ISSN 2997-1036
International Journal of Hematology | Vol. 12, No. 8, August 2021 | pp. 57–64
DOI: 10.46882/2021/IJH/000138
Original Article
Title: Evaluation of automated immature reticulocyte fraction and red blood cell fragmentation flags in separating iron deficiency from thrombotic thrombocytopenic purpura
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 thrombotic thrombocytopenic purpura variants. Evaluations were conducted on 125 adult patients presenting with thrombocytopenia and microcytosis, and diagnoses were validated via serum ferritin, ADAMTS13 activity, and manual visual blood film schistocyte counts. Thrombotic thrombocytopenic purpura was confirmed in 50 cases (ADAMTS13 < 10%), while 75 presented with severe iron deficiency. The mean immature reticulocyte fraction was significantly higher in the thrombotic thrombocytopenic purpura cohort compared to the iron-deficient group (0.36 ± 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 92.8% and a specificity of 89.1% 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, 2021; Revised: June 20, 2021; Accepted: July 09, 2021; Published: August 14, 2021