Clinical Significance of Reticulocyte Maturation Parameters in the Differential Diagnosis of Macrocytic Anemias

Mi Hyang Kim

doi:10.3343/kjlm.2007.27.1.13

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Kim: Clinical Significance of Reticulocyte Maturation Parameters in the Differential Diagnosis of Macrocytic Anemias

Original Article

Korean J Leg Med 2007;27(1):13-18.

Published online: 10 February 2007

DOI: https://doi.org/10.3343/kjlm.2007.27.1.13

Clinical Significance of Reticulocyte Maturation Parameters in the Differential Diagnosis of Macrocytic Anemias

Mi Hyang Kim, M.D.

Department of Laboratory Medicine, College of Medicine, Kosin University, Busan, Korea

Received 29 July 2006 Revised 4 December 2006 Accepted 6 December 2006

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Macrocytic anemias are commonly seen in clinical practice, and precise etiologic diagnosis is essential for proper management. We evaluated the clinical utility of reticulocyte maturation parameters in macrocytic anemias to discriminate among myelodysplastic syndrome (MDS), megaloblastic anemia (MA), and non-megaloblastic macrocytic anemia associated with chronic liver disease (MA-CLD).

Methods

Using an automated reticulocyte counter, we retrospectively analyzed and compared reticulocyte maturation parameters including immature reticulocyte fraction (IRF), mean reticulocyte volume (MRV), mean sphered cell volume (MSCV) of normal control (N=34), and patients diagnosed with MDS (N=31), MA (N=52), and MA-CLD (N=196).

Results

Macrocytic anemias from MA, MDS and MA-CLD showed higher values of reticulocyte maturation parameters including IRF, MRV and MSCV than normal control (P<0.01). MDS showed higher values of reticulocyte maturation parameters including IRF, MRV and MSCV than MA-CLD (P<0.01). IRF and MRV were significantly lower in MA-CLD than in both MA and MDS (P<0.01). MSCV was significantly higher in MDS than in MA (P<0.01).

Conclusions

This study indicates that the measurement of reticulocyte maturation parameters may be a useful tool in the differential diagnosis of macrocytic anemia. The presence of high values of IRF (≥0.39), MRV (≥ 129.5 fL), and MSCV (≥ 102.3 fL) makes the diagnosis of MA-CLD unlikely and underlying MDS should be considered.

Keywords: Myelodysplastic syndrome, Megaloblastic anemia, Macrocytic anemia, Chronic liver disease, Immature reticulocyte fraction, Mean reticulocyte volume, Mean sphered cell volume

References

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Fig. 1.

Reticulocyte maturation parameters. When MDS and MA-CLD are compared, there are statistical differences (P<0.01) in all reticulocyte maturation parameters: IRF, MRV and MSCV.

Table 1.

Routine hematological parameters

Parameters	Mean (SD)
Parameters	NC (N=34)	MA (N=52)	MDS (N=31)	MA-CLD (N=196)
Hemoglobin (g/dL)	14.38 (1.04)	10.06 (1.34)	9.30 (1.85)	10.09 (20.3)
Hematocrit (%)	41.14 (2.78)	28.81 (3.89)	26.85 (5.35)	29.23 (4.74)
MCV (fL)	89.56 (3.60)	104.06 (7.06)	101.11 (6.62)	102.76 (4.24)
MCH (pg)	31.30 (1.32)	36.33 (2.59)	35.02 (2.73)	35.97 (1.76)
MCHC (g/dL)	34.95 (0.37)	34.92 (1.01)	34.63 (0.94)	35.00 (0.85)
Reticulocyte counts (10⁶//L)	0.08 (0.03)	0.11 (0.10)	0.06 (0.02)	0.07 (0.05)
CRC (%)	0.08 (0.02)	0.07 (0.06)	0.03 (0.02)	0.04 (0.03)
IRF	0.24 (0.04)	0.38^* (0.13)	0.39^*,† (0.06)	0.32^* (0.11)
MRV (fL)	98.1 (5.34)	127.07^* (19.01)	129.49^*,† (14.26)	116.67^* (17.88)
MSCV (fL)	85.63 (4.52)	90.84^* (8.03)	102.31^*,†,‡ (5.83)	88.55^* (8.57)

^* P<0.01 as compared to NC.

^† P<0.01 as compared to MA-CLD.

^‡ P<0.01 as compared to MA.

Abbreviations: NC, normal control; MA, macrocytic anemia; MDS, myelodysplastic syndrome; MA-CLD, macrocytic anemia associated with chronic liver disease; SD, standard deviation; CRC, corrected reticulocyte count; IRF, immature reticulocyte fraction; MRV, mean reticulocyte volume; MSCV, mean sphered cell volume.

Abbreviations: See Table 1.

Table 2.

Score in normal control and macrocytic anemias

Score^*	Number of cases (%)
Score^*	NC (N=34)	MA (N=52)	MDS (N=31)	MA-CLD (N=196)
0	34 (100)	15 (29)	6 (19)	110 (56)
1	0 (0)	22 (42)	3 (10)	67 (34)
2	0 (0)	11 (21)	8 (26)	17 (9)
3	0 (0)	4 (8)	14 (45)	2 (1)

^* Final Score (0–3) is the sum of IRF, MCV, and MSCV of each samples. IRF <0.39 and ≥0.39 score 0 and 1 respectively, MRV <129.5 and ≥ 129.5 score 0 and 1 respectively, MSCV <102.3 and ≥102.3 score 0 and 1 respectively.

Abbreviations: See Table 1.

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