Reticulocyte hemoglobin content (CHr) untuk skrining defisiensi besi pada ibu hamil

Bambang Sasangka(1), Tri Ratnaningsih(2*)

(1) Instalasi Patologi Klinik Rumah Sakit Umum Daerah Kota Yogyakarta
(2) Departemen Patologi Klinik dan Kedokteran, Laboratorium Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan Universitas Gadjah Mada / Sub. Hematologi Instalasi Laboratorium Klinik Rumah Sakit Umum Pusat Dr. Sardjito
(*) Corresponding Author


Reticulocyte hemoglobin content (CHr) for iron deficiency screening in pregnant women

Background: Anemia in pregnancy is a major public health problem in developing countries. In Indonesia, such anemia is generally caused by nutritional deficiencies, particularly iron deficiency. Iron deficiency screening is needed to prevent the development of iron-deficiency anemia in pregnant women that may affect the health of the mother and fetus.

Objective: The study objective was to determine the diagnostic validity of reticulocyte hemoglobin content (CHr) for iron deficiency screening in pregnant women.

Method: This research is analytic observational research with a cross-sectional design. The subjects were 73 pregnant women in Bantul district with various gestational ages. CHr was examined with an Advia 120 automatic hematology analyzer. Examination of ferritin as gold standard uses chemiluminescens method with Elecsys 1010 immunology analyzer. Table 2x2 is used to test several CHr values in the CHr range for women of reproductive age of 28.8 - 34.5 pg.

Results: Based on ferritin <15 μg / L as a gold standard, 13 pregnant women were suffered from iron deficiency while others were normal.

Conclusion: CHr at 30.7 pg cut off has a sensitivity of 92.31%; negative predictive value (NPV) 96.2%; and likelihood ratio (LR) produce conclusive changes in post-test probability. In this cut-off, CHr can be used as an iron deficiency screening test in pregnant women.


diagnostic validity; iron deficiency; pregnant; reticulocyte hemoglobin content (CHr); screening

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  1. WHO. Worldwide prevalence of anemia 1993-2005: WHO global database on anemia. [series online] 2008 [cited 1 Agustus 2016]. Available online: URL:
  2. Pavord S, Myers B, Robinson S, Allard S, Strong J, Oppenheimer C. UK guidelines on the management of iron deficiency in pregnancy. BJH 2012;156(5):588-600. doi: 10.1111/j.1365-2141.2011.09012.x
  3. Noronha JA, Bhaduri A, Vinodbhat H, Kamath A. Maternal risk factors and anaemia in pregnancy: a prospective retrospective cohort study. J Obstet Gynaecol 2010 Feb;30(2):132-6. doi: 10.3109/01443610903267457
  4. Bilimale, Anjum, J, Sangolli HN, Mallapur M. Improving adherence to oral iron supplementation during pregnancy. AMJ 2010;3(5):281-90. doi: 10.4066/AMJ.2010.291
  5. McMullin MF, White R, Lappin T, Reeves J, MacKenzie G. Haemoglobin during pregnancy: relationship to erythropoietin and haematinic status. Eur J Haematol 2003;71(1):44-50. doi: 10.1034/j.1600-0609.2003.00085.x
  6. Shaw JG, Friedman JF. Iron deficiency anemia: focus on infectious diseases in lesser developed countries. Anemia 2011; 260380. doi: 10.1155/2011/260380
  7. Turner LTS, Seybold D, Celestinef C, Williams D. Incidence of anemia among obstetric patients in an Appalachian teaching clinic. Mil Med 2012;177(10):1212-6. doi: 10.7205/milmed-d-11-00445
  8. McMahon LP. Iron deficiency in pregnancy. Obstet Med 2010 Mar;3(1):17-24. doi: 10.1258/om.2010.100004
  9. Wu AC, Lesperance L, Bernstein H. Screening for iron deficiency. Pediatr Rev 2002 May;23(5):171-8. doi: 10.1542/pir.23-5-171
  10. Ervasti M, Kotisaari S, Heinonen S, Punnonen K. Use of advanced red blood cell and reticulocyte indices improves the accuracy in diagnosing iron deficiency in pregnant women at term. Eur J Haematol 2007;79(6):539-45. doi: 10.1111/j.1600-0609.2007.00964.x
  11. Thomas C, Thomas L. Biochemical markers and hematologic indices in the diagnosis of functional iron deficiency. Clin Chem 2002;48(7):1066-76.
  12. Brugnara C, Schiller B, Moran J. Reticulocyte hemoglobin equivalent (Ret He) and assessment of iron-deficient states. Clin Lab Haem 2006 Oct;28(5):303-8. doi: 10.1111/j.1365-2257.2006.00812.x
  13. Buttarello M, Plebani, M. Automated blood cell counts state of the art. Am J Clin Pathol 2008 Jul;130(1):104-16. doi: 10.1309/EK3C7CTDKNVPXVTN
  14. Bakr AF, Sarette G. Measurement of reticulocyte hemoglobin content to diagnose iron deficiency in Saudi children. Eur J Pediatric 2006 Jul;165(7):442-5. doi: 10.1007/s00431-006-0097-0
  15. Ullrich C, Wu A, Armsby C, Rieber S, Wingerter S, Bernstein H, et al. Screening healthy infants for iron deficiency using reticulocyte hemoglobin content. JAMA 2005 Aug;294(8):924-30. doi: 10.1001/jama.294.8.924
  16. Stoffman N, Brugnara C, Woods ER. An algorithm using reticulocyte hemoglobin content (CHr) measurement in screening adolescent for iron deficiency. J Adolesc Health 2005 Jun;36:529. doi: 10.1016/j.jadohealth.2004.09.011
  17. Karlsson T. Comparative evaluation of the reticulocyte hemoglobin content assay when screening for iron deficiency in elderly anemic patients. Anemia 2011; 925907. doi: 10.1155/2011/925907
  18. Sastroasmoro S, Ismael S. Dasar-dasar metodologi klinis, edisi-3. Jakarta: Sagung Seto; 2008.
  19. Surbakti IS, Aman AK, Sitepu M. Perbandingan retikulosit hemoglobin (Ret-He) dengan feritin sebagai parameter diagnostik pada ibu hamil yang mengalami defisiensi besi. Buku Panduan Acara dan Kumpulan Abstrak Konas VIII-PIT XII PDS Patklin Yogyakarta; 2013.
  20. Schoorl M, Gaag D, Bartels P. Changes in red cell hemoglobinization during pregnancy. Ned Tijdschr Klin Chem Labgeneesk 2010;35(3):206-8
  21. Tiwari LM, Kotwal CJ, Kotwal A, Mishra, MP, Dutta BV, Chopra BS. Correlation of haemoglobin and red cell indices with serum feritin in Indian women in second and third trimester of pregnancy. Med J Armed Forces India. 2013 Jan;69(1):31-6. doi: 10.1016/j.mjafi.2012.07.016
  22. Dahlan MS. Penelitian diagnostik: dasar-dasar teoritis dan aplikasi dengan program SPSS dan Stata. Jakarta: Salemba Medika; 2009.


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