Clinica chimica acta; international journal of clinical chemistry · 2026
Combining conventional hemogram and reticulocyte metrics enhances iron deficiency detection in asymptomatic individuals.
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Gautam Mugdha, Sharma Prashant, Pal Arnab, Rastogi Pulkit, Sharma Praveen, Khadwal Alka Rani, Jamwal Manu, Gupta Minakshi, Das Reena
Аннотация
INTRODUCTION: Iron deficiency (ID) is the most common micronutrient deficiency globally, often underdiagnosed due to nonspecific symptoms and limitations of standard laboratory tests. Reticulocyte-derived indices from modern hematology analyzers offer enhanced early detection of iron-restricted erythropoiesis.
METHODS: We studied 103 self-reported asymptomatic healthy adults who underwent complete blood counts and reticulocyte analysis on XN-2000 analyzers (Sysmex Corp., Kobe, Japan). Detailed biochemical iron profile and vitamin B12/folate testing were done. Diagnostic performance of hematologic parameters was assessed and combinatorial logistic regression models and discriminant indices were developed.
RESULTS: Participants' median age was 28 years (range 22-79); 69.9% (n = 72) were women. 54.4% (n = 56) had ID and 21.4% (n = 22) were anemic. Latent ID was detected in 34.9% (36/103). B12 and folate deficiencies were present in 41% and 40%, respectively - extensively overlapping with ID. Key individual indices for ID included RET-He, RET-Y, and RET-RBC-Y, each with area under the ROC curve (AUC) >85%. A comprehensive 21-variable logistic regression model yielded AUC 93.7% (95% C.I. 88.9-98.5), sensitivity 89.1%, and specificity 70.2%. A pared-down 3-variable model achieved AUC 90.1% (95% C.I. 84.1-96.1), sensitivity 87.5%, and specificity 70.9%. Of the two heuristic composite indices tested, one - [RDW-CV × PLT × 105] / [RET-He × RET-RBC-Y × IRF-Y × RET-Y] - showed AUC 89.8% (95% C.I. 83.7-95.9), sensitivity 87%, and specificity 72.3%.
CONCLUSION: In a cohort with high rates of nutritional deficiency, cost-effective equations combining conventional and advanced reticulocyte indices demonstrated strong diagnostic utility for screening ID, with potential for broader application in resource-limited settings.
METHODS: We studied 103 self-reported asymptomatic healthy adults who underwent complete blood counts and reticulocyte analysis on XN-2000 analyzers (Sysmex Corp., Kobe, Japan). Detailed biochemical iron profile and vitamin B12/folate testing were done. Diagnostic performance of hematologic parameters was assessed and combinatorial logistic regression models and discriminant indices were developed.
RESULTS: Participants' median age was 28 years (range 22-79); 69.9% (n = 72) were women. 54.4% (n = 56) had ID and 21.4% (n = 22) were anemic. Latent ID was detected in 34.9% (36/103). B12 and folate deficiencies were present in 41% and 40%, respectively - extensively overlapping with ID. Key individual indices for ID included RET-He, RET-Y, and RET-RBC-Y, each with area under the ROC curve (AUC) >85%. A comprehensive 21-variable logistic regression model yielded AUC 93.7% (95% C.I. 88.9-98.5), sensitivity 89.1%, and specificity 70.2%. A pared-down 3-variable model achieved AUC 90.1% (95% C.I. 84.1-96.1), sensitivity 87.5%, and specificity 70.9%. Of the two heuristic composite indices tested, one - [RDW-CV × PLT × 105] / [RET-He × RET-RBC-Y × IRF-Y × RET-Y] - showed AUC 89.8% (95% C.I. 83.7-95.9), sensitivity 87%, and specificity 72.3%.
CONCLUSION: In a cohort with high rates of nutritional deficiency, cost-effective equations combining conventional and advanced reticulocyte indices demonstrated strong diagnostic utility for screening ID, with potential for broader application in resource-limited settings.