Evaluation of the Diagnostic Value of Ret-He among Sickle Cell Disease Children with Iron Deficiency Anaemia on Haematinics

Introduction: The determination of the amount of hemoglobin in reticulocytes provides a more real-time assessment of the iron status of the bone marrow. Ret-He, the iron molecule found in reticulocytes, unlike most biochemical markers is not affected by inflammation. Hence its determination provides a better way of detecting the presence or absence of iron for erythropoiesis.

Objectives: The aim of the study was to evaluate the diagnostic value of Ret-He and to compare it with serum ferritin and Red Blood Cell (RBC) indices: haemoglobin (Hb), Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH) and Red Cell Distribution Width (RDW) in detecting iron deficiency among Sickle Cell Disease (SCD) children.

Materials and Methods: 89 SCD children attending KATH sickle cell clinic were enrolled in the study. Complete Blood Count (CBC), Reticulocyte haemoglobin content (Ret-He) and biochemical tests [ferritin and C - reactive protein (CRP)] were performed from venous blood samples. Iron deficiency anaemia (IDA) was diagnosed when subject’s Hb, MCV, MCH, RDW, serum ferritin and Ret-He were below cut-off values.

Results: Receiver Operating Characteristic (ROC) analysis showed the following results: RBC indices (AUC=0.953, sensitivity=90.7%, specificity=100%, p <0.05), Ret-He (AUC=0.647, sensitivity=34.9%, specificity=94.4%, p > 0.05) and serum ferritin (AUC=0.476, sensitivity=90.2%, specificity=11.1%, p > 0.05).

Conclusion: The findings of this study suggest that the red cell indices is the most accurate, sensitive and specific among the three diagnostics tools used in this study to detect IDA in SCD children on hematinics.