Diagnostic Performance of Automated Reticulocyte and Red Cell Indices for Detecting Iron Deficiency Anemia in Cirrhotic Patients.

INTRODUCTION

Iron deficiency anemia (IDA) diagnosis in cirrhotic patients is challenging due to the confounding effects of inflammation and altered iron metabolism. Conventional markers, such as the iron profile, may be unreliable in this population. This study aimed to evaluate the diagnostic performance of reticulocyte hemoglobin content (CHr), percentage of microcytic red blood cells (%MicroR), and percentage of hypochromic red blood cells (%HypoR) for the diagnosis of IDA in cirrhotic patients.

METHODS

Four groups were included in this cross-sectional study: healthy controls, IDA non-cirrhotic, IDA cirrhotic, and non-IDA cirrhotic patients. Complete blood counts and reticulocyte indices were analyzed using a Sysmex XN- 1000 hematology analyzer, and receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performance of the studied indices.

RESULTS

CHr demonstrated the highest diagnostic performance, with an area under the curve (AUC) of 0.925 at a cut-off value of ≤ 25.7 pg. %MicroR also demonstrated strong discriminative ability (AUC = 0.906) at a cut-off of > 10.8%, whereas ferritin showed good diagnostic performance (AUC = 0.858) at a cut-off of ≤ 101 μg/L.

CONCLUSION

CHr demonstrated excellent diagnostic performance and may serve as a valuable adjunctive marker for assessing iron status in cirrhotic patients, outperforming ferritin and other automated red blood cell indices. These findings support the potential role of reticulocyte indices as valuable tools for diagnosing IDA in cirrhosis, where conventional iron markers may be unreliable.