Study On Application Of Reticulocyte Hemoglobin Content In The Nutritional Assessment Of Iron Status In Chinese Adults

ObjectivesBy using bone marrow staining negative for iron as the gold standard criterion for iron deficiency anemia, our study aim to analyze the correlations between reticulocyte hemoglobin content (CHr) and other indicators and to compare the sensitivity and specificity of CHr to other traditional hemocytic and biochemical iron parameters when diagnosing iron deficiency anemia (IDA) in adult patients. Our study also aimed to evaluate the differential diagnosis efficiency of CHr when diagnosing IDA in different anemia patients, and using receiver operation curve to get the best cut-off point for CHr and examine the efficiency of CHr in iron treatment monitoring.MethodsChoose those who seek treatment and need bone marrow aspiration for diagnosis at the hematology department in Peking Union Medical College Hospital, related information (including name, age, gender, outpatient service time, contact information, the preliminary diagnosis results, etc.) were collected. Based on these data, eligible patients were enrolled. Their test results were collected (including bone marrow iron staining, Hemoglobin (Hb), and reticulocyte Hemoglobin content and Mean Corpuscular Volume(MCV), Hematocrit (Hct), Mean Corpuscular Hemoglobin (MCH), Mean Corpuscular Hemoglobin Concentration (MCHC) and Free Erythrocyte Protoporphyrin (FEP). Another tube of venous blood were collected to measure iron nutritional status indicators (including Serum Ferritin (SF), Serum Transferrin Receptor (sTfR), Unsaturated Iron-Binding Capacity (UIBC))。According to the bone marrow iron staining results and hemoglobin levels, enrolled subjects were divided into the IDA group, non-IDA anemia group, control group and ID group. Subjects in IDA group were offered immediate iron treatment, and they were tested for hematological variables and iron nutritional parameters after one week’s therapy.By using receiver operation curve (ROC), we compared the sensitivities and specificities of different indicators and selected the best diagnostic value for CHr. Changes of each indicator of IDA patients before and after treatment were compared to examine the effectiveness of CHr in iron treatment monitoring. Results1.139consecutive subjects were recruited,51in IDA group,40in non-EDA anemia groups consisted,42in control group and6patients were ID. Mean age was45years old.2. Using bone marrow staining as the gold method, receiver operation curves (ROC) of diagnosing IDA were drawn for CHr and other5indicators suggested by WHO including Hb, MCV, FEP, SF, sTfR. The areas under the curve were0.901,0.717,0.883,0.785and0.833respectively. CHr has better efficiency in diagnosing IDA in adults. Using ROC method, we obtained best cut-off value for CHr to diagnose IDA in adults. The optimal cut-off value for CHr was28.5pg corresponding to a sensitivity and specificity of83.3%and89.5%, respectively.3. There is positive correlations between CHr and HCT, MCV, MCHC and MCH, the correlation coefficients were0.917,0.184,0.873,0.750and0.924respectively. Except HCT, other four hemocytic indicators were highly correlated with CHr. CHr and FEP, sTfR and UIBC were negatively correlated (P<0.001), the correlation coefficients were-0.486,-0.523and-0.442respectively; CHr and ln(1+SF) were positively correlated (P<0.001), the correlation coefficient was0.663. The above four iron nutritional status indicators were moderate correlated with CHr.4. In our study, CHr in IDA group was24.7±4.0pg, CHr in non-IDA anemia group was32.4±5.4pg. CHr in IDA group is significantly lower than in the non-IDA anemia group, and there are significant differences between groups (P<0.05). At the same time, the area under the ROC curve for CHr to diagnose IDA in anemia population is the largest.5. There is no significant difference in CHr between patients with and without inflammation (P=0.353). In the non-IDA anemia group and the control group, CHr had no significant sex difference (P=0.274).6. CHr, Hb, MCV and SF were significantly changed in IDA group after10days or7days treatment (P<0.05). CHr had no better efficiency in treatment monitoring than other traditional iron parameters after7days of treatment.ConclusionFor CHr, a sensitivity of83.3%and a specificity of89.5%, respectively, correspond to an optimal cut-off point of28.5pg. CHr has better efficiency in diagnosing IDA in adults and differential diagnosing. CHr was highly correlated with multiple hemocytic indicators, and was moderate correlated with several iron nutritional status indicators. CHr was not affected by inflammation and sex difference in CHr was not found in our study. In our study, CHr has no superior efficacy in evaluating therapeutic effect after7days of treatment.