Introduction: Iron deficiency is the most prevalent nutritional deficiency in the world. In developing country, iron deficiency is responsible for the most cases of anemia. Iron deficiency anemia (IDA) is rarely progressed into mortality but it has important role for the public health. Thus, the early indicators of iron deficient status are needed as prevention. The most common parameters used for iron status measurements are serum iron, serum ferritin, serum transferrin receptor (sTfR) and the other advanced hematology parameters. However, all of them have financial and geographical limitations. Due to higher cost and complicated equipment, consideration of looking for a simple alternative assessment tool for laboratory facility located in rural and remote areas is important. Recently, the measurement of schistocytes, the red blood cell fragments, are considered as an alternative. In this study, we evaluate the implementation of Schistocytes parameter as prospective assesment of iron deficiency.
Methods: A number of 65 microcytic red blood cells (RBC) subjects aged from 18 to 82 years old were enrolled in this study. Schistocyte morphology was determined following International Council for Standardization in Hematology (ICSH) 2015 guideline. The schistocyte count was then further compared to Ferritin level using Receiver Operating Characteristic (ROC) curve to determine the diagnosis of iron deficiency.
Result: In this study, we obtained AUC value was 82.7%. The Schistocyte cut-off point selected by ROC curve analysis was 7.5 per 1000 RBC (sensitivity: 80%, specificity: 75%, Youden Index: 0.55). Schistocyte count > 7.5 per 1000 RBC reflected an iron deficiency in microcytic RBC subjects.
Conclusion: We demonstrated enough performance of Schistocyte count as an assessment for iron state in microcytic RBC subjects with high risk of iron deficiency.
Keywords: Schistocyte, iron deficiency, anemia, ICSH