemia worldwide. In the United States, clinicians routinely screen for iron deficiency anemia upon initiation of prenatal care, at the start of the third trimester, and prior to birth. Treatment of iron deficiency anemia generally begins with oral supplementation of elemental iron, which is associated with adverse gastrointestinal effects. These adverse effects can decrease adherence, leading to subtherapeutic treatment. Newer evidence highlights the benefits of early screening for iron deficiency before the onset of anemia, as well as the use of intravenous iron to expedite the treatment of iron deficiency anemia. More research is needed on the potential consequences of over-supplementation and iron deficiency without anemia to guide treatment. This article reviews the evidence for best practices for screening, treatment, and continued monitoring of iron deficiency anemia during pregnancy and postpartum. Maternal, fetal, and neonatal implications are reviewed, as well as the risks and benefits of treatment options. Finally, an evidence-based algorithm is proposed to guide clinicians on continued monitoring after treatment.
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Affiliation(s)
- Christina Elmore
- Birthcare Healthcare, University of Utah College of Nursing, Salt Lake City, Utah
| | - Jessica Ellis
- Birthcare Healthcare, University of Utah College of Nursing, Salt Lake City, Utah
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Kılıç M, Özpınar A, Serteser M, Kilercik M, Serdar M. The effect of reticulocyte hemoglobin content on the diagnosis of iron deficiency anemia: A meta-analysis study. J Med Biochem 2022; 41:1-13. [PMID: 35291499 PMCID: PMC8882014 DOI: 10.5937/jomb0-31435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/27/2021] [Indexed: 12/17/2022] Open
Abstract
Background Iron deficiency anemia (IDA) is the most common type of anemia worldwide and has many adverse effects on life quality. This meta-analysis study aims to show that reticulocyte hemoglobin content (CHr) is more effective than routinely used parameters in the diagnosis of IDA. Methods Comprehensive and systematic research was done using international databases including PubMed, Web of Science, Cochrane Library, Science Direct, and Google Scholar, which contain all articles published on IDA until December 29, 2020. Seventeen articles were included in the meta-analysis. Results The analyses found the Cohen's deffect size (Standardized Mean Difference) values of the parameters. Accordingly, CHr is 2.84 (95% CI 2.36 to 3.31), mean corpus volume (MCV) is 2.46 (95% CI 1.97 to 2.95), ferritin is 2.37 (95% CI 1.63 to 3.11), and transferrin saturation (TSAT) is 3.76 (95% CI 2.14 to 5.38). To diagnose IDA, the sensitivity value of the CHr concentration was found as 83.5% (95% CI 76.1 to 89.8), specificity value to be 91.8% (95% CI 85.5 to 96.4), and mean cut-off value as 28.2 pg. Conclusions The results of our study reveal the findings that CHr is a better biomarker than MCV and ferritin used in determining IDA, and its efficacy is lower than TSAT. It is very important to use it routinely for the pre-diagnosis of IDA, which is very important for public health. The groups in the study are heterogeneous but contain bias. Therefore, meta-analyses of studies with less heterogeneity of CHr are needed.
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Affiliation(s)
- Merve Kılıç
- Acıbadem Mehmet Ali Aydinlar University, School of Medicine, Dept. Medical Biochemistry, Istanbul, Turkey
| | - Aysel Özpınar
- Acıbadem Mehmet Ali Aydinlar University, School of Medicine, Dept. Medical Biochemistry, Istanbul, Turkey
| | - Mustafa Serteser
- Acıbadem Mehmet Ali Aydinlar University, School of Medicine, Dept. Medical Biochemistry, Istanbul, Turkey
| | - Meltem Kilercik
- Acıbadem Mehmet Ali Aydinlar University, School of Medicine, Dept. Medical Biochemistry, Istanbul, Turkey
| | - Muhittin Serdar
- Acıbadem Mehmet Ali Aydinlar University, School of Medicine, Dept. Medical Biochemistry, Istanbul, Turkey
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8
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Neef V, Schmitt E, Bader P, Zierfuß F, Hintereder G, Steinbicker AU, Zacharowski K, Piekarski F. The Reticulocyte Hemoglobin Equivalent as a Screening Marker for Iron Deficiency and Iron Deficiency Anemia in Children. J Clin Med 2021; 10:jcm10163506. [PMID: 34441801 PMCID: PMC8397001 DOI: 10.3390/jcm10163506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/07/2021] [Accepted: 08/05/2021] [Indexed: 12/28/2022] Open
Abstract
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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Affiliation(s)
- Vanessa Neef
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60590 Frankfurt, Germany; (V.N.); (E.S.); (K.Z.)
| | - Elke Schmitt
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60590 Frankfurt, Germany; (V.N.); (E.S.); (K.Z.)
| | - Peter Bader
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Goethe University, 60590 Frankfurt, Germany;
| | - Frank Zierfuß
- Central Laboratory, Centre of Internal Medicine, University Hospital Frankfurt, Goethe University, 60590 Frankfurt, Germany; (F.Z.); (G.H.)
| | - Gudrun Hintereder
- Central Laboratory, Centre of Internal Medicine, University Hospital Frankfurt, Goethe University, 60590 Frankfurt, Germany; (F.Z.); (G.H.)
| | - Andrea U. Steinbicker
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany;
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60590 Frankfurt, Germany; (V.N.); (E.S.); (K.Z.)
| | - Florian Piekarski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60590 Frankfurt, Germany; (V.N.); (E.S.); (K.Z.)
- Correspondence: ; Tel.: +49-151-17191054
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Auerbach M, Staffa SJ, Brugnara C. Using Reticulocyte Hemoglobin Equivalent as a Marker for Iron Deficiency and Responsiveness to Iron Therapy. Mayo Clin Proc 2021; 96:1510-1519. [PMID: 33952394 DOI: 10.1016/j.mayocp.2020.10.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/25/2020] [Accepted: 10/13/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the accuracy of a simplified approach for the diagnosis of iron deficiency anemia (IDA) based on the complete blood cell count (CBC) and reticulocyte analysis. PATIENTS AND METHODS Five hundred fifty-six consecutive, nonselected patients referred for diagnosis and/or treatment of anemia were included in this diagnostic study to compare the performance of reticulocyte hemoglobin equivalent (RET-He) versus traditional biochemical markers for diagnosis and treatment of IDA. Complete blood count, serum ferritin, iron, and transferrin saturation were performed as clinically indicated. Reticulocyte hemoglobin equivalent was measured with a Sysmex XN-450 analyzer on the residual CBC sample. The study period was from September 20, 2017, through and including November 15, 2018. RESULTS Patients (N=556) were studied at baseline, of whom 150 were subsequently treated with intravenous iron. Receiver operating characteristic analysis yielded an RET-He cut-off of 30.7 pg to identify IDA (area under curve, 0.733; 95% CI, 0.692 to 0.775), with 68.2% sensitivity and 69.7% specificity. Patients (n=240) were seen at follow-up, with 57 treated and 183 not treated with intravenous iron. Responsiveness was defined as a hemoglobin increase of ≥1.0 g: a combination of RET-He <28.5 pg and hemoglobin value <10.3 g/dL had 84% sensitivity and 78% specificity as response predictor (area under the curve, 0.749; 95% CI, 0.622 to 0.875). CONCLUSION Data from CBC and RET-He can identify patients with IDA, determine need for and responsiveness to intravenous iron, and reduce time for therapeutic decisions. Limitations of this study are uncontrolled design, its single-site and retrospective nature, and that it requires prospective validation.
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Affiliation(s)
- Michael Auerbach
- Department of Medicine, Georgetown University School of Medicine, Washington, DC
| | - Steven J Staffa
- Department of Anesthesia, Boston Children's Hospital, Boston, MA
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, and Department of Pathology, Harvard Medical School, Boston, MA.
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Gerday E, Brereton JB, Bahr TM, Elmont JO, Fullmer S, Middleton BA, Ward DM, Ohls RK, Christensen RD. Urinary ferritin; a potential noninvasive way to screen NICU patients for iron deficiency. J Perinatol 2021; 41:1419-1425. [PMID: 32709979 DOI: 10.1038/s41372-020-0746-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/23/2020] [Accepted: 07/17/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Building on our previous study, showing a correlation between ferritin in serum and urine, we conducted a feasibility evaluation, measuring urinary ferritin as a potential noninvasive screening test for iron deficiency among NICU patients. STUDY DESIGN This was a prospective analysis of paired serum/urine ferritin levels. We defined iron-limited erythropoiesis by a RET-He <5th percentile lower reference interval (<28 pg). RESULTS We obtained 49 paired serum/urine samples from neonates judged as at-risk for iron deficiency. Urine ferritin ("corrected" for urine creatinine and specific gravity) correlated with serum ferritin (correlation coefficient of log10-transformed values 0.44). A corrected urine ferritin <12 ng/mL had a sensitivity of 82% (95% CI, 67-93%) and a specificity of 100% (CI, 66-100%) for detecting iron-limited erythropoiesis, with a positive predictive value of 100% (CI, 89-100%). CONCLUSIONS Measuring urinary ferritin in NICU patients is feasible. Since low values identify iron-limitation, this could become a useful noninvasive screen.
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Affiliation(s)
- Erick Gerday
- Intermountain Healthcare, Women and Newborns Clinical Program, Salt Lake City, UT, USA.,Department of Pediatrics, Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA
| | - Jennifer B Brereton
- Intermountain Healthcare, Women and Newborns Clinical Program, Salt Lake City, UT, USA
| | - Timothy M Bahr
- Department of Pediatrics, Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA
| | - Jennifer O Elmont
- Intermountain Healthcare, Women and Newborns Clinical Program, Salt Lake City, UT, USA
| | - Susan Fullmer
- Department of Nutrition, Dietetics, and Food Science, Brigham Young University, Provo, UT, USA
| | | | - Diane M Ward
- Center for Iron and Heme Disorders, University of Utah, Salt Lake City, UT, USA.,Department of Pathology, University of Utah Health, Salt Lake City, UT, USA
| | - Robin K Ohls
- Intermountain Healthcare, Women and Newborns Clinical Program, Salt Lake City, UT, USA.,Department of Pediatrics, Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA
| | - Robert D Christensen
- Intermountain Healthcare, Women and Newborns Clinical Program, Salt Lake City, UT, USA. .,Department of Pediatrics, Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA. .,Department of Pediatrics, Division of Hematology/Oncology, University of Utah, Salt Lake City, UT, USA.
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11
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Jamnok J, Sanchaisuriya K, Chaitriphop C, Sanchaisuriya P, Fucharoen G, Fucharoen S. A New Indicator Derived From Reticulocyte Hemoglobin Content for Screening Iron Deficiency in an Area Prevalent for Thalassemia. Lab Med 2021; 51:498-506. [PMID: 32052840 DOI: 10.1093/labmed/lmz099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To establish a new indicator derived from reticulocyte hemoglobin (Ret-He) content and red blood cell (RBC) indices for screening for iron deficiency anemia (IDA) in an area in whch thalassemia is prevalent. METHODS Blood specimens from 304 women aged between 18 and 30 years residing in northeast Thailand were collected and measured for RBC and reticulocyte parameters. Iron deficiency was diagnosed when a participant had a serum ferritin level of less than 15 ng per mL. Thalassemia genotypes were defined by hemoglobin (Hb) and DNA analyses. RESULTS Of the total participants, 25% had iron deficiency (ID) and 50% carried the thalassemia gene. Various mathematical formulas were established and analyzed using the receiver operating characteristic (ROC) curve. The formula derived from Ret-He: (Ret-He/RDW-SD) × 10, was the best predictor for identifying ID among participants (area under the curve [AUC] = 0.812). Further testing of this indicator among individuals with positive thalassemia-screening results revealed stronger performance with an AUC of 0.874. CONCLUSIONS The findings indicate that the formula derived from Ret-He might be applicable for screening ID in areas in which thalassemia is prevalent.
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Affiliation(s)
| | - Kanokwan Sanchaisuriya
- Centre for Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Thailand
| | - Chaninthorn Chaitriphop
- Centre for Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Thailand
| | | | - Goonnapa Fucharoen
- Centre for Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Thailand
| | - Supan Fucharoen
- Centre for Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Thailand
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Reconciling markedly discordant values of serum ferritin versus reticulocyte hemoglobin content. J Perinatol 2021; 41:619-626. [PMID: 33012780 DOI: 10.1038/s41372-020-00845-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/02/2020] [Accepted: 09/24/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine why serum ferritin and reticulocyte hemoglobin (RET-He), drawn to assess neonatal iron sufficiency, sometimes have markedly discordant results. STUDY DESIGN Retrospective records review of five NICUs over 28 months, identifying all patients with a ferritin and RET-He within 48 h. We examined records of all who had marked discordance (one value >95th % reference interval, the other <5th %). RESULTS Of 190 paired ferritin and RET-He measurements, 16 (8%) were markedly discordant. Fifteen of the 16 discordant samples involved a high ferritin and a low RET-He. In these, low MCV and high %Micro-R, and low MCH and high %HYPO-He were present. In total, 8 of the 15 had laboratory or clinical evidence of an inflammatory process and five had suspicion of infection documented. CONCLUSIONS When ferritin and RET-He were discordant, erythrocyte microcytosis and hypochromasia suggested that the RET-He gave the more accurate interpretation; that iron deficiency was likely present.
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13
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Alageeli AA, Alqahtany FS, Algahtani FH. The Role of Reticulocyte Hemoglobin Content for the Diagnosis of Functional Iron Deficiency in Hemodialyzed patients. Saudi J Biol Sci 2021; 28:50-54. [PMID: 33424282 PMCID: PMC7783634 DOI: 10.1016/j.sjbs.2020.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/17/2020] [Accepted: 08/17/2020] [Indexed: 11/26/2022] Open
Abstract
The effectiveness of reticulocyte hemoglobin content (CHr) had been reported to detect early functional iron deficiency especially among Chronic kidney disease (CKD) patients. CHr is more superior to classic biochemical indices in reflecting transient iron-deficiency status, therefore improving diagnosis and treatment. This study was conducted to determine the sensitivity of CHr in the diagnosis of functional iron deficiency (FID) in hemodialyzed patients. One hundred hemodialyzed patients along with 60 healthy controls were recruited and blood specimens were collected. Venous blood was used for hematological and biochemical investigations collected via 3 ml lavender-top tubes for hematological tests including CBC, blood film, ESR and CHr, and red-top tube for biochemical tests including TIBC, SF and CRP. A statistically significant decrease was noted in CHr values between hemodialysis patients and the control group (24.8 ± 2.0 pg vs. 30.9 ± 1.3 pg, p<0.001). CHr values showed a significant correlations with RBCs, Hb- hemoglobin, Hct- hematocrit level, MCV- mean corpuscular volume, MCH- mean corpuscular hemoglobin, MCHC, RDW- red cell distribution width , SI-Serum Iron, TIBC- Total iron binding capacity and TSAT- Transferrin saturation. The present study showed that CHr in comparison to the conventional hematological and biochemical markers commonly used to diagnose iron deficiency.
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Affiliation(s)
- Ali A. Alageeli
- Department of Clinical Laboratory Sciences, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia
| | - Fatmah S. Alqahtany
- Department of Pathology, Hematopathology Unit, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Farjah H. Algahtani
- Department of Medicine, Division of Oncology/Hematology, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
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14
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Bahr TM, Knudsen MC, Lozano-Chinga M, Agarwal AM, Meznarich JA, Ohls RK, Christensen RD. Infantile Pyknocytosis: End-Tidal CO, %Micro-R Measurements, Next-Generation Sequencing, and Transfusion Avoidance with Darbepoetin. Biomed Hub 2020; 5:227-234. [PMID: 34055814 PMCID: PMC8136318 DOI: 10.1159/000511388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/07/2020] [Indexed: 12/04/2022] Open
Abstract
Infantile pyknocytosis is a rare, self-limited, hemolytic condition of unknown pathogenesis. It is diagnosed when a neonate with Coombs-negative hemolytic anemia has abundant pyknocytes and a characteristic clinical course after other hemolytic disorders has been excluded. Previous reports suggest that transfusions might be avoidable in this condition by administering recombinant erythropoietin. We cared for a patient with this disorder where we employed novel diagnostics and therapeutics. Despite these, and a good outcome free of transfusions, we continue to consider the condition to be idiopathic.
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Affiliation(s)
- Timothy M Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Mari C Knudsen
- Pediatric Residency Program, University of Utah, Salt Lake City, Utah, USA
| | - Michell Lozano-Chinga
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Archana M Agarwal
- Division of Hematopathology, Department of Pathology, University of Utah, Salt Lake City, Utah, USA.,ARUP Laboratories, Salt Lake City, Utah, USA
| | - Jessica A Meznarich
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Robin K Ohls
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.,Division of Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
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15
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Retikulozyten-Hämoglobin-Äquivalent als diagnostischer Marker der aktuellen Eisendefizienz. Anaesthesist 2020; 69:919-925. [DOI: 10.1007/s00101-020-00870-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Pérez I, Redín ME. Red Blood Cells and Platelets Conventional and Research Parameters: Stability Remarks Before Their Interpretation. Lab Med 2020; 51:460-468. [PMID: 31943061 DOI: 10.1093/labmed/lmz083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To analyze the stability of red blood cells, platelets, and reticulocytes of the research parameters, in combination with the respective conventional parameters, for each analyte; and to quantify the morphological changes in these analytes, to propose a correction factor for each. METHODS Ethylenediaminetetraacetic acid (EDTA) blood specimens from patients were reanalyzed in 2-hour intervals and then, the mean percentage (X¯t%) changes were calculated. To evaluate the stability of the analyzed material, we used different criteria according to within-run and between-batch analytical variation, as well as intraindividual biological variation. Next, the mean deviation percentage of the parameters that undergo time-dependent significant changes was calculated, to obtain a correction factor. RESULTS Several conventional and research parameters showed significant alterations in the stability at an early time after arrival at the laboratory. CONCLUSION Cell variations over time can be quantified and corrected by applying a multiplying factor to the signal obtained in the analyzer.
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Affiliation(s)
| | - Maria Elena Redín
- Department of Laboratory Medicine, Core Laboratory, University Hospital Donostia, Guipuzcoa, Spain
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17
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Bahr TM, Lozano-Chinga M, Agarwal AM, Meznarich JA, Gerday E, Smoot JL, Taylor A, Christensen RD. Dizygotic twins with prolonged jaundice and microcytic, hypochromic, hemolytic anemia with pyropoikilocytosis. Blood Cells Mol Dis 2020; 85:102462. [PMID: 32623341 DOI: 10.1016/j.bcmd.2020.102462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 12/27/2022]
Abstract
Dizygotic twin males, born at 34 weeks gestation, had prolonged jaundice, microcytic, hypochromic anemia, FABarts hemoglobin, elevated end-tidal CO, and blood films consistent with hereditary pyropoikilocytosis. DNA sequencing revealed both had a heterozygous alpha spectrin (SPTA1) mutation (c.460_462dup) inherited from their asymptomatic mother, plus a 3-base pair duplication in alpha globin (HBA2) (c.364_366dupGTG) inherited from their asymptomatic father.
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MESH Headings
- Anemia, Hemolytic/blood
- Anemia, Hemolytic/complications
- Anemia, Hemolytic/genetics
- Anemia, Hypochromic/blood
- Anemia, Hypochromic/complications
- Anemia, Hypochromic/genetics
- Elliptocytosis, Hereditary/blood
- Elliptocytosis, Hereditary/complications
- Elliptocytosis, Hereditary/genetics
- Humans
- Infant, Newborn
- Jaundice/blood
- Jaundice/complications
- Jaundice/genetics
- Male
- Point Mutation
- Spectrin/genetics
- Twins, Dizygotic/genetics
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Affiliation(s)
- Timothy M Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, United States of America.
| | - Michell Lozano-Chinga
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, United States of America
| | - Archana M Agarwal
- Division of Hematopathology, Department of Pathology, University of Utah Health, Salt Lake City, UT, United States of America; ARUP Laboratories, Salt Lake City, UT, United States of America
| | - Jessica A Meznarich
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, United States of America
| | - Erick Gerday
- Department of Pediatrics, Division of Neonatology, Utah Valley Hospital, Provo, UT, United States of America
| | - Jennifer L Smoot
- Department of Pediatrics, Division of Neonatology, Utah Valley Hospital, Provo, UT, United States of America
| | - Ann Taylor
- Department of Pathology, Utah Valley Hospital, Provo, UT, United States of America
| | - Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, United States of America; Division of Hematology/Oncology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, United States of America
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18
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Reticulocyte Hemoglobin Content (Ret He): A Simple Tool for Evaluation of Iron Status in Childhood Cancer. J Pediatr Hematol Oncol 2020; 42:e147-e151. [PMID: 31851071 DOI: 10.1097/mph.0000000000001700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cancer-related anemia is a common complication of cancer and its treatment that may be mediated by nutritional deficiency or inflammatory cytokines inhibiting erythropoiesis. AIM We evaluated the value of reticulocyte hemoglobin content (Ret He) as a marker of iron availability for erythropoiesis in childhood cancer and the impact of oral iron supplementation on hematologic parameters in patients with low Ret He. MATERIALS AND METHODS This prospective study included 100 pediatric patients with cancer on chemotherapy who were screened for the presence of anemia. Patients with anemia underwent testing for complete blood count including Ret He on Sysmex XE 2100 and assessment of reticulocyte count, serum iron, serum ferritin, transferrin saturation, total iron-binding capacity, and C-reactive protein. Patients were classified according to their level of Ret He into normal or low Ret He using a cutoff level of 28 pg. Patients with low Ret He were subjected to 6 weeks' treatment with oral ion and were followed up with complete blood count and iron profile. RESULTS Thirty-one (77.5%) patients had normal Ret He, and 9 (22.5%) had low Ret He. Ret He was positively correlated with red cell indices, but not with iron parameters. After oral iron supplementation, a significant increase in hemoglobin, reticulocyte count, and iron was found. CONCLUSIONS We suggest that Ret He could be used as an easy and affordable tool for the assessment of iron deficiency anemia in childhood cancer during chemotherapy treatment. A trial of oral iron in patients with low Ret He may be useful to correct the associated anemia.
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Abstract
Bone marrow iron estimation remains the gold standard for diagnosing iron-deficiency anemia (IDA); serum ferritin, total iron-binding capacity, and transferrin saturation are routinely used as surrogate markers of IDA. However, these tests are marred by problems like poor specificity and sensitivity. Recently, hepcidin, a protein hormone synthesized in the liver and excreted in urine, has been shown to be related to iron status. We estimated the serum and urinary hepcidin levels in healthy children 6 to 60 months of age with (n=30) and without IDA (n=30). The mean (SD) serum hepcidin levels in children with IDA were significantly lower than those in children without IDA (3.03 [1.06] vs. 4.78 [3.94] ng/mL; P=0.02). The mean (SD) urinary hepcidin levels were also significantly lower in children with IDA than those in children without IDA (2.29 [0.53] vs. 2.79 [0.75] ng/mL; P=0.004). Performance of urinary and serum hepcidin compared with serum ferritin (<12 µg/L) for diagnosing IDA in terms of area under the receiver operating characteristic curve was 0.704 (P=0.007) and 0.59 (P=0.22), respectively. Serum hepcidin is not useful for diagnosing IDA in under-5 children. In contrast, urinary hepcidin holds promise as a noninvasive diagnostic tool for IDA in under-5 children.
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Amir N, Md Noor S, Subbiah I, Osman M, Seman Z. Percentage of hypochromic red cells as a potential screening test to evaluate iron status in blood donors. Int J Lab Hematol 2019; 41:418-423. [PMID: 30938931 DOI: 10.1111/ijlh.13009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 02/10/2019] [Accepted: 02/19/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Haemoglobin (Hb) levels are used to assess eligibility for blood donation but are not correlated with iron status. The percentage of hypochromic red cells (%Hypo-He) has been suggested as a useful screening parameter for iron deficiency. The aim of this study was to determine the cut-off level and accuracy of %Hypo-He screening among blood donors. MATERIALS AND METHODS A total of 170 blood donors were recruited into the study. Blood donors were classified into three groups: normal, latent iron deficiency and iron deficiency anaemia based on their Hb, serum ferritin and transferrin saturation (TSAT) levels. The diagnostic performance of %Hypo-He was evaluated with a validation group comprising 160 blood donors. RESULTS Receiver operating characteristic (ROC) curve analysis showed that %Hypo-He is an excellent parameter for detecting iron deficiency, with an area under the curve (AUC) of 0.906, a confidence interval (CI) of 0.854-0.957 at a cut-off of 0.6%, and 74.51% sensitivity and 88.24% specificity. A moderate negative correlation between %Hypo-He and TSAT (ρ = -0.576 [P < 0.001]) and a strong negative correlation between %Hypo-He and serum ferritin (ρ = -0.703 [P < 0.001]) were found. A cut-off value of 0.6% was applied to the validation group and showed 82.9% sensitivity and 96% specificity. CONCLUSION %Hypo-He with a cut-off value of 0.6% is a potential parameter with high sensitivity and specificity for evaluating iron status among blood donors. This parameter is suitable for screening because its measurement has a faster turnaround time than biochemical markers.
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Affiliation(s)
- Noraini Amir
- Hematology Unit, Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Sabariah Md Noor
- Hematology Unit, Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Indhira Subbiah
- Department of Pathology, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Malina Osman
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Zainina Seman
- Hematology Unit, Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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21
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Buttarello M, Rauli A, Mezzapelle G. Reticulocyte count and extended reticulocyte parameters by Mindray BC-6800: Reference intervals and comparison with Sysmex XE-5000. Int J Lab Hematol 2017; 39:596-603. [DOI: 10.1111/ijlh.12705] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- M. Buttarello
- Department of Laboratory Medicine; Azienda Ospedaliera-Università di Padova; Padova Italy
| | - A. Rauli
- Clinical Pathology Laboratory; Hospital of Adria; Adria Italy
| | - G. Mezzapelle
- Clinical Pathology Laboratory; Hospital of Adria; Adria Italy
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