1
|
Cheng W, Yanuarso PB, Wahidiyat PA, Rohimi S, Trihono PP, Kadim M, Muktiarti D. The role of reticulocyte hemoglobin equivalent on the evaluation of iron deficiency and iron deficiency anemia in pediatric cyanotic heart disease: a diagnostic study in Indonesia. BMC Pediatr 2024; 24:541. [PMID: 39174917 PMCID: PMC11342583 DOI: 10.1186/s12887-024-05000-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 08/08/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND In light of prolonged hypoxia, children with cyanotic heart disase (CHD) are at a high risk of developing iron deficiency iron deficiency (ID) and iron deficiency anemia (IDA). Reticulocyte hemoglobin equivalent (Ret-He) is a novel and dependable indicator for assessing iron status. However, there has been no previous study regarding cut-off value in pediatric CHD group. The purpose of this study is to assess the role of Ret-He and to establish cut-off points in the diagnosis of iron deficiency and IDA in pediatric cyanotic heart disease. METHOD This study was conducted in two tertiary hospitals in Jakarta, Indonesia. 59 children with CHD, aged 3 months to 18 years, were enrolled consecutively. To determine iron status, hematological parameters (hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin) and biochemical parameters for iron status (serum ferritin, transferrin saturation) were analysed and compared to Ret-He levels. The receiver operating characteristic (ROC) analysis was performed for the Ret-He cut-off points for ID and IDA. Sensitivity, specificity, positive and negative predictive value were calculated for each cut-off point. RESULT Normal iron status was identified in 27 (45.8%) subjects, ID in 8 (13.5%) subjects, and IDA 24 (40.7%) subjects. The ID cut-off value for Ret-He is 28.8 pg (sensitivity 75%, specificity 85.2%, PPV 60%, NPV 92%, and AUC 0.828) and the Ret-He cut-off point for IDA is 28.15 pg (sensitivity 75%, specificity 88.9%, PPV 85.7%, NPV 80%, and AUC 0.824). Hemoglobin should be used in conjunction with Ret-He. ID might be detected in this cohort with Ret-He 28.8 pg and hemoglobin > 16,5 g/dL. While Ret-He 28.15 pg or Ret-He 28.15-28.8 pg with hemoglobin 16.5 g/dL could be used to diagnose IDA. CONCLUSION The reticulocyte hemolgobin equivalent could be utilised as an iron status parameter in pediatric CHD, with a cut-off value of 28.8 pg for ID and 28.15 pg for IDA.
Collapse
Affiliation(s)
- William Cheng
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Piprim Basarah Yanuarso
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Pustika Amalia Wahidiyat
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Syarif Rohimi
- Harapan Kita Women's and Children's Hospital, Jakarta, Indonesia
| | - Partini Pudjiastuti Trihono
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Muzal Kadim
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Dina Muktiarti
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| |
Collapse
|
2
|
Prenzel F, Kaiser T, Willenberg A, Vom Hove M, Flemming G, Fischer L, Kratzsch J, Kiess W, Vogel M. Reference intervals and percentiles for soluble transferrin receptor and sTfR/log ferritin index in healthy children and adolescents. Clin Chem Lab Med 2024; 0:cclm-2024-0369. [PMID: 38965083 DOI: 10.1515/cclm-2024-0369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 06/11/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES Soluble transferrin receptor (sTfR) is a marker of both erythropoiesis and iron status and is considered useful for detecting iron deficiency, especially in inflammatory conditions, but reference intervals covering the entire pediatric age spectrum are lacking. METHODS We studied 1,064 (48.5 % female) healthy children of the entire pediatric age spectrum to determine reference values and percentiles for sTfR and the ratio of sTfR to log-ferritin (sTfR-F index) using a standard immunoturbidimetric assay. RESULTS Soluble TfR levels were highly age-specific, with a peak in infancy and a decline in adulthood, whereas the sTfR-F index was a rather constant parameter. There were positive linear relationships for sTfR with hemoglobin (Hb) (p=0.008) and transferrin (females p<0.001; males p=0.003). A negative association was observed between sTfR and ferritin in females (p<0.0001) and for transferrin saturation and mean corpuscular volume (MCV) in both sexes (both p<0.0001). We found a positive relationship between sTfR and body height, body mass index (BMI) and inflammatory markers (CrP p<0.0001; WBC p=0.0172), while sTfR-F index was not affected by inflammation. CONCLUSIONS Soluble TfR values appear to reflect the activity of infant erythropoiesis and to be modulated by inflammation and iron deficiency even in a healthy cohort.
Collapse
Affiliation(s)
- Freerk Prenzel
- Hospital for Children and Adolescents and Center for Pediatric Research (CPL), 70622 Leipzig University , Leipzig, Germany
| | - Thorsten Kaiser
- Institute for Laboratory Medicine, Microbiology and Pathobiochemistry, University Hospital Ostwestfalen-Lippe (UK-OWL) of Bielefeld University, Detmold, Germany
| | - Anja Willenberg
- 70622 Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig , Leipzig, Germany
| | - Maike Vom Hove
- Hospital for Children and Adolescents and Center for Pediatric Research (CPL), 70622 Leipzig University , Leipzig, Germany
| | - Gunter Flemming
- Hospital for Children and Adolescents and Center for Pediatric Research (CPL), 70622 Leipzig University , Leipzig, Germany
| | - Lars Fischer
- Hospital for Children and Adolescents and Center for Pediatric Research (CPL), 70622 Leipzig University , Leipzig, Germany
| | - Jürgen Kratzsch
- 70622 Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig , Leipzig, Germany
| | - Wieland Kiess
- Hospital for Children and Adolescents and Center for Pediatric Research (CPL), 70622 Leipzig University , Leipzig, Germany
- LIFE Leipzig Research Center for Civilization Diseases, 70622 University of Leipzig , Leipzig, Germany
| | - Mandy Vogel
- Hospital for Children and Adolescents and Center for Pediatric Research (CPL), 70622 Leipzig University , Leipzig, Germany
- LIFE Leipzig Research Center for Civilization Diseases, 70622 University of Leipzig , Leipzig, Germany
| |
Collapse
|
3
|
Poventud-Fuentes I, Chong TH, Dowlin M, Devaraj S, Curry CV. Reticulocyte hemoglobin equivalent as a marker to assess iron deficiency: A large pediatric tertiary care hospital study. Int J Lab Hematol 2024; 46:148-155. [PMID: 37850393 DOI: 10.1111/ijlh.14188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Detection of iron deficiency (ID) remains challenging. We aimed to evaluate the performance of reticulocyte hemoglobin equivalent (Ret-He) as a potential diagnostic marker to assess ID and iron deficiency anemia (IDA) in a large pediatric cohort. METHODS A total of 3158 patients (aged 15 days to 19 years with a median age of 8.5 years; 60.2% female) were retrospectively studied. Statistical analysis was performed (a) to evaluate relationship of Ret-He with other relevant complete blood count and iron panel parameters; (b) to compare the levels of Ret-He in ID and IDA groups to a control group; and (c) to assess sensitivity and specificity of Ret-He in ID, IDA, and anemia without ID groups. RESULTS Ret-He values were significantly positively correlated to ferritin and transferrin saturation (TSAT). The median Ret-He was significantly lower in ID. A Ret-He cutoff of ≤30.0 pg distinguished cases of ID from the control group with a sensitivity of 90.2%, specificity of 59.5%, and area under curve (AUC) of 0.88. Ret-He showed better diagnostic performance in the IDA group and acceptable performance for ID without anemia. The sensitivity, specificity, and AUC were 90.1%, 80.9%, and 0.93 for IDA at cutoff value of ≤27.4 pg, and 80.8%, 51.1%, and 0.70 for ID without anemia at cutoff value of ≤30.8 pg, respectively. CONCLUSION Our large pediatric tertiary care hospital study demonstrates that Ret-He is a reliable marker to help confirm IDA in pediatric population. However, further studies are needed for its use to capture the early stages of ID.
Collapse
Affiliation(s)
- Izmarie Poventud-Fuentes
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
- Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Thomas H Chong
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
- Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Michael Dowlin
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
- Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Sridevi Devaraj
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
- Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Choladda V Curry
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
- Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| |
Collapse
|
4
|
Barr H, Kulkarni K, Singh B, Sandila N, Morrison L, Beach L, Ghotra S. Accuracy of reticulocyte hemoglobin for diagnosing iron deficiency in former very preterm infants: a population-based cohort study. Front Pediatr 2023; 11:1281513. [PMID: 38054186 PMCID: PMC10694249 DOI: 10.3389/fped.2023.1281513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/30/2023] [Indexed: 12/07/2023] Open
Abstract
Background Serum ferritin (SF) is commonly used to diagnose iron deficiency (ID) but has limitations. Reticulocyte hemoglobin (Ret-He) is being increasingly used for ID diagnosis. This study aimed to assess accuracy of Ret-He for ID diagnosis in former very preterm infants (VPI) at 4-6 months corrected age (CA). Methods A retrospective population-based cohort study was conducted on all live VPI born between 23 and 30 weeks of gestational age (GA) in Nova Scotia from 2012 to 2018. Infants underwent SF and Ret-He testing at 4-6 months CA. ID was defined using two definitions. The first defined ID as SF < 20 mcg/L at both 4- and 6-months CA, and the second as SF < 30 mcg at at both 4- and 6-months CA. The accuracy of Ret-He for identifying ID was assessed using the area under the receiver operating characteristic curve (AUC). Results ID was present in 39.7% (62) of 156 infants in the first definition and 59.6% (93) in the second at 4-6 months CA. The AUC of Ret-He for ID diagnosis was 0.64 (p = 0.002) in the first definition and 0.59 (p = 0.04) in the second. The optimal cut-off was 29.4pg in the first and 29.7 in the second definition. The sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) at the 29.4 pg cut-off were 50.0%, 78.7%, 60.8%, and 70.5% for definition 1 and 44.1%, 74.6%, 71.9%, and 47.5% at the 29.7pg cut-off for definition 2. Conclusion Ret-He had low diagnostic accuracy for ID diagnosis in former VPI. Caution is advised when using Ret-He alone for ID diagnosis. Further research is needed to establish optimal approaches for identifying ID in VPI.
Collapse
Affiliation(s)
- Hudson Barr
- Department of Pediatrics, IWK Health Centre, Halifax, NS, Canada
| | - Ketan Kulkarni
- Department of Pediatrics, IWK Health Centre, Halifax, NS, Canada
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Balpreet Singh
- Department of Pediatrics, IWK Health Centre, Halifax, NS, Canada
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Navjot Sandila
- Research Methods Unit, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Lisa Morrison
- Department of Pediatrics, IWK Health Centre, Halifax, NS, Canada
| | - Lori Beach
- Department of Pediatrics, IWK Health Centre, Halifax, NS, Canada
| | - Satvinder Ghotra
- Department of Pediatrics, IWK Health Centre, Halifax, NS, Canada
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
5
|
Ringoringo HP. Prevalence of Iron Deficiency Anemia and Reference Range of Complete Blood Count, Reticulocyte Parameters in Infants Aged 9-11 Months. Int J Gen Med 2022; 15:8017-8024. [PMID: 36348977 PMCID: PMC9637362 DOI: 10.2147/ijgm.s383055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/25/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Iron deficiency anemia (IDA) is still a major global health problem. Determination of reference ranges for complete blood count (CBC), reticulocyte hemoglobin content (Ret-He), immature reticulocyte fraction (IRF), and reticulocyte production index (RPI) are essential to help diagnose a disease. PURPOSE The study aims to know the prevalence of IDA, risk factors that influence it, and set a reference range for CBC and reticulocyte parameters in infants aged 9-11 months in Indonesia. PATIENTS AND METHODS The study was conducted prospectively at 10 Community Health Centers in Banjarbaru, South Kalimantan, Indonesia, from August 2020 to August 2021. RESULTS This study recruited 100 healthy infants (47% boys, 53% girls) aged 9-11 months. The prevalence of IDA was 32%. There is no association between IDA prevalence with the mother's education and occupation, maternal parity, family income, and infant nutritional status (p > 0.05). The reference range for hemoglobin (Hb) at P2.5-P97.5, P3-P97, P5-P95 and mean ± 2SD was 11.06 to 14.34 g/dL, 11.10 to 14.31 g/dL, 11.13 to 13.90 g/dL and 10.57 to 13.65 g/dL, respectively. This study also defined the reference ranges for reticulocyte parameters. CONCLUSION The reference range of CBC, Ret-He, IRF, and RPI for healthy infants aged 9-11 months in this study can be used as a benchmark.
Collapse
Affiliation(s)
- Harapan Parlindungan Ringoringo
- Department of Child Health, Faculty of Medicine, Lambung Mangkurat University – RSD Idaman Banjarbaru, Banjarbaru, South Kalimantan, Indonesia,Correspondence: Harapan Parlindungan Ringoringo, Department of Child Health, Faculty of Medicine, Lambung Mangkurat University – RSD Idaman Banjarbaru, Jalan Citra Megah Raya III No. 14 RT 007/RW 002, Kelurahan Loktabat Utara, Kecamatan Banjarbaru Utara, Banjarbaru, Kalimantan Selatan, 70712, Indonesia, Tel +6282130877777, Email
| |
Collapse
|
6
|
Kılıç M, Özpınar A, Serteser M, Kilercik M, Serdar M. The effect of reticulocyte hemoglobin content on the diagnosis of iron deficiency anemia: A meta-analysis study. J Med Biochem 2022; 41:1-13. [PMID: 35291499 PMCID: PMC8882014 DOI: 10.5937/jomb0-31435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/27/2021] [Indexed: 12/17/2022] Open
Abstract
Background Iron deficiency anemia (IDA) is the most common type of anemia worldwide and has many adverse effects on life quality. This meta-analysis study aims to show that reticulocyte hemoglobin content (CHr) is more effective than routinely used parameters in the diagnosis of IDA. Methods Comprehensive and systematic research was done using international databases including PubMed, Web of Science, Cochrane Library, Science Direct, and Google Scholar, which contain all articles published on IDA until December 29, 2020. Seventeen articles were included in the meta-analysis. Results The analyses found the Cohen's deffect size (Standardized Mean Difference) values of the parameters. Accordingly, CHr is 2.84 (95% CI 2.36 to 3.31), mean corpus volume (MCV) is 2.46 (95% CI 1.97 to 2.95), ferritin is 2.37 (95% CI 1.63 to 3.11), and transferrin saturation (TSAT) is 3.76 (95% CI 2.14 to 5.38). To diagnose IDA, the sensitivity value of the CHr concentration was found as 83.5% (95% CI 76.1 to 89.8), specificity value to be 91.8% (95% CI 85.5 to 96.4), and mean cut-off value as 28.2 pg. Conclusions The results of our study reveal the findings that CHr is a better biomarker than MCV and ferritin used in determining IDA, and its efficacy is lower than TSAT. It is very important to use it routinely for the pre-diagnosis of IDA, which is very important for public health. The groups in the study are heterogeneous but contain bias. Therefore, meta-analyses of studies with less heterogeneity of CHr are needed.
Collapse
Affiliation(s)
- Merve Kılıç
- Acıbadem Mehmet Ali Aydinlar University, School of Medicine, Dept. Medical Biochemistry, Istanbul, Turkey
| | - Aysel Özpınar
- Acıbadem Mehmet Ali Aydinlar University, School of Medicine, Dept. Medical Biochemistry, Istanbul, Turkey
| | - Mustafa Serteser
- Acıbadem Mehmet Ali Aydinlar University, School of Medicine, Dept. Medical Biochemistry, Istanbul, Turkey
| | - Meltem Kilercik
- Acıbadem Mehmet Ali Aydinlar University, School of Medicine, Dept. Medical Biochemistry, Istanbul, Turkey
| | - Muhittin Serdar
- Acıbadem Mehmet Ali Aydinlar University, School of Medicine, Dept. Medical Biochemistry, Istanbul, Turkey
| |
Collapse
|
7
|
Prevalence and associated factors of iron deficiency in Spanish children aged 1 to 11 years. Eur J Pediatr 2021; 180:2773-2780. [PMID: 33759019 DOI: 10.1007/s00431-021-04037-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 01/01/2023]
Abstract
Iron deficiency (ID) is the most common nutritional deficiency affecting children worldwide. Most traditional laboratory parameters to assess ID can be altered by infections or other inflammatory states, including obesity. The aims of this study were to determine the prevalence of ID in healthy children and to analyse associated factors, avoiding potential confounding factors through the use of serum transferrin receptor (sTfR), reticulocyte haemoglobin content and sTfR/log ferritin index. A cross-sectional population-based study was conducted on 951 children aged 1 to 11 years in Almería (Spain). ID was detected in 7.7% of children and iron deficiency anaemia in 0.9%. Multivariate analysis identified the following as independent risk factors: age under 5 years (OR: 2.2, 95% CI: 1.35-3.6); excessive consumption of cow's milk and dairy products (OR: 1.87, 95% CI: 1.13-3.1); and insufficient consumption of vegetables (OR: 2.7, 95% CI: 1.2-6.1).Conclusions: Using a combination of iron status parameters with greater discriminatory power than classical measures, this study detected a considerable iron deficiency prevalence in Spanish children. Younger children and specific dietary habits exhibit a particular risk for ID, so special attention should be paid to this population. What is Known: • Iron deficiency remains the most prevalent nutritional deficit worldwide, and children aged under 3 years are the most vulnerable to this condition. • Accurate assessment of iron status, based on a combination of biochemical indicators, can often be complicated. What is New: • Iron deficiency continues to present a health problem in Spanish children aged 1 to 11 years, considering the serum transferrin receptor and reticulocyte haemoglobin content for diagnosis. • Excessive consumption of dairy products and low consumption of vegetables are independent risk factors for iron deficiency.
Collapse
|
8
|
Gómez-Bueno S, Vázquez-López MA, García-Escobar I, Cabrera-Sevilla JE, Ortiz Pérez M, Bonillo-Perales A, Lendinez-Molinos F. Status of folate in healthy children in Almeria. Eur J Pediatr 2021; 180:1825-1832. [PMID: 33517500 DOI: 10.1007/s00431-020-03902-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 11/27/2022]
Abstract
The objective of this study is to establish reference values for folic acid in a healthy population of children aged 4-11 years and to examine related epidemiological, dietary and analytical factors. A cross-sectional study of 658 healthy children aged 4-11 years was made. Epidemiological, socioeconomic and dietary variables were analysed, the BMI Z-score was obtained, levels of serum folate and serum vitamin B12 were determined and haematological, iron status and erythropoietic activity parameters were examined. The study data were analysed by non-parametric tests and linear multiple regression. The mean folate value was 8.6 ± 4.6 ng/mL (95% reference interval: 2.8-20 ng/mL). A level < 3 ng/mL (5th percentile) was considered as folate deficiency (4.6% of subjects). No child reported symptoms related to this deficiency. Folate values were significantly lower with age (p < 0.01), low NSE and low parental educational level (p: 0.0001). No relationship was found between folates and the analytical variables. According to multivariate linear regression, the variables significantly associated with serum folate were age, socioeconomic level and vitamin B12.Conclusions: Serum folate levels in healthy school children are described. Age, socioeconomic level and serum vitamin B12 are factors associated with folate status. Specific cut-off values for a paediatric population should be defined. What is Known: • Folic acid is an essential micronutrient for optimal growth and development; its deficit is associated with adverse health effects. • The studies on their status and deficit are not comparable due to a lack of agreement on appropriate indicators and reference values. What is New: • This study reports the levels of serum folate in a large population of healthy schoolchildren, with strict inclusion criteria in a developed country and identifies the associated sociodemographic, dietary and analytical (vitamin B12, iron parameters and erythropoietic activity) factors, avoiding potential confusion.
Collapse
Affiliation(s)
- Sara Gómez-Bueno
- Departament of Pediatrics, Hospital Universitario Torrecardenas, Paraje Torrecardenas s/n, 04009, Almería, Spain. .,, Almería, Spain.
| | - Maria A Vázquez-López
- Departament of Pediatrics, Hospital Universitario Torrecardenas, Paraje Torrecardenas s/n, 04009, Almería, Spain
| | - Iciar García-Escobar
- Departament of Pediatrics, Hospital Universitario Torrecardenas, Paraje Torrecardenas s/n, 04009, Almería, Spain
| | | | - María Ortiz Pérez
- Departament of Pediatrics, Hospital Universitario Torrecardenas, Paraje Torrecardenas s/n, 04009, Almería, Spain
| | - Antonio Bonillo-Perales
- Departament of Pediatrics, Hospital Universitario Torrecardenas, Paraje Torrecardenas s/n, 04009, Almería, Spain
| | - Francisco Lendinez-Molinos
- Departament of Pediatrics, Hospital Universitario Torrecardenas, Paraje Torrecardenas s/n, 04009, Almería, Spain
| |
Collapse
|
9
|
Keiner M, Fuchs J, Bauer N, Moritz A. Evaluation of reticulocyte hemoglobin content (RETIC-HGB) for the diagnosis of iron-limited erythropoiesis in cats. Vet Clin Pathol 2021; 49:557-566. [PMID: 33617045 DOI: 10.1111/vcp.12925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Decreased reticulocyte hemoglobin content (CHr) (Siemens ADVIA 2120) reflects iron-limited erythropoiesis (ILE). RETIC-HGB (IDEXX ProCyte Dx) is a novel marker of ILE for veterinary use. OBJECTIVES We aimed to evaluate reference intervals (RIs) and the utility of RETIC-HGB and CHr in the diagnosis of feline ILE. MATERIALS AND METHODS RIs were established in 59 healthy cats. Intra-assay coefficients of variation (CVs) and correlations between RETIC-HGB and CHr were assessed. Two hundred and seventy-five cats were classified as having ILE or not based on low plasma iron or low transferrin saturation along with anemia and/or altered RBC indices. CHr, RETIC-HGB, and serum amyloid A (SAA) were compared between the groups. The sensitivity and specificity of RETIC-HGB and CHr to diagnose ILE were analyzed to determine the RI lower limits. RESULTS RIs for RETIC-HGB and CHr were 12.5-18.0 and 14.0-19.9 pg, respectively. The CV was 3% for both variables. RETIC-HGB and CHr were moderately correlated (rs = 0.59) with a bias of -1.2 picograms (pgs). Twenty of the 275 cats were classified as having ILE. Compared with non-ILE cats, ILE cats had significantly lower median RETIC-HGB (14.3 vs 15.2 pg, P = .0046) and mean CHr (14.7 vs 16.5 pg, P < .0001) values and significantly increased median SAA (44.6 vs 2.3 µg/dl, P < .0001) values. Using the lower RI limits resulted in a low sensitivity and relatively high specificity to diagnose ILE in cats. CONCLUSIONS ILE was characterized by decreased CHr and RETIC-HGB; however, sensitivity was low. The moderate correlation between RETIC-HGB and CHr is likely due to species differences and different methodology.
Collapse
Affiliation(s)
- Miriam Keiner
- Small Animal Clinic, Internal Medicine, Justus-Liebig-University, Giessen, Germany
| | - Jannika Fuchs
- Department of Veterinary Clinical Sciences, Clinical Pathology and Clinical Pathophysiology, Justus-Liebig-University, Giessen, Germany
| | - Natali Bauer
- Department of Veterinary Clinical Sciences, Clinical Pathology and Clinical Pathophysiology, Justus-Liebig-University, Giessen, Germany
| | - Andreas Moritz
- Small Animal Clinic, Internal Medicine, Justus-Liebig-University, Giessen, Germany.,Department of Veterinary Clinical Sciences, Clinical Pathology and Clinical Pathophysiology, Justus-Liebig-University, Giessen, Germany
| |
Collapse
|
10
|
Ruiz-Tudela L, Vázquez-López MA, García-Escobar I, Cabrera-Sevilla JE, Gómez-Bueno S, Martín-Gonzalez M, Muñoz-Vico FJ. Blood Lead Level in a Paediatric Population of South-Eastern Spain and Associated Risk Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1825. [PMID: 33668485 PMCID: PMC7918575 DOI: 10.3390/ijerph18041825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/07/2021] [Accepted: 02/10/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine blood lead levels (BLL) in a healthy paediatric population and to analyse related sociodemographic, dietary and haematological factors. METHODS A cross-sectional study was made of 1427 healthy subjects aged 1-16 years from the city of Almería (south-eastern Spain). BLL, iron parameters and erythropoietin were determined, and sociodemographic and dietary data obtained. The study paramateters was analyses in BLL toxic and BLL no toxic group by multiple logistic regression. RESULTS The mean BLL was 1.98 ± 1.1 µg/dL (95% CI:1.91-2.04). For 5.7% of the population, mean BLL was 2-5 µg/dL, for 2.1% it was >5 µg/dL and for 0.15% it was >10 µg/dL. Multivariate analysis showed that immigrant origin (OR:11.9; p < 0.0001), low level of parental education (OR:4.6; p < 0.02) and low dietary iron bioavailability (OR: 3.2; p < 0.02) were all risk factors for toxic BLL. Subjects with toxic and non-toxic BLL presented similar iron and erythropoiesis-related parameters, except erythrocyte protoporphyrin, which was significantly higher in the BLL >5 µg/dL group. CONCLUSIONS BLL and the prevalence of toxic BLL in healthy subjects aged 1-16 years living in south-eastern Spain are low and similar to those found in other developed countries. The factors associated with toxic BLL are immigrant origin, low level of parental education and dietary iron deficiency. The toxicity of BLL was not related to changes in the analytical parameters studied.
Collapse
Affiliation(s)
- Lucía Ruiz-Tudela
- Departament of Pediatric, Rafael Méndez University Hospital, 30813 Lorca, Spain
| | - Maria Angeles Vázquez-López
- Departament of Pediatric, Torrecárdenas University Hospital, 04009 Almería, Spain; (I.G.-E.); (S.G.-B.); (M.M.-G.)
| | - Iciar García-Escobar
- Departament of Pediatric, Torrecárdenas University Hospital, 04009 Almería, Spain; (I.G.-E.); (S.G.-B.); (M.M.-G.)
| | | | - Sara Gómez-Bueno
- Departament of Pediatric, Torrecárdenas University Hospital, 04009 Almería, Spain; (I.G.-E.); (S.G.-B.); (M.M.-G.)
| | - Manuel Martín-Gonzalez
- Departament of Pediatric, Torrecárdenas University Hospital, 04009 Almería, Spain; (I.G.-E.); (S.G.-B.); (M.M.-G.)
| | | |
Collapse
|
11
|
Prevalence of iron deficiency and related factors in Spanish adolescents. Eur J Pediatr 2020; 179:1587-1595. [PMID: 32342190 DOI: 10.1007/s00431-020-03651-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 04/12/2020] [Accepted: 04/15/2020] [Indexed: 12/21/2022]
Abstract
Iron deficiency anaemia continues to be the world's most important cause of years lived with disability in children and adolescents. Assessment of iron deficiency traditionally depended on laboratory parameters that may be modified by inflammation states, including obesity, which is nowadays a current condition in adolescent population of high-income countries. The present study ascertains the prevalence of iron deficiency and its related factors in adolescents, using the serum transferrin receptor and the reticulocyte haemoglobin content, in order to avoid this confusing effect of classical parameters. A cross-sectional study was conducted on a population-based representative sample for teenagers in Almería (Spain), of 405 subjects aged 12 to 16 years. Iron deficiency was present in 13.3% of adolescents, but iron deficiency anaemia only in 1.2%. Multivariate logistic regression analyses showed that being part of an immigrant family, a low iron bioavailability diet, meat consumption below four times a week and fish consumption below twice a week, were independent risk factors for iron deficiency.Conclusion: This study provides an estimate iron deficiency prevalence of 13.3% in Spanish healthy adolescents, avoiding potential confounding factors through the use of new iron status parameters, based on a wide representative sample of adolescents from the city of Almería. What is Known: • For children and adolescents, iron deficiency anaemia continues to be the world's most important cause of years lived with disability. • Assessment of iron deficiency has traditionally depended on laboratory parameters that may be modified by inflammatory states, including obesity. What is New: • Iron deficiency prevalence and their related factors were analysed in Spanish adolescents, avoiding potential confounding factors through the use of sTfR and CHr. • Being part of an immigrant family and consuming a low iron bioavailability diet are independent risk factors for iron deficiency.
Collapse
|
12
|
Ortíz Pérez M, Vázquez López MA, Ibáñez Alcalde M, Galera Martínez R, Martín González M, Lendínez Molinos F, Bonillo Perales A. Relationship between Obesity and Iron Deficiency in Healthy Adolescents. Child Obes 2020; 16:440-447. [PMID: 32877290 DOI: 10.1089/chi.2019.0276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The relationship between overweight/obesity (excess of weight [EW]) and iron deficiency (ID) is not well defined. Objective: To analyze the relationship between EW and ID in healthy adolescents, assessing the contribution of new diagnostic measures of iron status and erythropoietic activity. Method: A cross-sectional study was made of 405 healthy adolescents, 12-16 years of age. A total of 289 were normal weight (NW) and 116 were otherwise healthy EW. Epidemiological, socioeconomic, diet, BMI Z-score, CRP (C-reactive protein), hematological, iron status, and erythropoietic activity parameters were measured. Statistical tests were Student's, analysis of variance (ANOVA), Chi-square, Pearson's correlation, and odds ratio. Results: ID prevalence in the EW group was 22.6% vs. 29.5% in the NW group (p: 0.3). Greater body weight was associated with lower reticulocyte hemoglobin content (CHr) (NW: 31.3 ± 1.7 pg vs. OW: 30.2 ± 1.7 pg, p: 0.007) and greater CRP (NW: 0.1 ± 0.2 mg/dL vs. OW: 0.2 ± 0.18 mg/dL, p < 0.001), leukocytes (NW: 6.69 ± 1.57 × 103/L vs. OW: 7.43 ± 1.63 × 103/L, p < 0.02), platelets (NW: 265.6 ± 58.9 × 103/L vs. OW: 291.8 ± 54.4 × 103/L, p < 0.002), ferritin (NW: 32.1 ± 17.9 ng/mL vs. OW: 42.8 ± 20.3 ng/mL, p: 0.01), serum transferrin receptor (sTfR) (NW: 1.39 ± 0.4 mg/L vs. OW: 1.73 ± 0.45 mg/L, p: 0.008), sTfR-F index (sTfR/log Ferritin) (NW: 1.06 ± 0.7 vs. OW: 1.33 ± 0.85, p: 0.036) and reticulocyte count (NW: 54.2 ± 18 × 103/L vs. OW: 65.4 ± 24.2 × 103/L, p: 0.003). A positive correlation was observed between the BMI Z-score and CRP, ferritin, sTfR, leukocytes, platelets, and reticulocyte count, and a negative one between the BMI Z-score and CHr and medium corpuscular volume. Conclusions: The prevalence of ID in otherwise healthy EW adolescents was no higher than in NW. The effect of obesity on iron status was low. The findings reveal the concomitant low-grade inflammation, and probably the effect of adiposity on erythropoietic activity. Specific cutoff values for ID in adolescents with OW need to be defined.
Collapse
|
13
|
Mattiello V, Schmugge M, Hengartner H, von der Weid N, Renella R. Diagnosis and management of iron deficiency in children with or without anemia: consensus recommendations of the SPOG Pediatric Hematology Working Group. Eur J Pediatr 2020; 179:527-545. [PMID: 32020331 DOI: 10.1007/s00431-020-03597-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 11/26/2022]
Abstract
Iron deficiency is the most prevalent nutritional deficiency affecting children and adolescents worldwide. A consistent body of epidemiological data demonstrates an increased incidence of iron deficiency at three timepoints: in the neonatal period, in preschool children, and in adolescents, where it particularly affects females.Conclusion: This narrative review focuses on the most suggestive symptoms of iron deficiency in childhood, describes the diagnostic procedures in situations with or without anemia, and provides Swiss expert-based management recommendations for the pediatric context.What is Known:• Iron deficiency (ID) is one of the most common challenges faced by pediatricians.• Significant progress in the diagnosis and therapy of ID has been made over the last decade.What is New:• Our expert panel provides ID management recommendations based on the best available evidence.• They include strategies for ID diagnosis and therapy, both oral and intravenous.
Collapse
Affiliation(s)
- Veneranda Mattiello
- Department "Woman-Mother-Child and Adolescent", Pediatric Hematology-Oncology Unit, Division of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - Markus Schmugge
- Division of Pediatric Hematology, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Heinz Hengartner
- Pediatric Hematology-Oncology Unit, Children's Hospital of Sankt Gallen, Sankt Gallen, Switzerland
| | - Nicolas von der Weid
- Pediatric Hematology-Oncology Department, University Children's Hospital and University of Basel, Basel, Switzerland
| | - Raffaele Renella
- Department "Woman-Mother-Child", Pediatric Hematology-Oncology Unit, Division of Pediatrics, Lausanne University Hospital and University of Lausanne, Vaudois, BH11, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| |
Collapse
|
14
|
Malczewska-Lenczowska J, Surała O, Orysiak J, Turowski D, Szczepańska B, Tomaszewski P. Utility of Novel Hypochromia and Microcythemia Markers in Classifying Hematological and Iron Status in Male Athletes. Nutrients 2019; 11:nu11112767. [PMID: 31739525 PMCID: PMC6893463 DOI: 10.3390/nu11112767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 01/01/2023] Open
Abstract
In athletes, no reliable indices exist for an unambiguous evaluation of hematological and iron status. Therefore, the utility of some new red blood cell (RBC) parameters was explored in 931 elite male athletes aged 13–35 years. To diagnose iron status, the values of ferritin and soluble transferrin receptor (sTfR), total iron binding capacity (TIBC), and basic blood morphology were determined in blood. The new hematological markers included among others: mean cellular hemoglobin content in reticulocytes (CHr), percentage of erythrocytes (HYPOm) and reticulocytes (HYPOr) with decreased cellular hemoglobin concentration, percentage of erythrocytes (LowCHm) and reticulocytes (LowCHr) with decreased cellular hemoglobin content, mean volume of reticulocytes (MCVr), and percentage of erythrocytes with decreased volume (MICROm). Despite adverse changes in reticulocyte hypochromia indices (CHr, LowCHr, HYPOr; p < 0.001) in the iron depletion state, the area under the receiver operating characteristic curve (AUC-ROC) values calculated for them were relatively low (0.539–0.722). In iron-deficient erythropoiesis (IDE), unfavorable changes additionally concern microcythemia indices in both reticulocytes and erythrocytes (MCVr, MCV, MICROm, and red cell volume distribution width—RDW), with especially high values of AUC-ROC (0.947–0.970) for LowCHm, LowCHr, and CHr. Dilutional sports anemia was observed in 6.1% of athletes. In this subgroup, only hemoglobin concentration (Hb), hematocrit (Hct), and RBC (all dependent on blood volume) were significantly lower than in the normal group. In conclusion, the diagnostic utility of the new hematology indices was not satisfactory for the detection of an iron depletion state in athletes. However, these new indices present high accuracy in the detection of IDE and sports anemia conditions.
Collapse
Affiliation(s)
- Jadwiga Malczewska-Lenczowska
- Department of Nutrition Physiology and Dietetics, Institute of Sport, National Research Institute, Trylogii 2/16, 01-982 Warsaw, Poland; (O.S.); (J.O.); (B.S.)
- Correspondence: ; Tel.: +48-22-569-99-00
| | - Olga Surała
- Department of Nutrition Physiology and Dietetics, Institute of Sport, National Research Institute, Trylogii 2/16, 01-982 Warsaw, Poland; (O.S.); (J.O.); (B.S.)
| | - Joanna Orysiak
- Department of Nutrition Physiology and Dietetics, Institute of Sport, National Research Institute, Trylogii 2/16, 01-982 Warsaw, Poland; (O.S.); (J.O.); (B.S.)
| | - Dariusz Turowski
- Department of Biochemistry, Institute of Sport, National Research Institute, Trylogii 2/16, 01-982 Warsaw, Poland;
| | - Beata Szczepańska
- Department of Nutrition Physiology and Dietetics, Institute of Sport, National Research Institute, Trylogii 2/16, 01-982 Warsaw, Poland; (O.S.); (J.O.); (B.S.)
| | - Paweł Tomaszewski
- Department of Biometry, Józef Piłsudski University of Physical Education, Marymoncka 34, 00-968 Warsaw, Poland
| |
Collapse
|
15
|
Amin K, Bansal M, Varley N, Wang H, Amin S. Reticulocyte hemoglobin content as a function of iron stores at 35-36 weeks post menstrual age in very premature infants. J Matern Fetal Neonatal Med 2019; 34:3214-3219. [PMID: 31662016 DOI: 10.1080/14767058.2019.1680631] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Premature infants are born with lower iron stores and are at risk for iron deficiency during early infancy. To prevent iron deficiency, premature infants are routinely supplemented with 2 mg/kg/day oral elemental iron. Reticulocyte hemoglobin content (RET-He), a measure of iron deficiency, has not been well evaluated prior to discharge in premature infants. OBJECTIVES Our objectives were to evaluate RET-He and its correlation with serum ferritin (SF), an index of iron stores, at 35-36 weeks postmenstrual age (PMA) in ≤32 weeks gestational age (GA) infants. METHODS We performed a prospective nested study involving 24-32 weeks GA infants who were receiving 2 mg/kg/day oral elemental iron with full enteral feedings at 35-36 weeks PMA. Infants with the following conditions were excluded: craniofacial malformation, chromosomal disorders, TORCH (toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes simplex), culture-proven sepsis, C-reactive protein >5 mg/l within 10 days of iron status assessment, or erythropoietin therapy. SF and RET-He were measured at 35-36 weeks PMA using chemiluminescence immunoassay and Sysmex XN hematology analyzer, respectively. RET-He <27 pg was deemed indicative of iron deficiency. RESULTS Ninety-eight infants were studied, of which 21 infants had RET-He <27 pg. There was a positive correlation between RET-He and SF (coefficient 0.22, p = .03) that remained significant after controlling for GA (coefficient 0.21, p = .03) and frequency of prior erythrocyte transfusions (coefficient 0.21, p = .03). On stratified analysis, there was a positive correlation between SF and RET-He in females (N = 52, coefficient 0.23, p = .02), but not in males (N = 46, coefficient 0.05). CONCLUSIONS Most premature infants receiving 2 mg/kg/day oral elemental iron are iron replete for erythropoiesis at 35-36 weeks PMA. RET-He increases with an increase in iron stores, suggesting that additional iron supplementation prior to discharge to very premature infants with borderline low RET-He may help prevent iron deficiency during early infancy.
Collapse
Affiliation(s)
- Kanhai Amin
- Student Academic Internship Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Meenakshi Bansal
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center and Rochester General Hospital, Rochester, NY, USA
| | - Nonie Varley
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center and Rochester General Hospital, Rochester, NY, USA
| | - Hongyue Wang
- Department of Biostatistics, University of Rochester Medical Center, Rochester, NY, USA
| | - Sanjiv Amin
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|