Objective: The aim of this study was to evaluate the effectiveness of mature red cell and reticulocyte parameters to identify three conditions: iron deficiency anemia, anemia of chronic disease, and anemia of chronic disease associated with absolute iron deficiency. Methods: Peripheral blood cells from 117 adult patients with anemia were classified accord- ing to iron status, inflammation, and hemoglobinopathies as: iron deficiency anemia (n = 42), anemia of chronic disease (n = 28), anemia of chronic disease associated with iron deficiency anemia (n = 22), and heterozygous β-thalassemia (n = 25). The percentage of microcytic eryth-rocytes, hypochromic erythrocytes, and the levels of hemoglobin in both reticulocytes and mature red cells were determined. Receiver operating characteristic analysis was used to evaluate the accuracy of the parameters in differentiating anemia. Results: There was no difference between the groups of iron deficiency and anemia of chronic disease associated with absolute iron deficiency for any of the parameters. The percentage of hypochromic erythrocytes was the best parameter to identify absolute iron deficiency in patients with anemia of chronic disease (area under curve = 0.785; 95% confidence interval: 0.661-0.909 with sensitivity of 72.7%, and specificity of 70.4%; cut-off value 1.8%). The formula microcytic erythrocyte count minus hypochromic erythrocyte count was very accurate to differentiate iron deficiency anemia from heterozygous β-thalassemia (area under curve = 0.977; 95% confidence interval: 0.950-1.005 with a sensitivity of 96.2%, and specificity of 92.7%; cut-off value 13.8). Conclusion: The erythrocyte and reticulocyte indices are moderately good to identify absolute iron deficiency in patients with anemia of chronic disease.

Objective:The purpose of this study was to evaluate the effectiveness of mature red cell and reticulocyte parameters under three conditions: iron deficiency anemia, anemia of chronic disease, and anemia of chronic disease associated with absolute iron deficiency.Methods:Peripheral blood cells from 117 adult patients with anemia were classified according to iron status, and inflammatory activity, and the results of a hemoglobinopathy investigation as: iron deficiency anemia (n = 42), anemia of chronic disease (n = 28), anemia of chronic disease associated with iron deficiency anemia (n = 22), and heterozygous β thalassemia (n = 25). The percentage of microcytic red cells, hypochromic red cells, and levels of hemoglobin content in both reticulocytes and mature red cells were determined. Receiver operating characteristic analysis was used to evaluate the accuracy of the parameters in differentiating between the different types of anemia.Results:There was no significant difference between the iron deficient group and anemia of chronic disease associated with absolute iron deficiency in respect to any parameter. The percentage of hypochromic red cells was the best parameter to discriminate anemia of chronic disease with and without absolute iron deficiency (area under curve = 0.785; 95% confidence interval: 0.661–0.909, with sensitivity of 72.7%, and specificity of 70.4%; cut-off value 1.8%). The formula microcytic red cells minus hypochromic red cells was very accurate in differentiating iron deficiency anemia and heterozygous β thalassemia (area under curve = 0.977; 95% confidence interval: 0.950–1.005; with sensitivity of 96.2%, and specificity of 92.7%; cut-off value 13.8).Conclusion:The indices related to red cells and reticulocytes have a moderate performance in identifying absolute iron deficiency in patients with anemia of chronic disease.

Os fenótipos de haptoglobina (HP) foram determinados em 188 pacientes brasileiros com os quatro principais tipos de leucemia (LMA, LMC, LLA e LLC) e comparados a 197 controles normais. A existência de associação entre a LMA, a LMC e a LLA e o gene HP-1 e o fenótipo HP 1-1, previamente sugerida na literatura, não foi confirmada no presente estudo. Uma prevalência maior de haptoglobinêmicos (HP0) foi verificada entre os pacientes, em concordância com estudos prévios.

Haptoglobin (HP) phenotypes were determined in 188 Brazilian patients with the four most common types of leukemia: acute myeloid leukemia (AML), chronic myeloid leukemia (CML), acute lymphoblastic leukemia (ALL) and chronic lymphocytic leukemia (CLL), and were compared to 197 normal controls. We could not confirm the previously suggested increased incidence of the HP1 gene and the HP1-1 phenotype among leukemic patients. A higher frequency of haptoglobinemics (HP0) was observed among patients, in agreement with previous findings.

A deficiência de ferro e a beta-talassemia heterozigótica são importantes causas de microcitose e hipocromia. São propostos dois parâmetros laboratoriais para auxiliar na diferenciação entre essas anemias. O número de reticulócitos altamente imaturos e níveis do receptor solúvel da transferrina foram determinados em pacientes com anemia ferropriva (n = 49) e com beta-talassemia heterozigótica (n = 43). Não houve diferença significativa entre os valores de reticulócitos altamente imaturos e níveis de receptor solúvel da transferrina nos dois grupos, mas foi observada uma correlação entre reticulócitos altamente imaturos e níveis de receptor solúvel da transferrina no grupo com anemia ferropriva, provavelmente devido à um estímulo para a síntese do receptor em resposta à deprivação de ferro nos eritrócitos.

Iron deficiency and heterozygous beta-thalassemia are important causes of hypochromic-microcytic anemia. Two laboratory parameters are suggested for the differentiation of such anemia. High-fluorescence reticulocyte counts and soluble transferrin receptor levels were determined in iron-deficiency anemia patients (n = 49) and heterozygous beta-thalassemia patients (n = 43). There was no significant difference in high-fluorescence reticulocyte and soluble transferrin receptor values between the two groups, but a correlation was observed between high-fluorescence reticulocytes and soluble transferrin receptors in iron-deficiency anemia, probably due to increased receptor synthesis as a response to decreased iron content in erythrocytes.

OBJETIVO: Relacionar a função esplênica com os níveis do receptor solúvel da transferrina (sTfR) e com os valores da ferritina intra-eritrocitária (RCF) em pacientes com doenças falciformes. TIPO DE ESTUDO: Estudo prospectivo. LOCAL: Hospital das Clínicas da Faculdade de Ciências Médicas da UNICAMP, atendimento terciário. PARTICIPANTES: 60 pacientes portadores de doenças falciformes, na fase estável da doença, sem transfusão de sangue nos últimos 3 meses; 28 indivíduos normais, sem sinais clínicos e laboratoriais de anemia. VARIÁVEIS ESTUDADAS: Determinação do ferro sérico, capacidade de ligação do ferro à transferrina, ferritina sérica, RCFe sTfR. Avaliação da função esplênica: quantificação de hemácias com "pits". RESULTADOS: Pacientes com anemia falciforme: os níveis de sTfR foram significativamente mais elevados do que nos indivíduos normais e com Hb SC (p=0,0001); correlação inversa entre sTfR e Hb Fetal (p=0,0016); valores de RCF significativamente mais elevados do que nos indivíduos normais e pacientes SC (p=0,0001); correlação entre RCF e hemácias com "pits" (p=0,0512).CONCLUSÕES: A associação entre sTfR e Hb Fetal confirma a contribuição da Hb Fetal na melhora do quadro hemolítico, o que, conseqüentemente, minimiza a reativação da expansão eritróide. Os altos níveis de sTfR observados nos pacientes com doença falciforme não estão relacionados com o grau de hipofunção esplênica. A deficiência do processo de exocitose exercido pelo baço pode contribuir para o acúmulo de RCF nos pacientes com anemia falciforme.

OBJECTIVE: To correlate spleen function with soluble transferrin receptor (sTfR) levels and red cell ferritin (RCF) values in patients with sickle cell diseases. DESIGN: Prospective study. LOCATION: University Hospital, School of Medical Sciences, State University of Campinas; a tertiary hospital. PARTICIPANTS: 60 patients with sickle cell diseases, in a steady state, who had not received blood transfusions for 3 months; 28 normal individuals with no clinical or laboratory signs of anemia. MEASUREMENTS: Determination of serum iron, transferrin iron-binding capacity, serum ferritin, RCF and sTfR. Evaluation of spleen function: erythrocytes with pits were quantified. RESULTS: Patients with sickle cell anemia had sTfR levels significantly higher than in normal individuals or those with HbSC (p=0.0001) and there was an inverse correlation between sTfR and fetal Hb (p=0.0016). RCF values were significantly higher in sickle cell anemia patients than in normal individuals or those with HbSC (p=0.0001), and there was a correlation between RCF and pitted erythrocytes (p=0.0512). CONCLUSION: The association between sTfR and fetal Hb confirms the contribution of fetal Hb to improving the hemolytic state by minimizing the consequent reactive erythrocyte expansion. High sTfR levels are not related to the degree of spleen function deficiency seen in sickle cell disease patients. The deficiency in the exocytosis process of the spleen occurring in sickle cell anemia patients may contribute to their accumulation of RCF.

A função discriminante baseada na distribuição do tamanho dos eritrócitos (RDW) e outra função discriminante incorporando o RDW (MCV² x RDW/Hgb x 100) foram determinadas em um grupo de 30 pacientes com anemia ferropriva, 30 pacientes com beta talassemia menor e 30 indivíduos normais. Os valores médios do RDW e do (MCV² x RDW/ Hgb x 100) foram significativamente maiores em pacientes com anemia ferropriva quando comparados aos obtidos em pacientes com beta talassemia menor (p<0.001). Considerando os valores de RDW iguais ou superiores a 21.0% entre os pacientes com anemia microcítica, nós identificamos corretamente 90% dos pacientes com anemia ferropriva, sendo que a sensibilidade e a especificidade do teste foram 90.0% (IC 95%: 0.75 - 0.96) e 77.0% (IC 95%: 0.60 - 0.88), respectivamente. Valores de RDW menores do que 21.0% identificaram corretamente 77.0% dos pacientes com beta talassemia menor, com sensibilidade e especificidade de 77.0% (IC 95%: 0.60 - 0.88) e 90.0% (IC 95%: 0.75 - 0.96), respectivamente. Considerando valores de (MCV² x RDW/Hgb x 100) maiores e menores do que 80.0% como indicativos de anemia ferropriva e beta talassemia menor, respectivamente, nós identificamos corretamente 97.0% dos pacientes de cada grupo, com sensibilidade e especificidade de 97.0 (IC 95%: 0.84 - 0.99). Estes resultados indicaram que a função discriminante (MCV² x RDW/Hgb x 100) é um método altamente sensível e específico para a triagem inicial de pacientes com anemia microcítica e é superior ao RDW para a diferenciação de pacientes com anemia ferropriva daqueles com beta talassemia menor.

The red cell distribution width (RDW), and another red cell discriminant function incorporating RDW (MCV² x RDW/Hgb x 100) were determined in a group of 30 patients with iron deficiency anemia, 30 patients with beta thalassemia trait, and 30 normal subjects. Both RDW and (MCV² x RDW/Hgb x 100) mean values were significantly higher in iron deficiency anemia than in beta thalassemia trait (p<0.001). Taking RDW equal or above 21.0 percent among microcytic anemia patients, we identified correctly 90.0 percent of patients with iron deficiency anemia. The sensitivity and specificity of the test were 90.0 percent (IC 95 percent: 0.75 - 0.96) and 77.0 percent (IC 95 percent: 0.60 - 0.88), respectively. RDW values below 21.0 percent identified correctly 77.0 percent of beta thalassemia trait with a sensitivity and a specificity of 77.0 percent (IC 95 percent: 0.60 - 0.88) and 90.0 percent (IC 95 percent: 0.75 - 0.96), respectively. Taking values of (MCV² x RDW/Hgb x 100) above and below 80.0 percent as indicative of iron deficiency and beta thalassemia trait, respectively, we identified correctly 97.0 percent of those patients in each group. Both sensitivity and specificity were 97.0 percent (IC 95 percent: 0.84 - 0.99). These results indicated that the red cell discriminant function incorporating volume dispersion (MCV² x RDW/Hgb x 100) is a highly sensitive and specific method in the initial screening of patients with microcytic anemia and is better than RDW in differentiating iron deficiency anemia from beta thalassemia trait.