Reticulocyte hemoglobin and hypochromic erythrocytes in the study of erythropoiesis in patients with inflammatory bowel disease

Abstract

Anemia due to lack of iron (absolute or functional deficiency) is a common complication of inflammatory bowel disease (IBD). We investigated the potential utility of reticulocyte hemoglobin content (Ret-He) and percentage of hypochromic red cells (Hypo-He) in the assessment of erythropoiesis. We recruited 123 anemic outpatients with IBD. Biochemical tests for iron deficiency were carried out. Full blood counts were performed on a XN 20 system (Sysmex Diagnostics). Differences among groups were studied using analysis of variance and post-hoc tests, considering p < .05 to be significant. Receiver operating characteristic analysis was used to assess the diagnostic performance of Ret-He and Hypo-He for detecting iron-deficient erythropoiesis. The gold standard used for diagnosing iron deficiency was soluble transferrin receptor (sTfR), with a cut-off of >52 nmol/L. Overall, 60 patients had iron deficiency anemia (IDA), 27 anemia of chronic disease (ACD) and 36 mixed ACD + IDA. Ret-He showed the best performance, with an area under curve (AUC) of 0.858 (95% CI 0.816–0.952), considering a cut-off of 30.0 pg, sensitivity of 76.8% and specificity of 99.8% (vs. AUC 0.727 [95% CI 0.624–0.814], considering a cut-off of 4.0%, sensitivity 72.0% and specificity 72.5% for Hypo-He). Ret-He and Hypo-He can be used to assess iron supply for erythropoiesis in patients with IBD, to evaluate long-term (Hypo-He) and short-term (Ret-He) periods.

Keywords:

• Anemia
• iron metabolism
• gastrointestinal diseasesreticulocyte hemoglobin
• hypochromic cells

Disclosure statement

The authors have no conflicts to declare. The authors alone are responsible for the content of the paper. None of the authors has accepted any funding or support from an organization that may in any way gain or lose financially from the results of the present study.