الفهرس 
Iron Homeostasis and Iron Deficiency
Causes of iron deficiencyOnly 14 pages are availabe for public view
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Abstract
Anemia is a significant worldwide health problem. Approximately one third of the world’s population suffers from anemia, half of which is due to iron deficiency. Iron deficiency has bad sequelae on the cognitive and physical functions and on the growth and development of children. It also increases maternal complications.
Signs and symptoms are nonspecific and so the diagnosis of iron deficiency comes from the laboratory.
Diagnosis of iron deficiency anemia requires information on several parameters such as hematocrite, mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) as well as iron metabolism markers as serum iron, serum ferritin level and TIBC. Serum ferritin is the most effective test to detect iron deficiency, however false positive serum ferritin values may be observed in inflammation, malignancy or liver disease.
The life span of the mature red blood cells is about 120 days so using the RBC indices will delay the diagnosis of iron deficiency. Thus the requirement of a simple, rapid and reliable parameters to assess the iron status is mandatory.
With the life span of the reticulocytes being only two to three days, hence measuring the reticulocyte parameters is an early predictor of iron deficiency.The latest hematology analyzers made it possible to quantitate the reticulocyte hemoglobin content (RET- He) by flowcytometry principle. This directly assess iron incorporation in to erythrocyte hemoglobin, reflecting iron status. Moreover RET –He can be used to follow up response to iron supplementation.
Ret- He is a sensitive marker of iron deficiency especially in children, pregnant women and blood donors. It is also very useful in assessing iron status in patients on hemodialysis. It is not acute phase reactant and measured in the same blood sample used for routine CBC.
In this study, we aimed to assess the role of reticulocyte hemoglobin equivalent (RET- He) in the diagnosis of iron deficiency anemia.
This study is a case control study that was conducted on patients attending Ain Shams University Hospitals. The study took place from December 2017 till May 2018. Subjects were classified in 4 groups:
group (1): Included 52 iron deficient patients with low serum ferritin.
group (2): Included 16 iron deficient anemia patients with both low serum ferritin and hemoglobin concentration.
group (3): 14 patients with anemia of chronic disorder (ACD)
group (4): 20 race, sex and age matched healthy subjects as control.
Informed oral consent was taken from the participants.The following laboratory tests were done for all participants: Complete blood count. Iron profile (sFe, ferritin and TIBC). RET using Sysmex XN1000 hematology analyzer.
Upon comparing the cases (IDA+ID without anemia) and controls regarding RET- He, there was a highly significant statistical difference between the two groups (p<0.001).
On comparing the four groups regarding RET- He, the lowest value for RET- He was detected in the IDA group (median= 17.1 pg). A highly significant statistical difference was found between the IDA and the other three groups (ID without anemia, ACD and control) (p< 0.001). On the other hand, there was no significant difference between the control and ID without anemia.
Pearson‘s correlation test was done for correlation of RET- He with Hb, RBC indices, sFe, TIBC, and TSAT. It revealed that, in the IDA group RET-He was positively correlated with Hb, sFe, MCV, MCH, ferritin and TSAT and correlated negatively with TIBC.
Finally, ROC curve analysis was done to assess the diagnostic performance of RET- He in diagnosis of iron deficiency anemia. The area under ROC curve (AUC) of RET- He as a diagnostic marker exceeded that of ferritin, showing that RET- He is a more useful marker for diagnosis of IDA. Cutoff value of ≤ 26.5 pg had the best overall sensitivity (80%) and specificity (90%).
from all our previous findings, we can say that RET- He is a useful marker for diagnosis of IDA.