ISSN 2997-1036
International Journal of Hematology | Vol. 6, No. 8, August 2015 | pp. 57–64
DOI: 10.46882/2015/IJH/000068
Original Article
Title: Evaluation of automated immature reticulocyte fraction parameters in distinguishing vitamin B12 deficiency from bone marrow aplasia
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: Pancytopenia with macrocytic indices requires differentiation between nutritional megaloblastic deficiencies and primary bone marrow failure syndromes. This study evaluated the diagnostic performance of the automated immature reticulocyte fraction (IRF) in separating vitamin B12 deficiency from aplastic anemia in 60 patients presenting with unexplained pancytopenia. Full blood counts and reticulocyte maturity indices were measured using a fluorescent flow cytometry hematology analyzer, and diagnoses were confirmed via bone marrow biopsy and serum B12 assays. Vitamin B12 deficiency was diagnosed in 35 patients, while 25 were confirmed as aplastic anemia. The mean immature reticulocyte fraction was significantly higher in vitamin B12 deficient patients compared to the aplastic anemia cohort (0.34 ± 0.08 versus 0.06 ± 0.02, P < 0.001), reflecting an active but ineffective erythroid drive in megaloblastosis versus a total lack of bone marrow activity in aplasia. Receiver operating characteristic analysis established an immature reticulocyte fraction threshold above 0.18 as optimal for identifying megaloblastic processes, achieving a sensitivity of 88.5% and a specificity of 84.0%. Measuring the immature reticulocyte fraction provides a rapid, automated tool that helps differentiate causes of marrow failure before invasive biopsy results are available.
Keywords: Immature reticulocyte fraction, pancytopenia, vitamin B12 deficiency, aplastic anemia, erythropoiesis
Manuscript Timeline: Received: May 12, 2015; Revised: June 20, 2015; Accepted: July 09, 2015; Published: August 14, 2015