Diagnostic Utility of Reticulocyte Hemoglobin Equivalent for Identifying Iron Deficiency in Hospitalized Children in a Thalassemia-endemic Region: A Single-center Cross-sectional Study

Phakatip  Sinlapamongkolkul; Tasama  Pusongchai; Jassada  Buaboonnum; Wallee  Satayasai; Pacharapan Surapolchai

doi:10.33192/smj.v78i1.277456

Authors

Phakatip Sinlapamongkolkul Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Tasama Pusongchai Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Jassada Buaboonnum Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Wallee Satayasai Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Pacharapan Surapolchai Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand

DOI:

https://doi.org/10.33192/smj.v78i1.277456

Keywords:

Anemia, children, diagnostic accuracy, hospitalization, iron deficiency, receiver operating characteristic, reticulocyte hemoglobin equivalent, thalassemia

Abstract

Objective: Reticulocyte hemoglobin equivalent (RET-He) has been identified as a useful marker for diagnosing and monitoring iron deficiency anemia (IDA). This study evaluated anemia prevalence and assessed RET-He’s effectiveness in detecting IDA in pediatric inpatients with high thalassemia burden.

Materials and Methods: A cross-sectional design was employed involving children aged 6 months to 15 years admitted with anemia. RET-He and red blood cell (RBC) indices were compared to explore diagnostic implications.

Results: Among the 881 pediatric inpatients included during the study period, 17% (154 patients) were identified as having anemia. IDA was the major cause of anemia (98%), including IDA (70.1%) and IDA coexisting with thalassemia (27.9%). Median RET-He (IQR) of all anemic patients was 21.05 (18.70, 24) pg. Notably, RET-He values were lower in patients with combined IDA and thalassemia than in those with IDA alone (p = 0.004). Significant correlations were observed between RET-He and RBC indices such as mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). With a cut-off of ≤20.3 pg, RET-He showed moderate sensitivity (70.3%) and specificity (60.5%) for diagnosing IDA.

Conclusion: These findings advocate for RET-He’s use as an iron status marker in hospitalized children, especially in areas endemic for thalassemia. Low RET-He in non-responders to iron therapy should raise suspicion of underlying thalassemia.

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