Utility of Reticulocyte Hemoglobin Equivalent in Screening for Iron Deficiency in Pregnancy

Area of Science:

• Hematology
• Clinical Chemistry
• Reproductive Medicine

Background:

• Ferritin is a common but costly diagnostic for iron deficiency (ID) in pregnancy, susceptible to inflammatory interference.
• Reticulocyte hemoglobin equivalent (Ret-He) offers an inflammation-resistant alternative, analyzed alongside complete blood count (CBC).

Purpose of the Study:

• To evaluate the diagnostic accuracy of Ret-He for ID in pregnant women compared to ferritin.
• To assess Ret-He's utility across varying severities of iron deficiency during pregnancy.

Main Methods:

• Prospective cohort study of 200 pregnant participants.
• Concurrent collection of Ret-He, ferritin, and CBC.
• ID defined as ferritin < 30 ng/mL; patients categorized into no ID, ID alone, and ID anemia (IDA).
• Receiver operating curve (ROC) analysis and ANOVA used to assess Ret-He accuracy and group differences.

Main Results:

• Prevalence of ID was 82% in the cohort.
• Ret-He showed suboptimal discrimination with an Area Under the Curve (AUC) of 0.65.
• Ret-He differed significantly across ID severity groups (p < 0.001).
• Ret-He was significantly lower in IDA vs. ID groups, but only trended lower in ID vs. non-ID groups.

Conclusions:

• Ret-He demonstrates low accuracy for diagnosing general iron deficiency in pregnancy.
• Ret-He may assist in identifying severe iron deficiency anemia but not mild ID.
• Ferritin remains preferable for diagnosing ID in pregnancy when available.