Main Article Content

Abstract

BACKGROUND


Menometrorrhagia is a common cause of iron deficiency anemia (IDA) in women of reproductive age group. Latent iron deficiency (LID) is a precursor stage of IDA in which there is evidence of iron deficiency without anemia. LID causes cognitive impairment, impaired immunity and reduced work capacity which can be corrected by iron supplementation. Conventional biochemical and hematological parameters have limitations in the diagnosis of LID. This study was done to assess the performance characteristics of percentage of hypochromic red cells (% HYPO) in the detection of LID in women with menometrorrhagia.


METHODS


This study was done on 226 women attending the Gynaecology OP clinic of our institution, of which 183 had menometrorrhagia, and the remaining being controls. After testing for conventional hematological indices and serum ferritin, the subjects were divided into 3 groups: a LID group, an IDA group, and a control group without iron deficiency. ROC curve analysis was performed to assess % HYPO and other conventional hematological parameters in identifying LID.


RESULTS


Most hematological indices were within normal ranges in LID population, thus limiting their utility. The AUC for % HYPO in LID population was 0.736 with an optimum cut-off of 8.7 corresponding to a sensitivity and specificity of 62.3 and 76.74 respectively.


CONCLUSIONS


% HYPO is a sensitive, specific, fast, cheap, and practical and thus serves as a better predictive marker than conventional biochemical and hematological parameters in the detection of LID.

Keywords

Percentage of Hypochromic red Cells, Latent Iron Deficiency, Menometrorrhagia.

Article Details

How to Cite
Swathy S. Lal, Vivek George, & Himiki Selvin. (2023). Performance Characteristics of Percentage of Hypochromic Red Cells in the Detection of Latent Iron Deficiency in Women with Menometrorrhagia. Journal of Evolution of Medical and Dental Sciences, 12(12), 358–362. https://doi.org/10.14260/jemds.v12i12.525

References

  1. Paul MP, Taylor RB, Audrey AP, et al. Family medicine: principles and practice. 8th edn. New York: Springer Cham 2022.
  2. Coad J, Pedley K. Iron deficiency and iron deficiency anemia in women. Scand J Clin Lab Invest 2014;74(Suppl 244):82–9.
  3. Donnez J. Menometrorrhagia during the premenopause: an overview. Gynecol Endocrinol 2011;27(Suppl 1):1114-9.
  4. Greer JP, Arber DA, Glader BE, et al. Wintrobe's clinical hematology. 14th edn. United States: Wolters Kluwer Health 2018.
  5. Suominen P, Punnonen K, Rajamäki A, et al. Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits. Blood 1998;92(8).
  6. Soppi ET. Iron deficiency without anemia – a clinical challenge. Clin Case Rep 2018;6(6):1082-6.
  7. Stugiewicz M, Tkaczyszyn M, Kasztura M, et al. The influence of iron deficiency on the functioning of skeletal muscles: experimental evidence and clinical implications. Eur J Heart Fail 2016;18(7):762-73.
  8. Stugiewicz M, Tkaczyszyn M, Kasztura M, et al. The influence of iron deficiency on the functioning of skeletal muscles: experimental evidence and clinical implications. Eur J Heart Fail 2016;18(7):762-73.
  9. Macdougall LG, Anderson R, McNab GM, et al. The immune response in iron-deficient children: Impaired cellular defense mechanisms with altered humoral components. J Pediatr 1975;86(6):833-43.
  10. Leonard A, Chalmers K, Collins C, et al. A study of the effects of latent iron deficiency on measures of cognition: a pilot randomised controlled trial of iron supplementation in young women. Nutrients 2014;6(6):2419-35.
  11. Urrechaga E, Borque L, Escanero JF. Biomarkers of hypochromia: the contemporary assessment of iron status and erythropoiesis. Biomed Res Int 2013;2013:603786.
  12. Cullen P, Soffker J, Hopfl M, et al. Hypochromic red cells and reticulocyte haemoglobin content as markers of iron-deficient erythropoiesis in patients undergoing chronic haemodialysis. Nephrol Dial Transplant 1999;14(3):659-65.
  13. Thomas C, Thomas L. Biochemical markers and hematologic indices in the diagnosis of functional iron deficiency. Clin Chem 2002;48(7):1066-76.
  14. Capel-Casbas MJ, Duran JJ, Diaz J, et al. Latent Iron metabolism disturbances in fertile women and its detection with the automated hematology instrument LH750®. Blood 2005;106(11):3707-7.
  15. Saha DJ, Sarkar DD. Prevalence of iron deficiency and iron deficiency anaemia among nursing students of Bilaspur Chhattisgarh. Int J Med Res Rev 2015;3(7):738-42.
  16. Liao QK. Prevalence of iron deficiency in pregnant and premenopausal women in China: a nationwide epidemiological survey. Zhonghua Xue Ye Xue Za Zhi 2004;25(11):653-7.
  17. Ridefelt P, Larsson A, Rehman JU, et al. Influences of sleep and the circadian rhythm on iron-status indices. Clin Biochem 2010;43(16-17):1323-8.
  18. Dignass A, Farrag K, Stein J. Limitations of serum ferritin in diagnosing iron deficiency in inflammatory conditions. Int J Chronic Dis 2018;2018:1-11.
  19. Phiri KS, Calis JCJ, Siyasiya A, et al. New cut-off values for ferritin and soluble transferrin receptor for the assessment of iron deficiency in children in a high infection pressure area. J Clin Pathol 2009;62(12):1103-6.
  20. Bainton DF, Finch CA. The diagnosis of iron deficiency anemia. Am J Med 1964;37(1):62-70.
  21. Malczewska-Lenczowska J, Surała O, Orysiak J, et al. Utility of novel hypochromia and microcythemia markers in classifying hematological and iron status in male athletes. Nutrients 2019;11(11):2767.
  22. Aulakh R, Sohi I, Singh T, et al. Red cell distribution width (RDW) in the diagnosis of iron deficiency with microcytic hypochromic anemia. Indian J Pediatr 2009;76(3):265-8.
  23. Robertson PD, MaClean DW. Iron deficiency without anaemia - The M.C.H.C. in screening. J Chronic Dis 1970;23(3):191-5.
  24. Ervasti M, Kotisaari S, Heinonen S, et al. Use of advanced red blood cell and reticulocyte indices improves the accuracy in diagnosing iron deficiency in pregnant women at term. Eur J Haematol 2007;79(6):539-45.
  25. Schaefer RM, Schaefer L. The hypochromic red cell: a new parameter for monitoring of iron supplementation during rhEPO therapy. J Perinat Med 1995;23(1-2):83-8.
  26. Luo D. Percentage of hypochromic red cells: a better predictive marker than conventional hematological parameters in the diagnosis of latent iron deficiency in women with menometrorrhagia. Int J Clin Exp Med 2016;9(5):8593-8.
  27. Tessitore N, Solero GP, Lippi G, et al. The role of iron status markers in predicting response to intravenous iron in haemodialysis patients on maintenance erythropoietin. Nephrol Dial Transplant 2001;16(7):1416-23.
  28. Clénin GE. The treatment of iron deficiency without anaemia (in otherwise healthy persons). Swiss Med Wkly 2017;147(2324):w14434.
  29. Kee YK, Jeon HJ, Oh J, et al. Hypochromic red cells as predictors of anemia in patients undergoing hemodialysis: an observational retrospective study. Scientific Reports 2021;11(1).
  30. Katodritou E, Terpos E, Zervas K, et al. Hypochromic erythrocytes (%): a reliable marker for recognizing iron-restricted erythropoiesis and predicting response to erythropoietin in anemic patients with myeloma and lymphoma. Ann Hematol 2007;86(5):369-76.
  31. Bovy C, Tsobo C, Crapanzano L, et al. Factors determining the percentage of hypochromic red blood cells in hemodialysis patients. Kidney Int 1999;56(3):1113-9.
  32. Urrechaga E, Borque L, Escanero JF. Percentage of hypochromic erythrocytes as a potential marker of iron availability. Clin Chem Lab Med 2012;50(4).
  33. Wish JB. Assessing iron status: Beyond serum ferritin and transferrin saturation. Clin J Am Soc Nephrol 2006;1(Suppl 1):S4–8.
  34. Schapkaitz E. Stability of new erythrocyte and reticulocyte parameters in testing for anemia on the Sysmex XN 9000. Lab Med 2018;49(3):219-25.