The Paediatric Iron Deficiency Assessment with Reticulocyte Haemoglobin Equivalent (Ret-He) in Comparison with Biochemical Markers of Serum Ferritin and Transferrin Saturation
Ret-He in the Diagnosis of IDA among Paediatric Patients
Abstract
Diagnosis of iron deficiency anaemia (IDA) is a challenge as the conventional methods often diagnose the disease at the later stage. Haemoglobin content of reticulocytes is useful to identify IDA at earlier stage. The objective of this study was to evaluate reticulocyte-haemoglobin equivalent (Ret-He) in diagnosing IDA in children and to compare it with other conventional methods. This prospective study was conducted on 120 paediatric patients aged 12 years and below, who attended Hospital Sultanah Aminah Johor Bahru, Malaysia with haemoglobin <12 g/dL. Ret-He and serum iron, ferritin and transferrin saturation were measured. Using a cut-off point of 20% for transferrin saturation, 81 out of 120 subjects (67.5%) were found as iron deficient. Based on the diagnosis of IDA, cut-off value for Ret-He using the Receiver Operating Characteristics (ROC) curve analysis was found as 22.65 pg. Ret-He showed a good sensitivity and specificity of 77.8% and 66.7%, respectively. As compared with Ret-He, serum ferritin showed a sensitivity of only 18.9%. However, a good specificity of 100% suggest it is useful for ruling in the disease but not suitable for screening. Transferrin saturation showed a good sensitivity and specificity, but it is biologically variable and not cost effective as a screening tool. Correlation study showed serum iron and transferrin saturation have significant positive correlation with Ret-He (r=0.415 to 0.518). However, there was no correlation between Ret-He and serum ferritin (r=0.051, p=0.578). This study shows that Ret-He at a cut-off point of 22.65 pg has a better sensitivity and potentially be useful as a screening tool in the paediatric population.
Keywords :
iron deficiency anaemia,
paediatric,
reticulocyte haemoglobin equivalent,
Abstrak
Terdapat cabaran dalam diagnosis kekurangan zat besi anemia atau "iron deficiency anaemia" (IDA) pada masa kini. Hal ini kerana jika menggunakan kaedah konvensional, penyakit ini sering dikesan pada peringkat akhir. Kandungan retikulosit hemoglobin berguna untuk mengenal pasti IDA pada peringkat awal. Objektif kajian ini adalah untuk menilai retikulosit hemoglobin setara (Ret-He) dalam mendiagnosis IDA pada kanak-kanak dan membandingkannya dengan kaedah konvensional yang lain. Kajian prospektif ini dijalankan ke atas 120 orang pesakit pediatrik berusia 12 tahun dan ke bawah, yang hadir ke Hospital Sultanah Aminah Johor Bahru, Malaysia dengan kadar hemoglobin <12 g/dL. Ret-He dan serum besi, ferritin dan saturasi transferin telah diukur. Dengan menggunakan titik 'cut-off' 20% untuk saturasi transferin, 81 daripada 120 subjek (67.5%) didapati kekurangan zat besi. Berdasarkan diagnosis IDA, nilai cut-off untuk Ret-He apabila diuji menggunakan analisis keluk "Receiver Operating Characteristics" (ROC) adalah sebanyak 22.65 pg. Ret-He menunjukkan sensitiviti dan spesifisiti yang baik, di mana nilai masing-masing ialah 77.8% dan 66.7%. Jika dibandingkan dengan Ret-He, serum feritin menunjukkan hanya 18.9% sensitiviti, namun, spesifisiti sebanyak 100% menunjukkan ianya berguna untuk ketetapan penyakit ini tetapi tidak sesuai bagi tujuan ujian saringan. Saturasi transferin menunjukkan sensitiviti dan spesifisiti yang baik, namun secara biologi ianya berubah-ubah dan tidak efektif sebagai alat ujian saringan. Kajian korelasi menunjukkan serum zat besi dan saturasi transferin mempunyai hubungan positif, signifikan dengan Ret-He (r = 0,415 hingga 0,518), namun, hubungan di antara Ret-He dan serum feritin tidak signifikan (r = 0,051, p = 0,578). Kajian ini menunjukkan bahawa Ret-He pada titik cut-off 22.65 pg mempunyai sensitiviti yang lebih baik dan berpotensi di gunakan sebagai alat ujian saringan pada populasi pediatrik.
Kata Kunci :
kekurangan zat besi anemia,
pediatrik,
retikulosit hemoglobin setara,
Correspondance Address
Associate Professor Dr Nurasyikin Yusof. Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91455373 Email: drsyikin@ppukm.ukm.edu.my
