The Reticulocyte Hemoglobin Equivalent as a Screening Marker for Iron Deficiency and Iron Deficiency Anemia in Children
Related Experiment Video
Updated: Oct 22, 2025
Author Spotlight: Developing a Point-of-Care Hemoglobin Estimation Method for Anemia Management
Published on: January 19, 2024
Vanessa Neef1, Elke Schmitt1, Peter Bader2
1Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60590 Frankfurt, Germany.
Insights
Reticulocyte hemoglobin equivalent (Ret-He) effectively screens for iron deficiency (ID) and iron deficiency anemia (IDA) in children. This single marker simplifies diagnosis, potentially reducing costs and improving efficiency in pediatric care.
Area of Science:
- Pediatric Hematology
- Nutritional Deficiencies
- Diagnostic Markers
Background:
- Iron deficiency (ID) is a prevalent global nutritional deficit in children, often leading to iron deficiency anemia (IDA).
- Reticulocyte hemoglobin equivalent (Ret-He) reflects iron availability during red blood cell production.
- Validating Ret-He as a screening tool for ID and IDA in pediatric populations is crucial.
Purpose of the Study:
- To evaluate the efficacy of Ret-He as a screening marker for iron deficiency (ID) and iron deficiency anemia (IDA) in children.
- To compare Ret-He's performance against established iron status parameters.
- To assess the clinical utility and economic benefits of using Ret-He for pediatric iron status assessment.
Main Methods:
- Retrospective analysis of blood samples from 970 children.
- Anemia defined by WHO criteria; ID defined by transferrin saturation (TSAT) < 20% and ferritin < 100 ng/mL.
- Children categorized into IDA, non-anemia iron deficiency (NAID), control, and other groups.
Main Results:
- Out of 970 children, 34.2% had NAID and 28.7% had IDA.
- Ret-He showed significant correlations with ferritin (rho=0.41), TSAT (rho=0.66), and sTfR (rho=-0.72).
- ROC analysis yielded an AUC of 0.771 for ID and 0.845 for IDA detection using Ret-He, with optimal cut-offs identified.
Conclusions:
- Ret-He serves as a reliable screening marker for both ID and IDA in children.
- Ret-He can be utilized as a standalone parameter, simplifying the diagnostic process.
- Implementing Ret-He screening can lead to economic benefits by reducing the need for additional blood tests.
Background:
Iron deficiency (ID) is one of the most common nutritional deficiencies in children worldwide and may result in iron deficiency anemia (IDA). The reticulocyte hemoglobin equivalent (Ret-He) provides information about the current availability of iron in erythropoiesis. This study aims to examine the validation of Ret-He as a screening marker for ID and IDA in children.
Methods:
Blood samples were retrospectively obtained from medical records. Anemia was defined according to the definition provided by the World Health Organization (WHO) for children. ID was defined by transferrin saturation (TSAT) < 20% and ferritin < 100 ng/mL. Children were classified into four groups: IDA, non-anemia iron deficiency (NAID), control and others.
Results:
Out of 970 children, 332 (34.2%) had NAID and 278 (28.7%) presented with IDA. Analysis revealed that Ret-He significantly correlates with ferritin (rho = 0.41; p < 0.001), TSAT (rho = 0.66; p < 0.001) and soluble transferrin receptor (sTfR) (rho = -0.72; p < 0.001). For ROC analysis, the area under the curve (AUC) was 0.771 for Ret-He detecting ID and 0.845 for detecting IDA. The cut-off value for Ret-He to diagnose ID was 33.5 pg (sensitivity 90.7%; specificity 35.8%) and 31.6 pg (sensitivity 90.6%; specificity 50.4%) to diagnose IDA.
Conclusions:
The present study demonstrates Ret-He to be a screening marker for ID and IDA in children. Furthermore, Ret-He can be used as a single screening parameter for ID and IDA in children without considering other iron parameters. Economically, the use of Ret-He is highly relevant, as it can save one blood tube per patient and additional costs.
