Applying newer parameter Ret-He (reticulocyte haemoglobin equivalent) to assess latent iron deficiency (LID) in blood donors-study at a tertiary care hospital in India
Vox Sanguinis. 2018;113((7):):639-646.
BACKGROUND It is important to detect Latent Iron Deficiency (LID) to prevent development of an overt iron deficiency anemia. Early detection is difficult by using conventional hematological and biochemical parameters. Soluble transferrin receptor (sTfR) is presently the gold standard for diagnosing LID. We evaluated the utility of Reticulocyte Hemoglobin Equivalent (Ret-He), a newer hematological parameter, to predict LID in blood donors as compared to sTfR. METHODS This was a randomized prospective study performed on 501 donor samples over a period of three-months. All donors were included after administering medical history questionnaire and a brief physical examination in accordance with national guidelines (Hb ≥12.5). Additional samples were collected during donation according to the institutional standard operating procedure (SOP). All hemograms were performed on the Sysmex XE-2100 analyzer which included Ret-He. sTfR was measured in batch assays by ELISA (Biovendor, Czech Republic). Ret He <28 pg and sTfR≥3mug/ml were used to diagnose LID. Serum Iron, Total Iron Binding Capacity (TIBC) and Serum Ferritin were also measured simultaneously. RESULTS Of the 501 blood donors, sTfR and Ret-He detected LID in 148 and 135 donors respectively. In comparison to sTfR, Ret-He had sensitivity of 92.7%, a specificity of 97.16%, PPV of 93.1% and NPV of 96.3%. Serum Ferritin, TIBC and serum Iron had comparatively lower sensitivity of 87.16%, 79.7% and 77.7% respectively. CONCLUSION Ret-He can be used as a routine screening test to detect LID in blood donors. This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation.
A randomized control study to evaluate effects of short-term oral iron supplementation in regular voluntary blood donors
Indian Journal of Hematology & Blood Transfusion : an Official Journal of Indian Society of Hematology and Blood Transfusion. 2016;32((3)):299-306.
Regular blood donation can lead to iron deficiency anaemia. Early recognition and reversal of excessive iron loss by iron supplementation may avoid symptomatic iron store depletion in blood donors. The aim of this study was to assess the efficacy of iron supplementation in maintaining the iron stores of voluntary blood donors. A total of 200 regular volunteers who donated twice in previous year were randomly divided into two groups. Iron: oral iron supplementation tablets of elemental iron as ferrous fumarate. Placebo group: glucose containing capsules, to be taken once daily for 21 days after one unit of blood donation. Their hemogram, serum ferritin, red cell indices and red cell distribution width were determined at baseline and after 1 month and at the time of next blood donation. Out of 200 volunteers enrolled 98 were assigned to iron group and rest 102 into placebo group. Total of 37 % donors dropped out, yielding a dropout rate of 35 % in iron group and 39 % in the placebo group. The haemoglobin and ferritin levels showed significant improvement in iron group compared to placebo group (p < 0.05). Three weeks of oral iron therapy (98.6 mg elemental iron/day) was able to maintain iron stores at 1 month after donation but was not sufficient to sustain the iron stores over a period of 3 months. Thus there is need to evaluate increased dosage or duration of iron supplementation in maintaining the iron stores.