The measurement of reticulocyte hemoglobin content: a modern approach to the diagnosis of iron deficiency in children

Iron deficiency is one of the most widely spread types of microelementosis, especially in a growing organism. It is essential to diagnose iron deficiency at an early stage in order to start treatment timely. Diagnostics of iron deficiency can be complicated by concomitant diseases that distort biochemical parameters of iron metabolism, thus making them not informative enough. In this connection, hemoglobin count in reticulocytes (Ret-Hb) and delta-hemoglobin (Delta-He) may be useful indicators as they help to diagnose true iron deficiency at earliest stages and do not depend on concomitant conditions, which is described in reference sources. In this work, Ret-Hb and Delta-He were detected in the structure of blood hematology test performed on hematology analyzers Sysmex XT-4000 and Sysmex XN-9000 (Japan) in 24 children aged 1–18 with absolute iron deficiency; three of these children had absolute iron deficiency manifested as latent deficiency, and 19 children had hypochromic microcytic anemia of mild or medium severity. The parameter was below the normal limit (the average count was 24.2 ± 3.5 pg), while the normal limit is 28 pg, according to the reference sources. After two weeks of treatment, Ret-Hb increased up to 26.0 ± 2.9 pg. Delta-He, being initially as low as 2.9 ± 0.9 pg (with the lower threshold of 4.0 pg) rose up to 6.3 ± 3.4 pg. The results of our research have demonstrated that Ret-Hb and Delta-He may be regarded as informative, economical and affordable diagnostic parameters that do not require collection of additional blood samples. Their dynamics during treatment should be investigated further. This study was approved by the Independent Ethics Committee and the Scientific Council of Saint Petersburg State Pediatric Medical University of Ministry of Healthcare of the Russian Federation.