title: An algorithm using reticulocyte hemoglobin content (CHr) measurement in screening adolescents for iron deficiency.
abstract: OBJECTIVE
  To evaluate whether the use of an algorithm including reticulocyte hemoglobin content (CHr), a new hematologic parameter, in addition to the screening complete blood count (CBC), improves detection of iron deficiency and iron deficiency anemia in healthy adolescents.
  
  
  METHODS
  After initiation of an algorithm using CHr in addition to CBC results for identifying iron-deficient patients in a primary care hospital-based adolescent clinic, we reviewed results of all hematological tests performed in the clinic during an 8-month period. Electronic medical records were screened for health status and inclusion criteria. We determined the number of patients with low hematocrit values, low mean cell volume (MCV), and low CHr. To evaluate the impact of the protocol, we calculated the percentage of cases in which the CHr results suggested a management plan different from that which would have been formulated using the CBC results only.
  
  
  RESULTS
  A total of 381 patients (mean age 16.8 +/- 3.1 years) were included in the study. Anemia was diagnosed by the Centers for Disease Control (CDC) guidelines in 63 patients (16.5%), low MCV in 170 patients (44.6%), and a low CHr in 80 (21%) patients. In 68% of anemia cases, a normal CHr suggested that iron deficiency was not the cause of the anemia. Although low MCV values were found in 38 (60.4%) of all anemic cases, mean MCV was significantly (p < 0.001) lower in the 19 cases with a low CHr as well. In 19% of 318 patients with a normal hematocrit (HCT), a low CHr suggested the need for treatment of early iron deficiency. In 103 (27%) cases, CHr suggested a different treatment plan from that which would have been formulated using the screening CBC only.
  
  
  CONCLUSIONS
  The use of an algorithm including CHr to screen for iron deficiency anemia may increase the accuracy of diagnosis, enabling early detection and treatment of iron deficiency in adolescents without the need for additional costly iron studies.
authors.affiliation: Division of Adolescent/Young Adult Medicine, Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA
authors.forename: Nava
authors.initials: N
authors.lastname: Stoffman
authors.forename: Carlo
authors.initials: C
authors.lastname: Brugnara
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Woods
mesh_terms: D000293:Adolescent; D000295:Adolescent Medicine; D000465:Algorithms; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000175:diagnosis*; D002648:Child; D004909:Erythrocyte Indices; D005260:Female; D006454:Hemoglobins; D006801:Humans; D000090463:Iron Deficiencies; D008297:Male; D017701:Reticulocyte Count
chemical_list: D006454:Hemoglobins