Diagnosis of Iron Deficiency and Iron Deficiency Anemia with Reticulocyte Hemoglobin Content among Children Aged 6-18 Years

Background: Iron deficiency (ID) is the most common micronutrient deficiency in the world. If left untreated, ID will lead to iron deficiency anemia (IDA) and other irreversible consequences. The American Academy of Pediatrics recommended reticulocyte hemoglobin content (Ret-He) as an alternative laboratory examination to screen and detect ID. We aimed to compare Ret-He with other laboratory parameters to screen for iron status in healthy children.  Methods: This is a cross-sectional study comprising 207 children aged 6-18 years in Jakarta, Indonesia. Children were divided according to their iron status. Ret-He was compared with hemoglobin (Hb), mean corpuscular volume (MCV), ferritin, and transferrin saturation (TS) to assess iron status in children. Receiver operating characteristic (ROC) curve was performed to determine the optimal cut-off value for Ret-He using SPSS software.  Results: Ret-He had a positive correlation with MCV (r=0.690, n=207, P<0.001), Hb (r=0.491, n=207, P<0.01), and ferritin (r=0.336, n= 207, P<0.001). Ret-He can not be used  to detect iron depletion with the cut-off value of 30.3 pg with 100% sensitivity, 19.7% specificity, 100% negative predictive value (NPV), and 5.4% positive predictive value (PPV). A Ret-He cut-off value of 28.9 pg was established as optimal to identify ID (78.9% sensitivity, 56.2% specificity, 92.2% NPV, and 28.9% PPV) and 27 pg to detect IDA (75% sensitivity, 80% specificity, 98.1% NPV, and 18.7% PPV). Conclusion: Ret-He can be used as an alternative screening parameter to detect ID and IDA in children aged 6-18 years. Screening for IDA with Ret-He has to be done with other parameters, such as Hb examination.