Reticulocyte hemoglobin content as a predictor of iron deficiency anemia
Abstract
Background Iron deficiency anemia (IDA) is the most common form of anemia in developing countries, such as Indonesia. Iron deficiency anemia in children is a serious problem because it affects their growth and development. Early detection of IDA and subsequent treatment in childhood may prevent future health problems.
Objective To assess the use of reticulocyte hemoglobin content (CHr) to detect IDA in children aged 6-60 months.
Methods We performed a cross-sectional study to measure the sensitivity and specificity of CHr compared to serum ferritin which is considered to be the gold standard for IDA diagnosis. The study was conducted from September 2011 to March 2013 in children aged 6-60 months who visited the Pediatric Outpatient Clinic, Sanglah Hospital, and Puskesmas II in West Denpasar. Data analysis was performed by 2x2 table. The results were assessed by area under the curve (AUC) and receiver operating characteristic (ROC).
Results Of 121 children underwent blood testing during the study period, 69 children were excluded because they did not have hypochromic microcytic anemia, leaving 52 subjects eligible for the study. The prevalence of IDA in this study was 31%. Reticulocyte hemoglobin content (CHr) ≤ 23.1 pg had 88% (95%CI 71 to 100%) sensitivity and 25% (95%CI 11 to 39%) specificity.
Conclusion Reticulocyte hemoglobin content < 23.1 pg may be a good predictor of IDA.
References
Amalia P, Wahidiyat W. Pendekatan diagnosis anemia pada anak. In: Abdulsalam M, Trihono P, Kaswandani N, Endyarni B, editors. Pendekatan praktis pucat. Jakarta: Departemen Ilmu Kesehatan Anak FKUI/RSCM; 2007. p. 20-30.
Departemen Kesehatan RI. Survei kesehatan rumah tangga 1995. Badan penelitian dan pengembangan kesehatan departemen kesehatan RI; 1997. p. 23-30.
Atmarita. Nutrition problem in Indonesia. Yogyakarta: Gadjah Mada University; 2005. p.1-15
WHO. Worldwide prevalence of anaemia 1993–2005. Global Database on Anaemia. Geneva, Switzerland: World Health Organization; 2008. p. 1-40.
Gunadi D, Lubis B, Rosdiana N. Terapi dan suplementasi besi pada anak. Sari Pediatri. 2009;11:207-11.
Pudjiadi S. Kekurangan dan keracunan mineral. In: Ilmu gizi klinis pada anak. Jakarta: Balai Penerbit FK UI; 2005. p. 189-95.
Soedjatmiko. Pengaruh defisiensi besi pada kecerdasan dan perilaku anak. In: Abdulsalam M, Trihono P, Kaswandani N, Endyarni B, editors. Pendekatan praktis pucat. Jakarta: Departemen Ilmu Kesehatan Anak FKUI/RSCM; 2007. p. 72-86.
Sjarif DR. Nutritional anemia. In: Abdulsalam M, Trihono P, Kaswandani N, Endyarni B, editors. Pendekatan praktis pucat. Jakarta: Departemen Ilmu Kesehatan Anak FKUI/RSCM; 2007. p. 102-16.
Killip S, Bennett JM, Chambers DM. Iron deficiency anemia. Am Fam Physcian. 2007;75:671-8.
Insel P, Elaine RT, Ross D. Iron in trace mineral. Massachusetts: Jones and Bartlett Publisher, Sudbury, Massachusetts. American Dietetic Association; 2002. p. 443-52.
Suega K, Bakta IM, Losen A, Dharmayuda TG. Perbandingan beberapa metode, diagnosis anemia defisiensi besi: usaha mencari cara diagnosis yang tepat untuk penggunaan klinik. J Peny Dalam. 2007;8:1-12.
Mast A. The clinical utility of peripheral blood test in the diagnosis of iron deficiency anemia. Bloodline. 2001;1:7–9.
Mast AE, Blinder MA, Lu Q, Flax S, Dietzen DJ. Clinical utility of the reticulocyte hemoglobin content in the diagnosis of iron deficiency. Blood.2002;99:1489-91.
Pusponegoro PD, Wila W, Pudjiadi A, Bisanto J, Zulkarnain S. Uji Diagnostik. In: Sastroasmoro S, Ismael S, editors. Dasar-dasar Metodologi Penelitian Klinis. Jakarta: CV Sagung Seto; 2010. p. 193-216.
Brugnara C. Hematologic â€gold standard†for iron deficiency. Clin Chem. 2002;48:981-2.
Wahidiyat I. Masalah anemia pada anak di Indonesia. In: Abdulsalam M, Trihono P, Kaswandani N, Endyarni B, editors. Pendekatan praktis pucat. Jakarta: Departemen Ilmu kesehatan Anak FKUI/RSCM; 2007. p. 1-4.
Pasricha SR, Black J, Muthayya S, Shet A, Bhat V, Nagaraj S, et al. Determinants of anemia among young children in rural India. Pediatrics. 2010;126:140-9.
Baker RD, Greer FR. Diagnosis and prevention of iron deficiency and iron deficiency anemia in infants and young children (0-3 years of age). Pediatrics. 2010;126:1040-50.
Cahyaningdiah D, Utomo B, Hidayat A. Faktor-faktor yang berhubungan dengan anemia pada bayi usia 5-7 bulan. J Kedokter Trisakti. 2001;20:1-8.
Queiroz S, Torres M. Iron deficiency anemia in children. J Pediatr (Rio J). 2000;76:298-304.
Schneider JM, Fujii ML, Lamp CL, Lönnerdal B, Dewey KG, Zidenberg-Cherr S. The use of multiple logistic regression to identify risk factors associated with anemia and iron deficiency in a convenience sample of 12–36-mo-old children from low-income families. Am J Clin Nutr. 2008;87:614-20.
Brugnara C, Zurakowski D, DiCanzio J, Boyd T, Platt O. Reticulocyte hemoglobin content to diagnose iron deficiency in children. JAMA. 1999;281:2225-30.
Brugnara C, Schiller B, Moran J. Reticulocyte hemoglobin equivalent (Ret He) and assessment of iron-deficient states. Clin Lab Haem. 2006;28:303–8. doi: 10.1111/j.1365-2257.2006.00812.x
Ullrich C, Wu A, Armsby C, Rieber S, Wingerter S, Brugnara C, et al. Screening healthy infants for iron deficiency using reticulocyte hemoglobin content. JAMA. 2005;294:924-30.
Losen-Adnyana IW, Bakta IM, Suega K, Dharmayuda TG. Hubungan feritin serum dengan kadar IL-2 pada penderita anemia defisiensi besi. J Peny Dalam. 2007;8:13-22.
Thomas C, Thomas L. Biochemical markers and hematologic indices in the diagnosis of functional iron deficiency. Clin Chem. 2002;48:1066–76.
Wu AC, Lesperance L, Bernstein P. Screening for iron deficiency. Pediatr Rev. 2002;23:171-8.
Dahlan MS. Analisis penelitian diagnostik. In: Novianty A, editor. Seri evidence based medicine 5: Penelitian diagnostik. Jakarta: Salemba Medika; 2009. p. 19-30.
Dahlan MS. Memperoleh nilai area under the curve dengan prosedur receiver operating characteristic. In: Novianty A, editor. Seri evidence based medicine 5: Penelitian diagnostik. Jakarta: Salemba Medika; 2009. p. 55-60.
Dahlan MS. Menentukan titik potong dengan prosedur receiver operating characteristic. In: Novianty A, editor. Seri evidence based medicine 5: Penelitian diagnostik. Jakarta: Salemba Medika; 2009. p. 61-74.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Accepted 2016-02-12
Published 2015-06-30
