Implementing Reticulocyte Hemoglobin Into Current Hematology Algorithms

This systematic review investigates reticulocyte hemoglobin's capabilities in screening iron deficiency and iron-deficiency anemia with and without comorbidities.

Participant background and laboratory characteristics were extracted from 14 unique studies between 2015 and 2022. Hemoglobin, reticulocyte hemoglobin, and mean cell volume (MCV) values were used in a meta-analysis for iron-deficiency anemia with no secondary conditions. Mean laboratory values for each patient population were calculated and then used to determine sensitivity, specificity, and the area under the curve (AUC) for iron deficiency and iron-deficiency anemia. The ferritin and reticulocyte hemoglobin ranges were calculated using the mean values.

The meta-analysis demonstrates that hemoglobin and MCV values do not significantly differ between studies, unlike reticulocyte hemoglobin values. The reticulocyte hemoglobin range is smaller than ferritin for the controls, iron deficiency, and iron-deficiency anemia. Reticulocyte hemoglobin values less than 26 pg can distinguish iron-deficiency anemia, while 26 to 31.5 pg can distinguish iron deficiency, with an AUC of 0.889. The sensitivity and specificity are 92.3% and 100% for iron-deficiency anemia, 100% and 81.5% for iron deficiency, and 94.4% and 71.4% for both, respectively (reference range, <31.5 pg).

Reticulocyte hemoglobin is potentially a quick screening test for iron deficiency and iron-deficiency anemia.