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Evaluation of derived Coulter red blood cell parameters for the assessment of iron deficiency in adults with congenital heart disease


Jelena Martinovic, Health Center Rakovica, Laboratory Department, Kraljice Jelene 11, Belgrade, Serbia. Tel.: +381 11 3052 052; Fax: +381 11 3582 842; E-mail:


Introduction:  The aim of our study was to evaluate derived red blood cell parameters in determining the presence of iron depletion and iron-deficient erythropoiesis, as states that precede iron deficiency anemia, in adults with congenital heart disease.

Methods:  Eighty-eight adults who were diagnosed with congenital heart disease were divided into two groups (cyanotic and acyanotic). In both groups, congenital heart disease patients were then divided into three subgroups: with iron depletion, with iron-deficient erythropoiesis, and a control group. The following parameters were measured: complete blood count, reticulocytes, ferritin, soluble transferrin receptor, haptoglobin, lactate dehydrogenase, and calculated parameters: low hemoglobin density (LHD), red cell size factor (RSF), and microcytic anemia factor (MAF).

Results:  Discriminant analysis indicated statistically significant differences in the first discriminant function: Function 1 – body iron, LHD, MAF, sTfR, and RSF (P < 0.001) in patients with acyanotic congenital heart disease and significant differences in both discriminant functions in patients with cyanotic congenital heart disease: Function 1 – body iron, soluble transferrin receptor, LHD, RSF, MAF, lactate dehydrogenase, and haptoglobin (P = 0.008) and Function 2 – reticulocytes (#), immature reticulocyte fraction and reticulocytes (%) (P = 0.049).

Conclusions:  Beside parameters that describe iron metabolism dynamics (body iron and soluble transferrin receptor), LHD, indicator of hypochromia, have the highest potential to differentiate and classify iron deficiency in patients with congenital heart disease.