title: Evaluation of erythrocyte and reticulocyte parameters as indicative of iron deficiency in patients with anemia of chronic disease.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effectiveness of mature red cell and reticulocyte parameters to identify 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, inflammation, and hemoglobinopathies 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 erythrocytes, hypochromic erythrocytes, and the levels of hemoglobin in both reticulocytes and mature red cells were determined. Receiver operating characteristic analysis was used to evaluate the accuracy of the parameters in differentiating anemia.
  
  
  RESULTS
  There was no difference between the groups of iron deficiency and anemia of chronic disease associated with absolute iron deficiency for any of the parameters. The percentage of hypochromic erythrocytes was the best parameter to identify absolute iron deficiency in patients with anemia of chronic disease (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 erythrocyte count minus hypochromic erythrocyte count was very accurate to differentiate iron deficiency anemia from heterozygous β-thalassemia (area under curve=0.977; 95% confidence interval: 0.950-1.005 with a sensitivity of 96.2%, and specificity of 92.7%; cut-off value 13.8).
  
  
  CONCLUSIONS
  The erythrocyte and reticulocyte indices are moderately good to identify 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; Erythrocyte indices; Erythropoiesis; Reticulocytes
references.citation: Eur J Pediatr. 2010 Sep;169(9):1097-104
references.pmid: 20336466
references.citation: Int J Lab Hematol. 2007 Oct;29(5):341-6
references.pmid: 17824914
references.citation: Int J Lab Hematol. 2011 Feb;33(1):30-6
references.pmid: 20492000
references.citation: Clin Chem Lab Med. 2009;47(11):1411-6
references.pmid: 19817651
references.citation: Haematologica. 2014 Sep;99(9):e171-3
references.pmid: 24895340
references.citation: Br J Haematol. 2001 Oct;115(1):84-9
references.pmid: 11722416
references.citation: Haematologica. 1998 Nov;83(11):963-6
references.pmid: 9864913
references.citation: Crit Rev Clin Lab Sci. 2000 Apr;37(2):93-130
references.pmid: 10811141
references.citation: Eur J Intern Med. 2013 Jan;24(1):63-6
references.pmid: 23063249
references.citation: J Clin Lab Anal. 2011;25(3):223-8
references.pmid: 21567473
references.citation: Pediatr Nephrol. 2004 Jun;19(6):655-61
references.pmid: 15064942
references.citation: Lab Hematol. 2005;11(1):14-23
references.pmid: 15790548
references.citation: Haematologica. 2005 Aug;90(8):1133-4
references.pmid: 16079114
references.citation: J Adolesc Health. 2005 Jun;36(6):529
references.pmid: 15909357
references.citation: Int J Lab Hematol. 2011 Feb;33(1):37-44
references.pmid: 20491998
references.citation: Clin Lab Haematol. 2006 Oct;28(5):303-8
references.pmid: 16999719
references.citation: Kidney Int. 2001 Dec;60(6):2406-11
references.pmid: 11737617
references.citation: Am J Clin Pathol. 2012 Aug;138(2):300-4
references.pmid: 22904143
references.citation: Nephrol Dial Transplant. 2001 Jul;16(7):1416-23
references.pmid: 11427634
references.citation: Blood. 1997 Feb 1;89(3):1052-7
references.pmid: 9028338
references.citation: Int J Lab Hematol. 2012 Dec;34(6):605-13
references.pmid: 22765164
references.citation: Blood. 2009 May 21;113(21):5277-86
references.pmid: 19293425