Clinical significance of immature reticulocyte fraction (IRF) and reticulocyte maturity indices in differential diagnosis of anemia

Abstract

Background: Anemia is most common public health problems in developing countries. It is important to know the cause of anemia to treat the patients. The Immature reticulocyte fraction (IRF) value is an early marker for evaluating the regeneration of erythropoiesis. In addition to conventional reticulocyte measurement, the fluorescence method allows the classification of reticulocytes into three maturation stages – LFR, MFR and HFR. Aims: To determine clinical significance of immature reticulocyte fraction (IRF) and reticulocyte maturity indices (LFR, MFR, HFR) in differential diagnosis of anemic patients. Material and Method: IRF and other reticulocyte parameters were measured by automated blood cell analyzer, Horiba Pentra XLR using fluorescence marker that labels RNA and DNA (such as thiazole orange or polymethines), in 124 patients with anemia. The anemia group consist of 50 iron deficiency anemia (IDA) patients, 29 cases of thalassemia trait patients and 45 patients with anemia due to chromic kidney diseases (CKD). In this retrospective and prospective type study, the values of IRF and other parameters were analysed and compared in each group for the duration of one year. Result: Total of 124 cases were evaluated with median age of age of 32.8 years showed that mean value of IRF was low in IDA (0.096±0.058) and in CKD (0.092±0.111) compare to thalassemia (0.116±0.094). The mean values of MFR and HFR were also found to be significantly lower in IDA group and in CKD when compared to the thalassemic group. Values of LFR were higher in IDA and in CKD compare to thalassemia. Conclusions: IRF assesses reticulocyte maturation by the intensity of the staining that reflects the mRNA content. The evaluation of IRF and reticulocyte maturity indices by automated cell counter analyzer seemed to be accurate and clinically useful for the early diagnosis of anemia and the differentiation of IDA and CKD from thalassemia.