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Abstract
Background. Blood donor anemia is due to serum iron spoliation during blood donation. Haemoglobin (Hb) decrease occurs late compared to iron deficiency (ID). Also, Hb level seems to be bad parameter for early diagnosis of ID states in blood donor. Our study aimed to describe the usefulness of Reticulocyte Hemoglobin equivalent (Ret-He) in the early diagnosis of ID states. Material and methods. We conducted a cross-sectional study involving 125 blood donors. We evaluated performances of Ret-He to early diagnose ID states in comparison to Hb, Mean corpuscular volume (MCV), Mean corpuscular haemoglobin (MCH) and Mean corpuscular haemoglobin concentration (MCHC). Results. Anemia concerned 16.8% of study population. ID anemia and ID without anemia occurred in 5.6% and 14.4% respectively. Ret-He had moderate to strong correlation with Hb (r = 0.48), MCV (r = 0.81) and MCH (r = 0.82). At a cut-point of 32 pg/cell, Ret-He had better diagnostic performances for decreased iron stores (Se = 63.3%, Sp = 77.9% and AUC = 0.706; p = 0.001) and absent iron stores (Se = 76.5%, Sp = 75.0% and AUC = 0.757; p = 0.0006) compared to Hb, MCV, MHC and MCHC. Conclusion. Our study shows that Ret-He could be a usefulness tool in anemia and ID management among blood donors in low-income countries.
RÉSUMÉ
Introduction. L'anémie chez les donneurs de sang est due à la spoliation du fer lors du don. La diminution de l'hémoglobine (Hb) survient tardivement comparée à celle du fer. Aussi, le taux d'Hb apparaît être un mauvais paramètre de diagnostic précoce des carences en fer (CF). Notre étude visait à évaluer l'apport de l'équivalent en Hémoglobine des réticulocytes (Ret-He) dans le diagnostic précoce des CF. Matériel et méthodes. Nous avons mené une étude transversale prospective sur 125 donneurs. Nous avons évalué les performances du Ret-He dans le diagnostic précoce des CF par rapport à l'Hb, au Volume globulaire moyen (VGM), à la Teneur corpusculaire moyenne en Hb (TCMH) et à la Concentration corpusculaire moyenne en Hb (CCMH). Résultats. L'anémie concernait 16,8% de la population. Une anémie ferriprive et une CF sans anémie ont été notées respectivement chez 5,6% et 14,4%. Le Ret-He avait une corrélation modérée à forte avec le taux d'Hb (r = 0,48), le VGM (r = 0,81) et la TCMH (r = 0,82). Au seuil de 32 pg/cellule, le Ret-He avait de meilleures performances diagnostiques des déficits en fer (Se = 63,3%, Sp = 77,9% et ROC = 0,706; p = 0,001) et des cas de réserves en fer épuisées (Se = 76,5%, Sp = 75,0% et ROC = 0,757; p = 0,0006) par rapport au taux d’Hb, au VGM, la CCMH et la TCMH. Conclusion. Notre étude montre que le Ret-He pourrait être utile pour le diagnostic de l'anémie et de la CF chez les donneurs dans les pays à faible revenu.
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References
- Goldman M. Iron depletion and routine ferritin measurement in blood donors. ISBT Sci Ser. 2015;10(S1):124-128.
- Fillet A-M, Gross S. Prévention de l’anémie chez les donneurs de sang. Transfus Clin Biol. 2017;24(3):143-147.
- Mittal R, Marwaha N, Basu S, Mohan H, Kumar AR. Evaluation of iron stores in blood donors by serum ferritin. Indian J Med Res. 2006;124:641-646.
- Ziegler AK, Grand J, Stangerup I, et al. Time course for the recovery of physical performance, blood hemoglobin, and ferritin content after blood donation: Time Course of Blood Donation Effects. Transfusion (Paris). 2015;55(4):898-905.
- Stone M, Brambilla D, Murcia K, et al. Feasibility of routine ferritin testing for donor management: validation of delayed processing and demonstration of within donor reproducibility over time: FERRITIN TESTING VALIDATION FOR DONOR MANAGEMENT. Transfusion (Paris). 2016;56(10):2422-2425.
- O’Meara A, Infanti L, Stebler C, et al. The value of routine ferritin measurement in blood donors: FERRITIN IN BLOOD DONORS. Transfusion (Paris). 2011;51(10):2183-2188.
- Tiwari AK, Bhardwaj G, Arora D, et al. Applying newer parameter Ret-He (reticulocyte haemoglobin equivalent) to assess latent iron deficiency (LID) in blood donors-study at a tertiary care hospital in India. Vox Sang. 2018;113(7):639-646.
- Brugnara C, Schiller B, Moran J. Reticulocyte hemoglobin equivalent (Ret He) and assessment of iron-deficient states. Clin Lab Haematol. 2006;28(5):303-308.
- Buttarello M, Pajola R, Novello E, Mezzapelle G, Plebani M. Evaluation of the hypochromic erythrocyte and reticulocyte hemoglobin content provided by the Sysmex XE-5000 analyzer in diagnosis of iron deficiency erythropoiesis. Clin Chem Lab Med CCLM. 2016;54(12):1939–1945.
- Cai J, Wu M, Ren J, et al. Evaluation of the Efficiency of the Reticulocyte Hemoglobin Content on Diagnosis for Iron Deficiency Anemia in Chinese Adults. Nutrients. 2017;9(540):6. doi:10.3390/nu9050450
- Dalimunthe NN, Lubis AR. Usefulness of Reticulocyte Hemoglobin Equivalent in Management of Regular Hemodialysis Patients with Iron Deficiency Anemia. Rom J Intern Med. 2016;54(1):31-36.
- Urrechaga Igartua E, Hoffmann JJML, Izquierdo-Álvarez S, Escanero JF. Reticulocyte hemoglobin content (MCHr) in the detection of iron deficiency. J Trace Elem Med Biol. 2017;43:29-32.
- Toki Y, Ikuta K, Kawahara Y, et al. Reticulocyte hemoglobin equivalent as a potential marker for diagnosis of iron deficiency. Int J Hematol. 2017;106(1):116-125.
- AABB. Updated strategies to limit or prevent iron deficiency in blood donors. AABB Association Bulletin. http://www.aabb.org/programs/publications/bulletins/Docs/ab17-02.pdf. Published 2017. Accessed January 10, 2020.
- Liu X. Classification accuracy and cut point selection. Stat Med. 2012;31(23):2676-2686.
- Dignass A, Farrag K, Stein J. Limitations of Serum Ferritin in Diagnosing Iron Deficiency in Inflammatory Conditions. Int J Chronic Dis. 2018;2018(ID 9394060):1-11.
- Tagny CT, Diarra A, Yahaya R, et al. Characteristics of blood donors and donated blood in sub-Saharan Francophone Africa. Transfusion (Paris). 2009;49(8):1592-1599.
- Jeremiah ZA, Koate BB. Anaemia, iron deficiency and iron deficiency anaemia among blood donors in Port Harcourt, Nigeria. Blood Transfus. 2010;8:113-117.
- Erhabor O, Imrana S, Buhari H, et al. Prevalence of anaemia among blood donors in Sokoto, North Western, Nigeria. Int J Clin Med Res. 2014;1(3):85-89.
- Bakrim S, Ouarour A, Jaidann K, Benajiba M, Masrar A. Profil de l’hémogramme et intérêt de la mesure de l’hémoglobine pré-don chez des donneurs de sang de la région Nord-Ouest du Maroc. Transfus Clin Biol. 2018;25(1):35-43.
- van den Berg K, Swanevelder R, Ingram C, et al. The iron status of South African blood donors: balancing donor safety and blood demand. Transfusion (Paris). 2019;59(1):232-241.
- Kafando E, Sawadogo M, Cotton F, Vertongen F, Gulbis B. Neonatal screening for sickle cell disorders in Ouagadougou, Burkina Faso: a pilot study. J Med Screen. 2005;12(3):112-114.
- De Benoist B, World Health Organization, Centers for Disease Control and Prevention (U.S.). Worldwide Prevalence of Anaemia 1993-2005 of: WHO Global Database of Anaemia. World Health Organization; 2008. Accessed January 12, 2020. http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdf
- Tagny CT, Owusu-Ofori S, Mbanya D, Deneys V. The blood donor in sub-Saharan Africa: a review. Transfus Med. 2010;20(1):1-10.
- OMS. Drépanocytose. In: Rapport du secrétariat. Cinquante-neuvième Assemblée Mondiale de la santé. Organisation Mondiale de la Santé; 2006:310. Accessed January 12, 2020. http://www.apps.who.int/gb/archive/pdf files/WHA59/A59 9-fr.pdf
- Antwi-Baffour S, Asare RO, Adjei JK, Kyeremeh R, Adjei DN. Prevalence of hemoglobin S trait among blood donors: a cross-sectional study. BMC Res Notes. 2015;8(1):583.
- Goldman M, Yi Q, Steed T, O’Brien SF. Changes in minimum hemoglobin and interdonation interval: impact on donor hemoglobin and donation frequency. Transfusion (Paris). 2019;59(5):1734-1741.
- Di Angelantonio E, Thompson SG, Kaptoge S, et al. Efficiency and safety of varying the frequency of whole blood donation (INTERVAL): a randomised trial of 45 000 donors. The Lancet. 2017;390(10110):2360-2371.
- Bialkowski W, Bryant BJ, Schlumpf KS, et al. The strategies to reduce iron deficiency in blood donors randomized trial: design, enrolment and early retention. Vox Sang. 2015;108(2):178-185.
- Nebie K, Sawadogo S, Kafando E, et al. Apports du contrôle qualité produits finis dans l’amélioration de la qualité des produits sanguins labiles au Centre régional de transfusion sanguine de Ouagadougou (Burkina Faso), 2014. Transfus Clin Biol. 2017;24(4):431-439.
- Archer NM, Brugnara C. Diagnosis of iron-deficient states. Crit Rev Clin Lab Sci. 2015;52(5):256-272.
- Nadarajan V, Sthaneshwar P, Eow GI. Use of red blood cell indices for the identification of iron deficiency among blood donors. Transfus Med. 2008;18(3):184-189.
- Semmelrock MJ, Raggam RB, Amrein K, et al. Reticulocyte hemoglobin content allows early and reliable detection of functional iron deficiency in blood donors. Clin Chim Acta. 2012;413(7-8):678-682.
- Urrechaga E, Borque L, Escanero JF. Erythrocyte and reticulocyte indices in the assessment of erythropoiesis activity and iron availability. Int J Lab Hematol. 2013;35(2):144-149.
- Peerschke EIB, Pessin MS, Maslak P. Using the Hemoglobin Content of Reticulocytes (RET-He) to Evaluate Anemia in Patients With Cancer. Am J Clin Pathol. 2014;142(4):506-512.
- Rungngu SLP, Wahani A, Mantik MFJ. Reticulocyte hemoglobin equivalent for diagnosing iron deficiency anemia in children. Paediatr Indones. 2016;56(2):90-94.
- Sanyoto A, Suega K, Adnyana L, Bakta IM. Diagnostic Test Equivalent Hemoglobin Reticulocyte in Iron Deficiency Anemia. Indones Biomed J. 2017;9(3):143-146.
- Poffenroth C, Mabbett C. The reticulocyte haemoglobin equivalent (RET_He) and laboratory screening for iron deficiency. N Z J Med Lab Sci. 2017;71:120-123.
- Jarc E, Preložnik Zupan I, Buturović Ponikvar J, Snoj N, Podgornik H. Comparison of erythrocyte and reticulocyte indices for the diagnosis of iron deficiency. Zdr Vestn. 2017;86(1-2):19–27.
References
Goldman M. Iron depletion and routine ferritin measurement in blood donors. ISBT Sci Ser. 2015;10(S1):124-128.
Fillet A-M, Gross S. Prévention de l’anémie chez les donneurs de sang. Transfus Clin Biol. 2017;24(3):143-147.
Mittal R, Marwaha N, Basu S, Mohan H, Kumar AR. Evaluation of iron stores in blood donors by serum ferritin. Indian J Med Res. 2006;124:641-646.
Ziegler AK, Grand J, Stangerup I, et al. Time course for the recovery of physical performance, blood hemoglobin, and ferritin content after blood donation: Time Course of Blood Donation Effects. Transfusion (Paris). 2015;55(4):898-905.
Stone M, Brambilla D, Murcia K, et al. Feasibility of routine ferritin testing for donor management: validation of delayed processing and demonstration of within donor reproducibility over time: FERRITIN TESTING VALIDATION FOR DONOR MANAGEMENT. Transfusion (Paris). 2016;56(10):2422-2425.
O’Meara A, Infanti L, Stebler C, et al. The value of routine ferritin measurement in blood donors: FERRITIN IN BLOOD DONORS. Transfusion (Paris). 2011;51(10):2183-2188.
Tiwari AK, Bhardwaj G, Arora D, et al. Applying newer parameter Ret-He (reticulocyte haemoglobin equivalent) to assess latent iron deficiency (LID) in blood donors-study at a tertiary care hospital in India. Vox Sang. 2018;113(7):639-646.
Brugnara C, Schiller B, Moran J. Reticulocyte hemoglobin equivalent (Ret He) and assessment of iron-deficient states. Clin Lab Haematol. 2006;28(5):303-308.
Buttarello M, Pajola R, Novello E, Mezzapelle G, Plebani M. Evaluation of the hypochromic erythrocyte and reticulocyte hemoglobin content provided by the Sysmex XE-5000 analyzer in diagnosis of iron deficiency erythropoiesis. Clin Chem Lab Med CCLM. 2016;54(12):1939–1945.
Cai J, Wu M, Ren J, et al. Evaluation of the Efficiency of the Reticulocyte Hemoglobin Content on Diagnosis for Iron Deficiency Anemia in Chinese Adults. Nutrients. 2017;9(540):6. doi:10.3390/nu9050450
Dalimunthe NN, Lubis AR. Usefulness of Reticulocyte Hemoglobin Equivalent in Management of Regular Hemodialysis Patients with Iron Deficiency Anemia. Rom J Intern Med. 2016;54(1):31-36.
Urrechaga Igartua E, Hoffmann JJML, Izquierdo-Álvarez S, Escanero JF. Reticulocyte hemoglobin content (MCHr) in the detection of iron deficiency. J Trace Elem Med Biol. 2017;43:29-32.
Toki Y, Ikuta K, Kawahara Y, et al. Reticulocyte hemoglobin equivalent as a potential marker for diagnosis of iron deficiency. Int J Hematol. 2017;106(1):116-125.
AABB. Updated strategies to limit or prevent iron deficiency in blood donors. AABB Association Bulletin. http://www.aabb.org/programs/publications/bulletins/Docs/ab17-02.pdf. Published 2017. Accessed January 10, 2020.
Liu X. Classification accuracy and cut point selection. Stat Med. 2012;31(23):2676-2686.
Dignass A, Farrag K, Stein J. Limitations of Serum Ferritin in Diagnosing Iron Deficiency in Inflammatory Conditions. Int J Chronic Dis. 2018;2018(ID 9394060):1-11.
Tagny CT, Diarra A, Yahaya R, et al. Characteristics of blood donors and donated blood in sub-Saharan Francophone Africa. Transfusion (Paris). 2009;49(8):1592-1599.
Jeremiah ZA, Koate BB. Anaemia, iron deficiency and iron deficiency anaemia among blood donors in Port Harcourt, Nigeria. Blood Transfus. 2010;8:113-117.
Erhabor O, Imrana S, Buhari H, et al. Prevalence of anaemia among blood donors in Sokoto, North Western, Nigeria. Int J Clin Med Res. 2014;1(3):85-89.
Bakrim S, Ouarour A, Jaidann K, Benajiba M, Masrar A. Profil de l’hémogramme et intérêt de la mesure de l’hémoglobine pré-don chez des donneurs de sang de la région Nord-Ouest du Maroc. Transfus Clin Biol. 2018;25(1):35-43.
van den Berg K, Swanevelder R, Ingram C, et al. The iron status of South African blood donors: balancing donor safety and blood demand. Transfusion (Paris). 2019;59(1):232-241.
Kafando E, Sawadogo M, Cotton F, Vertongen F, Gulbis B. Neonatal screening for sickle cell disorders in Ouagadougou, Burkina Faso: a pilot study. J Med Screen. 2005;12(3):112-114.
De Benoist B, World Health Organization, Centers for Disease Control and Prevention (U.S.). Worldwide Prevalence of Anaemia 1993-2005 of: WHO Global Database of Anaemia. World Health Organization; 2008. Accessed January 12, 2020. http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdf
Tagny CT, Owusu-Ofori S, Mbanya D, Deneys V. The blood donor in sub-Saharan Africa: a review. Transfus Med. 2010;20(1):1-10.
OMS. Drépanocytose. In: Rapport du secrétariat. Cinquante-neuvième Assemblée Mondiale de la santé. Organisation Mondiale de la Santé; 2006:310. Accessed January 12, 2020. http://www.apps.who.int/gb/archive/pdf files/WHA59/A59 9-fr.pdf
Antwi-Baffour S, Asare RO, Adjei JK, Kyeremeh R, Adjei DN. Prevalence of hemoglobin S trait among blood donors: a cross-sectional study. BMC Res Notes. 2015;8(1):583.
Goldman M, Yi Q, Steed T, O’Brien SF. Changes in minimum hemoglobin and interdonation interval: impact on donor hemoglobin and donation frequency. Transfusion (Paris). 2019;59(5):1734-1741.
Di Angelantonio E, Thompson SG, Kaptoge S, et al. Efficiency and safety of varying the frequency of whole blood donation (INTERVAL): a randomised trial of 45 000 donors. The Lancet. 2017;390(10110):2360-2371.
Bialkowski W, Bryant BJ, Schlumpf KS, et al. The strategies to reduce iron deficiency in blood donors randomized trial: design, enrolment and early retention. Vox Sang. 2015;108(2):178-185.
Nebie K, Sawadogo S, Kafando E, et al. Apports du contrôle qualité produits finis dans l’amélioration de la qualité des produits sanguins labiles au Centre régional de transfusion sanguine de Ouagadougou (Burkina Faso), 2014. Transfus Clin Biol. 2017;24(4):431-439.
Archer NM, Brugnara C. Diagnosis of iron-deficient states. Crit Rev Clin Lab Sci. 2015;52(5):256-272.
Nadarajan V, Sthaneshwar P, Eow GI. Use of red blood cell indices for the identification of iron deficiency among blood donors. Transfus Med. 2008;18(3):184-189.
Semmelrock MJ, Raggam RB, Amrein K, et al. Reticulocyte hemoglobin content allows early and reliable detection of functional iron deficiency in blood donors. Clin Chim Acta. 2012;413(7-8):678-682.
Urrechaga E, Borque L, Escanero JF. Erythrocyte and reticulocyte indices in the assessment of erythropoiesis activity and iron availability. Int J Lab Hematol. 2013;35(2):144-149.
Peerschke EIB, Pessin MS, Maslak P. Using the Hemoglobin Content of Reticulocytes (RET-He) to Evaluate Anemia in Patients With Cancer. Am J Clin Pathol. 2014;142(4):506-512.
Rungngu SLP, Wahani A, Mantik MFJ. Reticulocyte hemoglobin equivalent for diagnosing iron deficiency anemia in children. Paediatr Indones. 2016;56(2):90-94.
Sanyoto A, Suega K, Adnyana L, Bakta IM. Diagnostic Test Equivalent Hemoglobin Reticulocyte in Iron Deficiency Anemia. Indones Biomed J. 2017;9(3):143-146.
Poffenroth C, Mabbett C. The reticulocyte haemoglobin equivalent (RET_He) and laboratory screening for iron deficiency. N Z J Med Lab Sci. 2017;71:120-123.
Jarc E, Preložnik Zupan I, Buturović Ponikvar J, Snoj N, Podgornik H. Comparison of erythrocyte and reticulocyte indices for the diagnosis of iron deficiency. Zdr Vestn. 2017;86(1-2):19–27.