Utility of reticulocyte hemoglobin as a new predictor of anemia in intensive care unit patients

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Introduction Iron deficiency and anemia are common complications in critically ill patients, particularly in the Intensive Care Unit setting (ICU), where inflammation and infection are prevalent. Traditional markers like ferritin are unreliable in these contexts due to their behavior as acute-phase reactants. New hematimetric indices, such as Reticulocyte Hemoglobin Equivalent (RET-He) and Delta Hemoglobin Equivalent (Delta-He), may offer better predictive value for anemia in ICU patients. Objectives This study aimed to evaluate the predictive utility of RET-He and Delta-He for anemia in critically ill patients and compare their performance with serum ferritin levels. Methods A pilot, observational, prospective study was conducted on 40 ICU patients admitted for burns or polytrauma. Hematological and hematimetric parameters were analyzed at admission, 48 h, 4 days, and 7 days post-admission. Mixed-effects regression models were used to assess the predictive value of RET-He, Delta-He, and ferritin for hemoglobin levels and anemia. Results Significant reductions in hemoglobin and hematocrit were observed within the first 48 h of ICU admission, while RET-He and Delta-He remained stable. Over 4 and 7 days, decreases in RET-He and Delta-He were strongly associated with lower hemoglobin levels and increased risk of anemia (p < 0.01). Ferritin levels did not predict anemia in either period. Conclusion RET-He and Delta-He are valuable predictors of anemia in critically ill ICU patients, outperforming ferritin in this context. Their routine use could improve the early detection and management of iron deficiency and anemia in ICU settings.

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