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Abstract
Background
Iron deficiency anemia (IDA) is the most common anemia followed by anemia of chronic disease (ACD). Reticulocyte indices have been shown to be helpful indicators for detecting IDA. We investigated whether RBC and reticulocyte indices can be used to differentiate ACD from IDA.
Methods
A total of 85 women showing microcytic hypochromic anemia (38 IDA and 47 ACD cases) were enrolled. IDA was defined as those with ferritin level of <6 µg/dL and total iron binding capacity (TIBC) of >450 µg/dL. ACD was defined as ferritin level of ≥6 µg/dL, TIBC of ≤450 µg/dL, and presence of underlying diseases. We measured complete blood count, TIBC, iron, ferritin, and RBC and reticulocyte indices. The mean values of each item were compared between the two groups and sensitivity and specificity of each item in the differential diagnosis of ACD from IDA were determined by ROC curve analysis.
Results
In ACD, most of the RBC and reticulocyte indices were significantly higher than in IDA: mean cell volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), cellular hemoglobin concentration mean (CHCM), cellular hemoglobin content (CH), red cell distribution width (RDW), reticulocyte hemoglobin content (CHr), and mature RBC cellular hemoglobin content (CHm). All these indices, except MCV showed significant correlations with ferritin and/or TIBC. CHr level of ≥24.6 pg could be used to differentiate ACD from IDA with 85.1% sensitivity and 81.6% specificity.
Figures and Tables
Fig. 1
Comparison of receiver operating characteristic curves for differential diagnosis of anemia of chronic disease from iron deficiency anemia.
Abbreviations: CH, cellular hemoglobin content; CHr, reticulocyte hemoglobin content.
Table 1
Comparison of RBC and reticulocyte indices between anemia of chronic disease and iron deficiency anemia
Data were expressed as medians and interquartile ranges in parentheses.
*Mann-Whitney U-test.
Abbreviations: ACD, anemia of chronic disease; IDA, iron deficieny anemia; Hgb, hemoglobin; Hct, hemotocrit; MCV, mean cell volume; MCH, mean cell hemoglobin; MCHC, mean cell hemoglobin concentration; CHCM, cellular hemoglobin concentration mean; CH, cellular hemoglobin content; RDW, red cell distribution width; HDW, hemoglobin concentration distribution width; CHr, reticulocyte hemoglobin content; CHm, mature RBC cellular hemoglobin content.
Table 2
Areas under the ROC curves of RBC and reticulocyte indices for differential diagnosis of anemia of chronic disease from iron deficiency anemia
Abbreviations: AUC, area under the curve; CI, confidence interval; others, See Table 1.
Table 3
Cut-off CHr level for differential diagnosis of anemia of chronic disease from iron deficiency anemia
Table 4
Correlation coefficients between RBC and reticulocyte indices and ferritin and TIBC
*P<0.01; †P<0.05 by Pearson correlation.
Abbreviations: TIBC, total iron binding capacity; others, See Table 1.
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