Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Clinical Significance of Immature Reticulocyte Fraction and Reticulocyte Cellular Indices in Pediatric Anemia Patients

망상적혈구 지수 및 미성숙망상적혈구 분획의 소아 빈혈에서의 임상적 의의

  • Seo, Young (Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Jung, Hye Lim (Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Shim, Jae Won (Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Deok Su (Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Shim, Jeong Yeon (Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Park, Moon Soo (Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 서영 (성균관대학교 의과대학 강북삼성병원 소아과) ;
  • 정혜림 (성균관대학교 의과대학 강북삼성병원 소아과) ;
  • 심재원 (성균관대학교 의과대학 강북삼성병원 소아과) ;
  • 김덕수 (성균관대학교 의과대학 강북삼성병원 소아과) ;
  • 심정연 (성균관대학교 의과대학 강북삼성병원 소아과) ;
  • 박문수 (성균관대학교 의과대학 강북삼성병원 소아과)
  • Received : 2004.09.24
  • Accepted : 2004.10.15
  • Published : 2005.03.15
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Abstract

Purpose : Flow cytometric automated reticulocyte analysis is a superior method to manual reticulocyte counting, with respect to precision and sensitivity. Furthermore, flow cytometric analysis is able to measure immature reticulocyte fraction(IRF) and reticulocyte cellular indices(RCI : cell hemoglobin content : CHr, mean cell volume : MCVr, cell hemoglobin concentration mean : CHCMr, distribytion width : RDWr, HDWr, CHDWr). In this study, we investigated the mean values and clinical significances of IRF and RCI in healthy children and pediatric anemia patients. Methods : IRF and RCI were measured with an automated blood cell analyzer, ADVIA 120(Bayer, USA) using oxazine 750 dye, in 57 healthy children and 61 children with anemia. The anemia group consisted of 27 iron deficiency anemia(IDA) patients and 34 patients with anemia associated with acute infection(AAI). We compared the mean values of IRF and RCI in the control group classified according to age, between anemia groups and the control group, and between the IDA group and the AAI group. Results : For the normal control group, the mean values of IRF, CHr, MCVr and HDWr were higher in neonates when compared to older children. The mean values of IRF and RDWr were significantly higher, and the mean values of CHr and CHCMr were significantly lower in the IDA group when compared to the control group. The mean value of IRF was significantly higher, and the mean value of CHDWr was significantly lower in the AAI group when compared to the control group. The mean values of IRF, CHr and CHCMr were significantly lower in the IDA group when compared to the AAI group. Conclusion : We could determine the normal mean values of IRF and RCI in healthy children classified according to age for understanding of hematopoietic response differences according to age. The evaluation of IRF and RCI by automated reticulocyte analyzer seemed to be accurate and clinically useful for the early diagnosis of anemia and the differentiation of IDA from AAI.

목 적 : 최근에 개발된 자동화혈구계산기를 이용하여 신속 간편하고 정확하게 IRF과 다양한 RCI 측정이 가능해졌다. 저자들은 정상 소아의 연령군별 RCI와 IRF의 정상치를 구하고, 소아빈혈 중 가장 흔한 원인질환인 철결핍성빈혈과 급성감염성빈혈을 포함한 소아빈혈군에서 RCI와 IRF치를 조사하여 소아빈혈의 조기진단과 철결핍성빈혈과 급성감염성빈혈의 감별진단에 유용한지를 알아보고자 하였다. 방 법 : 소아빈혈환자군 61명(급성감염성빈혈 34명, 철결핍성 빈혈 28명)과 정상대조군 57명을 대상으로 자동화혈구계산기 ADVIA 120을 이용하여 IRF과 CHr, MCVr, CHCMr, RDWr, HDWr 및 CHDWr를 포함한 RCI를 측정 후 대조군과 빈혈군 및 철결핍성빈혈군과 급성감염성빈혈군간의 평균치를 비교 분석하였다. 결 과 : 1) 정상대조군의 각 연령군별 IRF 평균치는 신생아군에서 가장 높았다. 정상대조군의 각 연령군별 RCI의 평균값을 비교해보면 신생아군에서 CHr, MCVr 및 HDWr이 다른 연령군에 비해 높았으나 CHCMr과 RDWr은 연령군별 차이를 보이지 않았다. 2) 빈혈군의 IRF는 정상대조군에 비하여 의미 있게 높았고, CHr과 CHCMr은 빈혈군에서 대조군에 비해 낮게 측정되었다. 그러나 MCVr은 빈혈군과 대조군 사이에 차이를 보이지 않았다. 3) 철결핍성빈혈군의 IRF는 정상대조군에 비하여 의미 있게 높았고, RCI 중 CHr과 CHCMr은 철결핍성빈혈군에서 대조군에 비하여 낮게 측정되었으며, RDWr은 철결핍성빈혈군에서 높았고, MCVr과 HDWr은 두 군간에 차이를 보이지 않았다. 4) 급성감염성빈혈군과 대조군의 IRF와 RCI를 비교해 보면 IRF는 급성감염성빈혈군에서 의미 있게 높았고, RCI 중 CHDWr만 차이를 보였으며, CHr, MCVr, CHCMr, RDWr 및 HDWr은 두 군간에 의의 있는 차이를 보이지 않았다. 5) 철결핍성빈혈군과 급성감염성빈혈군 간에 평균연령, 혈색소치 및 망상적혈구수는 차이가 없었다. IRF은 철결핍성빈혈군에 비하여 급성감염성빈혈군에서 의의 있게 높았고, RCI 중 CHr과 CHCMr은 급성감염성빈혈군에 비하여 철결핍성빈혈군에서 의의 있게 낮았으나, MCVr, RDWr 및 HDWr은 두 군간에 차이를 보이지 않았다. 결 론 : 빈혈의 감별진단에 IRF와 RCI가 매우 유용하리라 생각되며 특히 IRF는 급성감염에 의한 빈혈군에서 증가하는 것으로 보아 급성염증에 의한 골수반응이 있음을 생각할 수 있고, 또한 RCI 중 CHr은 빈혈의 감별진단에 아주 유용하고 특히 철결핍성빈혈군의 초기 진단에 유용하나 이에 대해 더욱 많은 연구가 필요하리라 사료된다.

Keywords

References

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