Ceylan C, Miskioğlu M, Colak H, Kiliççioğlu B, Ozdemir E
Department of Hematology, Celal Bayar University Hospital, Manisa, Turkey.
Int J Lab Hematol. 2007 Oct;29(5):327-34. doi: 10.1111/j.1365-2257.2006.00872.x.
The aim of this study was to test the clinical utility of reticulocyte parameters in differential diagnosis in iron deficiency anemia (IDA), vitamin B(12) deficiency (B12) and beta-thalassemia minor (TM). We analyzed the percentage of reticulocyte, absolute reticulocyte count, mean content hemoglobin of reticulocyte (CHr), mean corpuscular volume of reticulocyte (MCVr), corpuscular hemoglobin concentration mean of reticulocyte (CHCMr), MCVr/MCV ratio, CHr/CH ratio and CHCMr/CHCM ratio in healthy donors (n = 34), iron deficiency (IDA) (n = 41), vitamin B(12) deficiency (B12) (n = 22), and TM (n = 34). This study demonstrates that the cutoff value of CHr was 25.7 as indicative of IDA (85.4% sensitivity, 97.1% specificity). CHr and MCVr may be useful for TM (cutoff value < or = 24.8 for CHr) and B12 (>102.1, cutoff value for MCVr), respectively. Sensitivity and specificity of these parameters were 90.9, 86.4% and 97.1, 82.4%, respectively. CHCMr is useful to differentiate IDA and TM from B12. While CHr was low value in microcytic groups (mean 21.8 +/- 3.3 for IDA, 21.0 +/- 2.9 for TM), it was high in B12 (mean 32.1 +/- 5.7). However, that of CHr/CH ratio was only significantly in IDA group compared with the control (P < 0.05, mean 0.98). Therefore, there are limitations regarding CHr and CHr/CH ratio differential diagnosis in microcytic and macrocytic groups. CHr, MCVr, and CHCMr are not sufficiently sensitive and specific to differentiate TM from IDA. We conclude that measurement of reticulocyte count and parameters may be a very useful implement in the diagnosis of IDA and TM.
本研究的目的是检测网织红细胞参数在缺铁性贫血（IDA）、维生素B12缺乏症（B12）和轻型β地中海贫血（TM）鉴别诊断中的临床效用。我们分析了健康供者（n = 34）、缺铁性贫血（IDA）（n = 41）、维生素B12缺乏症（B12）（n = 22）和轻型β地中海贫血（TM）（n = 34）中网织红细胞百分比、网织红细胞绝对计数、网织红细胞平均血红蛋白含量（CHr）、网织红细胞平均体积（MCVr）、网织红细胞平均血红蛋白浓度（CHCMr）、MCVr/MCV比值、CHr/CH比值及CHCMr/CHCM比值。本研究表明，CHr的截断值为25.7时可提示IDA（敏感性85.4%，特异性97.1%）。CHr和MCVr可能分别对轻型β地中海贫血（CHr截断截断截断值≤24.8）和维生素B12缺乏症（MCVr截断值>102.1）有用。这些参数的敏感性和特异性分别为90.9%、86.4%以及97.1%、82.4%。CHCMr有助于鉴别IDA和轻型β地中海贫血与维生素B12缺乏症。虽然CHr在小细胞组中为低值（IDA平均为21.8±3.3，轻型β地中海贫血为21.0±2.9），但在维生素B12缺乏症中较高（平均为32.1±5.7）。然而，与对照组相比，CHr/CH比值仅在IDA组中有显著差异（P<0.05，平均为0.98）。因此，CHr和CHr/CH比值在小细胞和大细胞组鉴别诊断中存在局限性。CHr、MCVr和CHCMr在鉴别轻型β地中海贫血与IDA时不够敏感和特异。我们得出结论，网织红细胞计数及参数的检测在IDA和轻型β地中海贫血的诊断中可能是非常有用的手段。
