Reticulocyte hemoglobin equivalent for diagnosing iron deficiency anemia in children
Abstract: The prevalence of
iron deficiency anemia (IDA) remains high in Indonesian children. When anemia
is detected in a patient, the physician’s task is to identify the cause,
address it, provide iron therapy, and prevent recurrence. However, prevention
is best done by early detection. The reticulocyte hemoglobin equivalent
(Ret-He) is a direct measurement of iron level in reticulocytes recently
produced in the bone marrow. The Ret-He measurement may be an early indicator
of iron deficiency, as it is sensitive at the initial stage of the condition.
Objective To assess for a relationship between Ret-He and IDA as well as
to evaluate the usefulness of Ret-He for diagnosing IDA in children.
Methods This analytic, observational study with cross-sectional approach
included 50 children aged 6-12 years and was performed from November 2013 to
March 2014. The subjects were divided into IDA or non-IDA groups, based on
ferritin levels. A correlation analysis using logistic regression was performed
and the sensitivity, specificity, positive predictive value (PPV), negative
predictive value (NPV), and odds ratio (OR) were calculated. Results were
considered to be statistically significant for P values <0.05.
Results A low Ret-He level was significantly associated with IDA in
children (P=0.005). The Ret-He cut-off point of 27.8 pg/L had sensitivity of
43.8%, specificity 85.3%, PPV 58.3%, and NPV 76.3%, with OR 4.5 (95%CI 1.1 to
17.7).
Conclusion We find a significant positive relationship between
Haemoglobin (Hb) and Ret-He in children, A low level of Ret-He is associated
with greater risk of IDA in children. The Ret-He has a high specificity. As
such, Ret-He may be useful as a screening tool for early detection of IDA in
children.
Author: Susanti Lisupindan
Palimbong Rungngu, Audrey Wahani, Max F.J. Mantik
Journal Code: jpkedokterangg160033
