Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi.
J Assoc Physicians India. 2022 Apr;70(4):11-12.
Anemia is common in patients with cancer and it's pathophysiology is complex and multifactorial . Conventional methods (Serum Iron, serum ferritin, TIBC, TSAT) to diagnosing iron deficiency anemia in cancer patients is affected by cancer type, duration, treatment, infection and inflammation related to cancer. RET-He measure the recent functional availability of iron and the correlation well with iron deficient / restricted erythropoiesis, and it is not affected by infection and inflammation related to cancer so it can be useful marker to rapidly rule out iron deficiency in cancer patients. Material: This is observation longitudinal study and study subjects including all type of diagnosed cancer patients with anemia (Hb <13 gm % in males and <12gm% in females) with or without treatment. Study duration was 18 month and 200 sample size was taken. Complete blood count (Hb, TLC, platelets, MCV, MCH, MCHC, reticulocyte hemoglobin) were analysed on SYSMEX XN 1000i. Serum Ferritin was estimated using AVANTOR CL-1000i and Serum iron, TIBC, TSAT was run on EBRA MANHEIN CHEM 5X machine. Bone marrow examination was done for diagnosis / staging . Iron stores were evaluated by Perl's Prussian blue stain and graded as per criteria laid down by Gale et al. Observation: At a cut off of 28.4 pg, RET-He achieved sensitivity of 96.77 % and specificity of 81.66% with NPV of 99.3% and PPV of 49.2% for iron deficient state in cancer patients. This cut off value rules out iron deficient erythropoiesis, reduces unnecessary iron studies and encourage early treatment of iron deficiency. There is also moderate agreement exist between iron stores of bone marrow and RET-He with Kappa 0.411 and p value <.0001. Conclusion: RET-He is better indicator of IDA in cancer patients as compared to other conventional methods of diagnosing IDA.This study also revealed a direct correlation between RET-He and bone marrow iron stores. In future it is advisable to use RET-He as a predictor of IDA, which is sensitive and specific at particular cut off points in routine evaluation in IDA in cancer patients.
贫血在癌症患者中很常见，其病理生理学复杂且多因素。传统的方法（血清铁、血清铁蛋白、总铁结合力、转铁蛋白饱和度）用于诊断癌症患者的缺铁性贫血会受到癌症类型、持续时间、治疗、与癌症相关的感染和炎症的影响。RET-He 测量铁的近期功能可用性，与缺铁/铁限制红细胞生成相关性良好，并且不受与癌症相关的感染和炎症的影响，因此它可以作为一种有用的标志物，快速排除癌症患者的缺铁情况。
这是一项观察性纵向研究，研究对象包括所有类型的诊断为贫血的癌症患者（男性 Hb <13gm%，女性 Hb <12gm%），无论是否接受治疗。研究持续时间为 18 个月，共纳入 200 例样本。使用 SYSMEX XN 1000i 分析全血细胞计数（Hb、TLC、血小板、MCV、MCH、MCHC、网织红细胞血红蛋白）。使用 AVANTOR CL-1000i 估计血清铁蛋白，使用 EBRA MANHEIN CHEM 5X 机器运行血清铁、总铁结合力、转铁蛋白饱和度。骨髓检查用于诊断/分期。铁储存通过 Perl 的普鲁士蓝染色进行评估，并根据 Gale 等人制定的标准进行分级。
在截断值为 28.4pg 时，RET-He 对癌症患者缺铁状态的敏感性为 96.77%，特异性为 81.66%，阴性预测值为 99.3%，阳性预测值为 49.2%。该截断值排除了缺铁性红细胞生成，减少了不必要的铁研究，并鼓励早期治疗缺铁。骨髓铁储存与 RET-He 之间也存在中度一致性，Kappa 值为 0.411，p 值 <0.0001。
与其他诊断缺铁性贫血的传统方法相比，RET-He 是癌症患者缺铁性贫血的更好指标。这项研究还揭示了 RET-He 与骨髓铁储存之间的直接相关性。在未来，建议在常规评估癌症患者缺铁性贫血时，在特定截断值处使用 RET-He 作为缺铁性贫血的预测指标，该指标具有敏感性和特异性。
