ISSN 2997-1036
International Journal of Hematology | Vol. 11, No. 8, August 2020 | pp. 57–64
DOI: 10.46882/2020/IJH/000128
Original Article
Title: Evaluation of automated immature reticulocyte fraction and red blood cell fragmentation flags in separating iron deficiency from microangiopathic hemolytic anemia
Names of Authors: Q. S. Abubakar¹, U. T. Maina²
Authors’ Affiliations: ¹Department of Haematology, National Hospital, Abuja, Nigeria; ²Department of Pathology, Bayero University, Kano, Nigeria
Abstract: Severe microcytic anemia fragments can mimic schistocytes on automated counters, requiring robust laboratory separation parameters to prevent inappropriate therapeutic decisions. This prospective diagnostic study evaluated the performance of automated immature reticulocyte fractions (IRF) and fragmented red blood cell (FRC) flags for separating absolute iron deficiency anemia from microangiopathic hemolytic anemia variants. Evaluations were conducted on 125 adult patients presenting with thrombocytopenia and microcytosis, and diagnoses were validated via serum ferritin and manual visual blood film schistocyte counts. Microangiopathic hemolysis (thrombotic thrombocytopenic purpura or hemolytic uremic syndrome) was confirmed in 50 cases, while 75 presented with severe iron deficiency. The mean immature reticulocyte fraction was significantly higher in the microangiopathic anemia cohort compared to the iron-deficient group (0.34 ± 0.08 versus 0.12 ± 0.03, P < 0.001), reflecting an intense bone marrow response. Conversely, automated fragmentation flags were elevated in both groups. Receiver operating characteristic analysis established a combined IRF and FRC model that achieved a diagnostic sensitivity of 91.2% and a specificity of 88.4% for identifying true microangiopathic processes. Utilizing automated reticulocyte maturity indices provides an efficient, low-cost asset for screening destructive hemolytic conditions.
Keywords: Immature reticulocyte fraction, fragmented red cells, iron deficiency anemia, schistocytes, cell counter indices
Manuscript Timeline: Received: May 12, 2020; Revised: June 20, 2020; Accepted: July 09, 2020; Published: August 14, 2020