Reticulocyte hemoglobin content (MCHr) in the detection of iron deficiency.

BACKGROUND: Blood hemoglobin (Hb) concentration within the reference interval does not exclude iron deficiency (ID): individuals with normal stores lose iron during a long period before their Hb falls below of the level that is defined as anemia. The process entails a decrease of storage iron, shown by serum ferritin below reference range, followed by iron depletion, eventually leading to iron restricted erythropoiesis; consequence of an imbalance between erythropoietic iron requirements and too low supply is a reduction of Hb synthesis in reticulocytes.

OBJECTIVE: We study the potential utility of mean reticulocyte hemoglobin content (MCHr), reported by CELL-DYN Sapphire (Abbott Diagnostics) analyzer, in the detection of ID in non-anemic adults.

METHODS: 207 patients with Hb within the reference range were enrolled. ID was defined as Hb>120g/L (women), >130g/L (men) and serum ferritin <30μg/L. Student's t-test was applied to detect deviations between groups, statistical significance P<0.05. The performance of MCHr in detecting ID was evaluated applying Receiver Operating Characteristic (ROC) curve analysis. Kappa test was applied to verify concordance between ferritin and MCHr.

RESULTS: 68 patients (33%) suffered ID, median MCHr in this group was 26.9 pg, statistically different from the normal group, MCHr 30.9pg (P<0.0001). ROC ANALYSIS (GOLD STANDARD FERRITIN <30μG/L): Area under curve AUC 0.851 (95% CI 0.770-0.912) at cut off 30.0 pg, with sensitivity 84.1% and specificity 71.1%. Kappa 0.667 (95% CI 0.527-0.858).

CONCLUSION: Due to their short lifespan reticulocytes and derived parameters reflect current erythropoiesis status, before Hb and erythrocyte indices drop. MCHr had the best AUC and diagnostic value compared to erythrocyte indices. MCHr is a reliable test for the investigation of ID and could improve the detection of iron deficient adults.