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Reticulocyte hemoglobin equivalent as a potential marker for diagnosis of iron deficiency

Abstract

Evaluation of parameters relating to serum ferritin and iron is critically important in the diagnosis of iron deficiency anemia (IDA). The recent development of automated systems for hematology analysis has made it possible to measure reticulocyte hemoglobin equivalent (RET-He), which is thought to reflect iron content in reticulocytes, in the same sample used for complete blood count tests. If RET-He is, indeed, capable of evaluating iron deficiency (ID), it would be useful for immediate diagnosis of IDA. In the present study, we examined the usefulness of RET-He for diagnosis of ID. Blood samples were obtained from 211 patients. Anemia was defined as hemoglobin (Hb) level of <12 g/dL. Iron deficiency was defined as serum ferritin level of <12 ng/mL. Patients were classified into four groups: IDA, ID, control, and non-ID with anemia. Patients in the IDA group had significantly lower RET-He levels than those in the control group. RET-He correlated with serum ferritin in the IDA and ID groups. The area under the curve for RET-He was 0.902, indicating that RET-He facilitates the diagnosis of ID with high accuracy. RET-He changed in parallel with changes in Hb during iron administration for 21 IDA patients. Our results indicate that RET-He may be a clinically useful marker for determining ID in the general population.

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Author contribution

Study concept and design: YT, KI, MF, and TO. Laboratory analysis: YT, KI, YK, NN, MK, ME, SI, and YT. Statistical analysis and interpretation of data: YT and KI. Obtaining informed consent, sample collection, and analysis of medical data: YT, KI, MH, MY, MS, YK, MI, and KS. Manuscript preparation: YT and KI.

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Correspondence to Katsuya Ikuta.

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Yasumichi Toki, Katsuya Ikuta, Mayumi Hatayama, Masayo Yamamoto, Motohiro Shindo, Mikihiro Fujiya, Toshikatsu Okumura (Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University), Masayoshi Kon, Kazuya Sato (Asahikawa-Kosei General Hospital), Motoki Enomoto, Mitsutaka Inoue (Engaru-Kosei General Hospital), Yuko Tada, and Yoko Kikuchi (Moriyama Hospital) received research funding from Sysmex Corporation. This study was also performed in collaboration with Sysmex Corporation. Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University also received collaborative research funding for research work concerning iron metabolism from Chugai Pharmaceutical Co. Ltd., Novartis Pharma K. K., Asahi Kasei Medical Co. Ltd., Shino-Test Corporation and USHIO INC. Yoshie Kawahara and Noriyasu Niizeki have no conflict of interests to declare.

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Toki, Y., Ikuta, K., Kawahara, Y. et al. Reticulocyte hemoglobin equivalent as a potential marker for diagnosis of iron deficiency. Int J Hematol 106, 116–125 (2017). https://doi.org/10.1007/s12185-017-2212-6

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Keywords

  • Reticulocyte hemoglobin equivalent (RET-He)
  • Iron deficiency anemia
  • Iron
  • Iron deficiency
  • Diagnosis