ArticleCureus2026
Diagnostic Utility of Reticulocyte Hemoglobin Equivalent in Iron-Deficiency Anemia: An Observational Study From Eastern India.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background Iron deficiency anemia (IDA) continues to be a major global health concern, especially in India. Serum ferritin, a conventional marker for iron deficiency, is considered unreliable in inflammatory conditions. Reticulocyte hemoglobin equivalent (Ret-He) reflects real-time iron availability for erythropoiesis and may overcome this limitation. This study aimed to evaluate the diagnostic efficacy of Ret-He and compare it with serum ferritin in detecting IDA in patients receiving treatment at an Eastern Indian tertiary care facility. Methods A hospital-based observational study was conducted at Tata Main Hospital, Jamshedpur, from December 2023 to December 2024. Patients with anemia (hemoglobin <12 g/dL for females and <13 g/dL for males), ≥18 years old, were included in the study. Complete blood count parameters, including Ret-He, were measured using the Sysmex XN-1000 analyzer (Sysmex, Kobe, Japan). IDA was diagnosed based on microcytic hypochromic indices, peripheral smear findings, and serum ferritin <70 ng/mL. Receiver operating characteristic (ROC) curve analysis was done to obtain the optimal cut-off values for serum ferritin and Ret-He and their respective specificity, sensitivity, and diagnostic accuracy; negative and positive predictive values were also calculated. To compare areas under the curve (AUC), the DeLong test was employed. Results Among 672 patients (mean age 61.3±17.3 years, 67% females), IDA was diagnosed in 257 (38.2%) patients, including 151 (58.8%) with pure IDA and 106 (41.2%) with IDA and concomitant inflammation. In comparison to non-IDA, Ret-He was considerably lower in IDA (21.0±4.8 vs. 27.6±4.6 pg, p<0.001). ROC analysis demonstrated superior diagnostic performance of Ret-He (AUC=0.839) over serum ferritin (AUC=0.728, p=0.045). At an "optimal cut-off" of <23.6 pg, Ret-He showed 81.7% sensitivity, 73.2% specificity, and 78.4% diagnostic accuracy. Serum ferritin (<39.0 ng/ml) had higher sensitivity (90.6%) but lower specificity (50.0%). Ret-He remained low in both pure IDA and IDA with inflammation, while ferritin was markedly elevated in inflammatory states. Conclusion Ret-He demonstrates superior diagnostic accuracy compared to serum ferritin for identifying IDA and remains unaffected by inflammation. Its integration into routine complete blood count analysis offers a cost-effective, reliable approach for early detection of iron deficiency, making it particularly valuable in resource-limited settings and patients with concurrent inflammatory conditions.
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