Diagnostic Performance of Automated Reticulocyte and Red Cell Indices for Detecting Iron Deficiency Anemia in Cirrhotic Patients.

Authors

Sahar Ma Ibrahim, Asmaa Ahmed Abd-El Gawad, Olfat M Hendy, Laila Shehata Dorgham, Eman Abdelsameea, Nessren Mohammed Bahaa El Deen, Sally S Mandour

Published in

International journal of laboratory hematology. Jul 20, 2026. Epub Jul 20, 2026.

Abstract

Iron deficiency anemia (IDA) diagnosis in cirrhotic patients is challenging due to the confounding effects of inflammation and altered iron metabolism. Conventional markers, such as the iron profile, may be unreliable in this population. This study aimed to evaluate the diagnostic performance of reticulocyte hemoglobin content (CHr), percentage of microcytic red blood cells (%MicroR), and percentage of hypochromic red blood cells (%HypoR) for the diagnosis of IDA in cirrhotic patients.
Four groups were included in this cross-sectional study: healthy controls, IDA non-cirrhotic, IDA cirrhotic, and non-IDA cirrhotic patients. Complete blood counts and reticulocyte indices were analyzed using a Sysmex XN- 1000 hematology analyzer, and receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performance of the studied indices.
CHr demonstrated the highest diagnostic performance, with an area under the curve (AUC) of 0.925 at a cut-off value of ≤ 25.7 pg. %MicroR also demonstrated strong discriminative ability (AUC = 0.906) at a cut-off of > 10.8%, whereas ferritin showed good diagnostic performance (AUC = 0.858) at a cut-off of ≤ 101 μg/L.
CHr demonstrated excellent diagnostic performance and may serve as a valuable adjunctive marker for assessing iron status in cirrhotic patients, outperforming ferritin and other automated red blood cell indices. These findings support the potential role of reticulocyte indices as valuable tools for diagnosing IDA in cirrhosis, where conventional iron markers may be unreliable.

PMID:
42476607
Bibliographic data and abstract were imported from PubMed on 21 Jul 2026.

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