Indian J Pediatr. 2026 Jun 19. doi: 10.1007/s12098-026-06195-9. Online ahead of print.
ABSTRACT
OBJECTIVES: To evaluate diagnostic utility of reticulocyte hemoglobin equivalent (Ret-He) in identifying iron deficiency anemia (IDA) in acutely ill hospitalized children in comparison to serum ferritin.
METHODS: After excluding chronic inflammatory and anemic conditions unrelated to iron deficiency (ID), patients were categorized as (1) IDA: low hemoglobin+ microcytosis+ red-cell-distribution-width (RDW) index >220, (2) Non-anemia-iron-deficiency (NAID): normal haemoglobin+ microcytosis+ RDW index >220 and (3) Normal-group: normal hemoglobin+ normocytosis. Diagnostic utility indices for IDA were calculated using low hemoglobin+ microcytosis + RDW index >220 as surrogate standard. Correlation coefficients and receiver-operating-characteristic (ROC) curve cut-offs for Ret-He and ferritin were calculated.
RESULTS: Anemic (n = 180) and non-anemic (n = 66) acutely ill children, after exclusion criteria, were classified into IDA (n = 102), NAID (n = 14) and normal (n = 21). IDA group had significantly lower Ret-He levels (p <0.001). Ferritin levels showed no significant difference (p = 0.062). For IDA detection, Ret-He cut-off of 27.7 pg yielded sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 87.2%, 80.9%, 95.7%, 56.7% and 86.2% whereas ferritin at cut-off of 147.0 ng/ml showed values of 58.8%, 66.7%, 89.5%, 25.0% and 60.2% respectively. For NAID detection, Ret-He cut-off of 29.1 pg showed sensitivity, specificity, PPV, NPV and accuracy of 71.4%, 57.1%, 52.6%, 75.0% and 62.9%, while ferritin at cut-off of 153 ng/ml showed values of 57.1%, 61.9%, 50.0%, 68.4%, and 60.0% respectively.
CONCLUSIONS: Ret-He demonstrated superior diagnostic utility compared to serum ferritin for IDA in acutely ill hospitalized children. Optimal cut-off for serum ferritin for IDA was significantly higher than WHO reference standard.
PMID:42319743 | DOI:10.1007/s12098-026-06195-9
