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CC BY 4.0 · Indian J Med Paediatr Oncol
DOI: 10.1055/s-0044-1779047
Original Article

The Role of Reticulocyte Hemoglobin Content in Diagnosing Iron Deficiency in Childhood Cancer

Murti Andriastuti 
1   Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
,
Anisa Dwi Fathinasari
2   Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
,
Afifa Fahriyani
1   Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
,
Kanthi Soraca Widiatmika
2   Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
,
Khansa Salsabila
2   Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
,
Fitri Primacakti
1   Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
› Author Affiliations Funding This study was supported by the International Indexed Publication (Publikasi Terindeks Internasional or PUTI) Universitas Indonesia research grant.
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Abstract

Background The prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) in children with cancer is not well studied. The detection of ID and IDA using sensitive laboratory tools may facilitate early diagnosis and treatment in this cohort. In this regard, reticulocyte hemoglobin (Ret-He) content serves as a cost-effective measurement that remains unaffected by inflammation, unlike the ferritin test.

Aim The objective of this study is to analyze the role of Ret-He as a diagnostic tool to identify functional and absolute ID and IDA in children with cancer.

Methods We conducted a cross-sectional study in children aged 0 to 18 years. Blood samples were collected to compare Ret-He values with iron status, reflected by hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), serum iron (SI), total iron binding capacity (TIBC), and ferritin and transferrin saturation. The overall discriminative power of Ret-He in detecting ID and IDA was assessed using receiver operating characteristic analysis.

Results Of the 135 children included in the study, 58 (43.0%) had anemia. Among them, 20 (14.8%) had IDA (8 [5.9%] absolute and 12 [8.9%] functional), while 25 (18.5%) had ID (16 [11.9%] absolute and 9 [6.7%] functional). The Ret-He value was significantly related to iron status (p ≤ 0.002). Ret-He was also shown to have a significant correlation with the abovementioned hematological parameters (p = 0.000), except TIBC. Multivariate analysis revealed a significant relationship between Hb (p = 0.051), MCH (p = 0.000), and MCHC (p = 0.001) and Ret-He. Ret-He values of 33.7, 32.7, 32.4 and 28.6 pg were established as optimal cut-off values to identify functional ID, absolute ID, functional IDA, and absolute IDA, respectively.

Conclusion Ret-He is a reliable diagnostic tool for absolute and functional IDA in children with cancer.

Keywords

absolute ID - absolute IDA - childhood cancer - functional ID - functional IDA - hemoglobin - Ret-He

Patient Consent

Patient consent was obtained from every subject.


Supplementary Material



Publication History

Article published online:
21 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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