Clinical Significance of Reticulocyte Maturation Parameters in the Differential Diagnosis of Macrocytic Anemias

BACKGROUND: Macrocytic anemias are commonly seen in clinical practice, and precise etiologic diagnosis is essential for proper management. We evaluated the clinical utility of reticulocyte maturation parameters in macrocytic anemias to discriminate among myelodysplastic syndrome (MDS), megaloblastic anemia (MA), and non-megaloblastic macrocytic anemia associated with chronic liver disease (MA-CLD). METHODS: Using an automated reticulocyte counter, we retrospectively analyzed and compared reticulocyte maturation parameters including immature reticulocyte fraction (IRF), mean reticulocyte volume (MRV), mean sphered cell volume (MSCV) of normal control (N=34), and patients diagnosed with MDS (N=31), MA (N=52), and MA-CLD (N=196). RESULTS: Macrocytic anemias from MA, MDS and MA-CLD showed higher values of reticulocyte maturation parameters including IRF, MRV and MSCV than normal control (P<0.01). MDS showed higher values of reticulocyte maturation parameters including IRF, MRV and MSCV than MA-CLD (P<0.01). IRF and MRV were significantly lower in MA-CLD than in both MA and MDS (P<0.01). MSCV was significantly higher in MDS than in MA (P<0.01). CONCLUSIONS: This study indicates that the measurement of reticulocyte maturation parameters may be a useful tool in the differential diagnosis of macrocytic anemia. The presence of high values of IRF (> or = 0.39), MRV (> or = 129.5 fL), and MSCV (> or = 102.3 fL) makes the diagnosis of MA-CLD unlikely and underlying MDS should be considered.