Reticulocytic hemoglobin behavior and its usefulness in differentiating thalassemia syndromes from iron deficiency in pediatrics.

Abstract

Introduction. Iron deficiency anemia and thalassemic syndromes represent the main causes of microcytic hypochromic anemia in pediatrics and share hematimetric features that make their initial diagnostic differentiation difficult. Reticulocyte hemoglobin content (RET-He) allows evaluation of hemoglobinization in recent erythropoiesis. This study has as its objective to assess the usefulness of RET-He in differentiating thalassemic syndromes from iron deficiency in pediatrics and to establish an optimal cutoff value. Materials and methods. A retrospective, cross-sectional, analytical observational study was conducted in patients aged 1 to 15 years between 2019 and 2024. Hematological parameters, iron metabolism studies, hemoglobin electrophoresis, and molecular studies for alpha thalassemia were analyzed. Patients were classified into four groups: iron deficiency anemia, iron deficiency without anemia, beta thalassemia and alpha thalassemia. Non-parametric tests and ROC curve analysis were performed. Results. RET-He showed statistically significant differences between the beta thalassemia group and the other groups (p < 0.05). ROC analysis identified a cutoff value of ≤ 22.8 pg, with 100% sensitivity and 100% specificity for discriminating beta thalassemia from alpha thalassemia and iron deficiency without anemia, and a specificity of 61% when compared with iron deficiency anemia. Discussion. RET-He is a useful parameter for differentiating beta thalassemia from other microcytic conditions, particularly with a high negative predictive value.