title: Evaluation of red cell and reticulocyte parameters as indicative of iron deficiency in patients with anemia of chronic disease.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the effectiveness of mature red cell and reticulocyte parameters under three conditions: iron deficiency anemia, anemia of chronic disease, and anemia of chronic disease associated with absolute iron deficiency.
  
  
  METHODS
  Peripheral blood cells from 117 adult patients with anemia were classified according to iron status, and inflammatory activity, and the results of a hemoglobinopathy investigation as: iron deficiency anemia (n=42), anemia of chronic disease (n=28), anemia of chronic disease associated with iron deficiency anemia (n=22), and heterozygous β thalassemia (n=25). The percentage of microcytic red cells, hypochromic red cells, and levels of hemoglobin content in both reticulocytes and mature red cells were determined. Receiver operating characteristic analysis was used to evaluate the accuracy of the parameters in differentiating between the different types of anemia.
  
  
  RESULTS
  There was no significant difference between the iron deficient group and anemia of chronic disease associated with absolute iron deficiency in respect to any parameter. The percentage of hypochromic red cells was the best parameter to discriminate anemia of chronic disease with and without absolute iron deficiency (area under curve=0.785; 95% confidence interval: 0.661-0.909, with sensitivity of 72.7%, and specificity of 70.4%; cut-off value 1.8%). The formula microcytic red cells minus hypochromic red cells was very accurate in differentiating iron deficiency anemia and heterozygous β thalassemia (area under curve=0.977; 95% confidence interval: 0.950-1.005; with sensitivity of 96.2%, and specificity of 92.7%; cut-off value 13.8).
  
  
  CONCLUSIONS
  The indices related to red cells and reticulocytes have a moderate performance in identifying absolute iron deficiency in patients with anemia of chronic disease.
authors.affiliation: Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Ana Beatriz Barbosa
authors.initials: AB
authors.lastname: Torino
authors.affiliation: Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Maria de Fátima Pererira
authors.initials: Mde F
authors.lastname: Gilberti
authors.affiliation: Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Edvilson
authors.initials: E
authors.lastname: da Costa
authors.affiliation: Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Gisélia Aparecida Freire
authors.initials: GA
authors.lastname: de Lima
authors.affiliation: Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil. Electronic address: lenagrotto@gmail.com.
authors.forename: Helena Zerlotti Wolf
authors.initials: HZ
authors.lastname: Grotto
keywords: Anemia, Iron-deficiency; Automation; Erythropoiesis; Red cell indices; Reticulocytes