KESAHIHAN DIAGNOSTIK HEMOGLOBIN RETIKULOSIT UNTUK DETEKSI DEFISIENSI ZAT BESI DI KEHAMILAN (Diagnostic Validity of Reticulocyte Hemoglobin for Iron Deficiency Detection in Pregnancy)

Tri Ratnaningsih, Budi Mulyono, Sutaryo Sutaryo, Iwan Dwiprahasto

Abstract


Entering the second trimester of pregnancy, more iron is required due to the increase in erythrocyte mass, plasma volume and
the development of fetus as well as chorion. Iron is needed the most in the third trimester. The existing hematological iron stage
parameters can only detect iron deficiency in the latest stage. The aim of this study was to know the assessment validity of Ret-He
examination as a new parameter to diagnose iron deficiency in pregnant women with anemia, as well as a screening tool for those in
term pregnancy without anemia. The research design was cross sectional. The subjects were women in term pregnancy, gathered from
PKU Muhammadiyah Hospital, Bantul Yogyakarta from May to November 2013. A seven (7) mL blood sample was taken from the
cubital vein of the subjects. Two mL of the sample was tested for routine hematological examination using an EDTA tube, while the
Ret-He was assessed using an automatic hematological instrument Sysmex XT-2000-i (Symex Corporation, Kobe, Japan). The serum
of the remaining five (5) mL was used to check the serum iron and TIBC to obtain the saturation value (Tsat) using Cobas analyzer
C501 (Roche Diagnostics, Germany), while the serum ferritin (SF) was examined using Minividas. The subjects were classified into two
(2) groups based on the Hb levels, namely: anemia (Hb<11 g/dL) and those who did not (Hb≥11 g/dL). Furthermore, they were also
classified into two (2) groups based on transferrin saturation values: iron deficient (Tsat <9%) and normal (Tsat ≥9%). From 291
subjects, 59 (20.3%) were found to have anemia and 232 (79.7%) did not. The cut off value of Ret-He to diagnose iron deficiency in
pregnant women with anemia was 29.8 pg (82% sensitivity and 72% specificity). Meanwhile, the cut-off value of Ret-He for iron
deficiency screening in pregnant women without anemia was 29.8 pg, with a sensitivity and specificity of 92% and 87% respectively.
The Ret-He holds a good diagnostic validity to detect iron deficiency in pregnancy, with or without anemia.


Keywords


Ret-He, diagnostic validity, iron deficiency, detection, pregnancy

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DOI: http://dx.doi.org/10.24293/ijcpml.v21i3.1282

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ACREDITED No. 36a/E/KPT/2016, 23 Mei 2016

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