Ambayya A, Sasmita AO, Sathar J (2019) Utilizing Extended Red Blood Cell Parameters to Distinguish Iron-Deficient Erythropoiesis - Related Disorders in Malaysian Female Population. Int J Blood Res Disord 6:035.


© 2019 Ambayya A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

RESEARCH ARTICLE | OPEN ACCESSDOI: 10.23937/2469-5696/1410035

Utilizing Extended Red Blood Cell Parameters to Distinguish Iron-Deficient Erythropoiesis - Related Disorders in Malaysian Female Population

Angeli Ambayya*, Andrew Octavian Sasmita and Jameela Sathar

Hematology Department, Clinical Hematology Referral Laboratory, Hospital Ampang, Malaysia



The full blood count (FBC) analyzers, Sysmex XE-5000 and Unicel DxH 800, are equipped to perform routine and extended parameters tests; thus, this study considered extended red blood cell (eRBC) parameters to distinguish iron-deficient erythropoiesis related disorders.


Malaysian female subjects comprising three main ethnic groups (Malay, Chinese and Indian) were included. Three groups of findings were distinguished based on FBC, morphology, and iron status of the subjects: normal, latent iron deficiency (LID) and iron deficiency anemia (IDA). Spearman's correlation test was performed to assess the concordance of FBC parameters in both analyzers. Test of normality and mean comparison tests were carried out to determine statistically significant parameters (p < 0.05) in discriminating iron-deficient erythropoiesis. Finally, receiver operating characteristic (ROC) curves were generated to determine area under the curve, sensitivity, and specificity of the parameters.


Malaysian female subjects of the Indian ethnic group were observed to have higher prevalence of IDA (55.8%) and LID (42.7%) compared to other ethnic groups. Both analyzers were confirmed to have good correlation between RBC-Y in Sysmex XE-5000 and MAF in Unicel DxH 800 (r = 0.918). The best parameter to distinguish LID from IDA is MAF (AUC: 0.954; 95% CI: 0.927-0.980; Cut-off: 9.25; Sensitivity: 89.02%; Specificity: 88.46%) while the best parameter to distinguish IDA from LID is %MicroR (AUC: 0.915; 95% CI: 0.874-0.956; Cut-off: 0.655%; Sensitivity: 85.57%; Specificity: 86.58%).


This study conclusively reported the utility of eRBC parameters from Sysmex XE-5000 and Unicel DxH 800 to distinguish LID from IDA. These eRBC parameters could potentially form more robust diagnosis of subjects suspected with iron-deficient erythropoiesis related disorders.