285P - Reticulocyte hemoglobin equivalent as an early predictor of iron deficiency anemia in cancer patients

Background

Reticulocyte hemoglobin equivalent (RET-He) measures the amount of hemoglobin in the reticulocytes and indicates red cell hemoglobinization, reflecting the quality of the newly produced reticulocytes. It is a useful parameter which allows the diagnosis of IDA before it manifests clinically in a patient and also for treatment follow-up. Therefore, the ability to assess iron deficiency, as part of automated CBC/reticulocyte analysis, may significantly enhance patient management. Etiology of CRA is multifactorial, and is due to myelosuppression secondary to chemotherapy, bone marrow failure, chronic inflammation, and/or iron deficiency. The goal of the present study was to establish a RET-He cut-off that could rapidly predict iron deficiency. The data suggests that RET-He, at a threshold of 32 pg/ cell, may be an important discriminator to rule out IDA in patients with cancer.

Methods

Patients were enrolled into the study based on the laboratory test values of CBC and serum iron studies.

Results

The statistical analysis was performed using (A) biochemical standards for ID i.e. serum iron less than 40 μg/dL, transferrin saturation less than 20% as well as (B) our in house standards i.e serum iron less than 40 μg/dL, transferrin saturation less than 30% with a RET-He cut-off at 30.4 pg. The PPV was calculated at 70.67 % and 75.9% for A & B respectively. The results were statistically significant in both (A) and (B) i.e. P value <0.001 as per table. Table: 285P

Conclusions

RET-He is a readily available parameter on automated hematology analyzers with no additional cost and effort. Hence, we recommend the incorporation of RET-He in the diagnostic algorithm for the rapid assessment of IDA in the oncology practice as a surrogate marker with cut-off value <30.4 pg which had a PPV of 76%.This will negate the requirement of iron biochemistry studies in CRA patients, expedite the process of anemia correction with I.v. iron therapy and further reduce the requirement of additional blood sampling, along with providing cost efficacy to the patient especially in the cost-limited healthcare settings. In case of non-responders, a further extensive work up should be performed to delineate the etiology of CRA.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.