Evaluating reticulocyte hemoglobin as a marker of iron depletion in pediatric patients in Banda Aceh

Ayu Rezky Oktariany -  Department of Pediatrics, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
Syafruddin Haris* -  Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh,, Indonesia
Heru Noviat -  Division of Hematology Oncology, Department of Pediatrics, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
Sulaiman Yusuf -  Division of Gastroenterology and Hepatology, Department of Pediatrics, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
Eka Destianti Edward -  Division of Hematology Oncology, Department of Pediatrics, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
Rusdi Andid -  Division of Endocrinology, Department of Pediatrics, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
DOI : 10.30867/action.v11i1.2535

Anemia in children remains a major public health problem worldwide and in Indonesia, where national data report a prevalence of 21.7% among children aged ≥1 year. Iron deficiency is the leading cause, with iron depletion representing the earliest subclinical stagewhich is often difficult to detect using conventional parameters. Reticulocyte hemoglobin (Ret-He) has been proposed as a marker of functional iron availability during erythropoiesis. This study aimed to evaluate the diagnostic performance of Ret-He in identifying iron depletion in pediatric patients. A cross-sectional analytical study was conducted at Dr. Zainoel Abidin General Hospital in Banda Aceh between July and September 2024. A total of 87 pediatric patients aged 1 month to 18 years were initially enrolled; after excluding subjects with anemia to focus on the iron depletion stage, 54 children were included in the final analysis. Iron depletion was identified in 12.6% of the subjects. Receiver operating characteristic (ROC) analysis showed an optimal Ret-He cut-off value of 29.5 pg, with an area under the curve (AUC) of 0.609, sensitivity of 70%, specificity of 63.6%, and a non-significant p-value (p = 0.398), indicating a limited diagnostic accuracy. Ret-He levels were significantly positively correlated with mean corpuscular volume (MCV) (r = 0.444; p = 0.001) and mean corpuscular hemoglobin (MCH) (r = 0.511; p < 0.001), but were not significantly associated with hemoglobin, ferritin, or transferrin saturation. In conclusion, Ret-He cannot be used as a standalone diagnostic marker of iron depletion in pediatric patients. However, its association with erythrocyte indices suggests that Ret-He may serve as a complementary parameter when interpreted alongside conventional iron status markers during the early evaluation of iron-related disorders.

Keywords : Iron Depletion, Reticulocyte Hemoglobin (Ret-He), Pediatric Patients

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Open Access Copyright (c) 2026 Ayu Rezky Oktariany, Syafruddin Haris, Heru Noviat, Sulaiman Yusuf, Eka Destianti Edward, Rusdi Andid
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AcTion: Aceh Nutrition Journal
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