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Reference Values of Reticulocyte Hemoglobin Content in Healthy Adolescents

Ibáñez-Alcalde, María, M., MPH*; Vázquez-López, María, Á., MD; Ruíz-Sánchez, Ana, M., MPH; Lendínez-Molinos, Francisco, J., MD; Galera-Martínez, Rafael, MD; Bonillo-Perales, Antonio, MD; Parrón-Carreño, Tesifón, MD

Journal of Pediatric Hematology/Oncology: May 2018 - Volume 40 - Issue 4 - p 298–303
doi: 10.1097/MPH.0000000000001119
Original Articles

Assessing iron status in a pediatric population is not easy, as it is based on parameters that undergo physiological variations in childhood and adolescence. Analysis of the reticulocyte hemoglobin content (CHr) to screen for iron deficiency may increase the accuracy of diagnosis, but, to date, reference values in healthy adolescents have not been adequately determined. A cross-sectional study was conducted on a population-based representative sample in the city of Almería (Spain), with 253 healthy non–iron-deficient (ID) subjects, aged 12 to 16 years. The mean CHr value was 31.6±1.3 pg. The CHr 2.5 percentile was 28.7 pg. There were no significant differences as regards age or sex. In the multivariate linear regression analysis, sex did not influence the variability of CHr, but it was related to age. CHr was influenced by hemoglobin and the Mentzer index, as well as by functional iron indicators such as erythrocyte protoporphyrin and serum transferrin receptor. These independent variables predicted two thirds of the variability in healthy adolescents (R2=0.55). This study provides CHr reference ranges in healthy adolescents for use in clinical practice for the early detection of ID states. In populations with similar sociodemographic characteristics, values above the 2.5 percentile rule out ID, as values under the 2.5 percentile could be suggestive of functional ID.

*Department of Pediatrics, Poniente Hospital

Department of Pediatrics, Torrecárdenas Hospital

Health Delegation of Almería, University of Almería, Almería, Spain

The authors declare no conflict of interest.

Reprints: María M. Ibáñez-Alcalde, MPH, Department of Pediatrics, Poniente Hospital, Avenida Almerimar, s/n., El Ejido, Almería 04700, Spain (e-mail:

Received April 4, 2017

Accepted October 24, 2017

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.