DOI: https://doi.org/10.14710/dimj.v7i1.30883

Immature Reticulocyte Fraction in Thalassemia Major Receiving Single and Combination Iron Chelation Therapy

*Nyoman Suci orcid scopus  -  Department of Clinical Pathology, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia, Indonesia
Andina Putri Aulia orcid scopus  -  Clinical Pathology Residency Program, Faculty of Medicine, Universitas Diponegoro, Semarang / Staff of the Department of Clinical Pathology, Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, Indonesia, Indonesia

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Abstract

Background: Ineffective erythropoiesis in thalassemia major causes anemia and requires regular blood transfusions. However, routine transfusions cause iron accumulation, which can be removed through iron chelation therapy (single or combination). To monitor erythropoietic activity non-invasively, Immature Reticulocyte Fraction (IRF) and reticulocyte count have been proven effective, eliminating the need for invasive bone marrow examination.

Objective: This study aimed to determine the differences in IRF percentage and reticulocyte count between thalassemia major patients receiving single and combination iron chelation therapy.

Methods: An observational analytical study with a cross-sectional design was conducted at the Paediatric Haematology and Oncology Clinic of Dr. Kariadi General Hospital, Semarang, from November 2023 to January 2024. Subjects were thalassemia patients aged ≤ 18 years and receiving more than 10 regular transfusions. IRF and reticulocyte count were examined using fluorescence flow cytometry on whole blood samples with EDTA anticoagulant.

Results: A total of 71 thalassemia major patients were enrolled, consisting of 40 males (56%) and 31 females (44%). The mean IRF percentage was 11.62±5.4% in thalassemia major patients receiving single iron chelation therapy and 17.01±10.0% (p<0.015) in the group that was administered combination therapy. Mean reticulocyte count was 0.106±0.08 x106/µL in thalassemia major patients receiving single iron chelation therapy and 0.110±0.08 x106/µL in the group administered combination therapy (p<0.83).

Conclusion: There is a difference in IRF between thalassemia major patients, with high erythropoietic activity in the group receiving combination iron chelation therapy.

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Keywords: Thalassemia Erythropoiesis Iron chelation IRF Reticulocyte

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