Less puncture, more precision: Immature reticulocyte fraction as an emerging diagnostic tool for pancytopenia
DOI:
https://doi.org/10.55629/pakjpathol.v36i4.958Abstract
Objective: To evaluate the diagnostic utility of Immature reticulocyte fraction as an early indicator of bone marrow regenerating activity in pancytopenia.
Material and Methods: A retrospective observational study was conducted in Fauji Foundation Hospital Rawalpindi and AL-Khidmat Razi hospital from Jan 2022 to Jan 2025. Ethical approval was taken from the ethical review committee. Patients of all ages and both genders who were diagnosed with pancytopenia were included in the study. Diagnosed patients of malignancies already taking chemotherapy or radiotherapy were excluded from the study. All pancytopenia were verified on peripheral smear. Values of % of retics, Immature reticulocyte fraction (IRF), and absolute reticulocyte count were recorded. Results of other diagnostic workups done to identify the etiology of pancytopenia including malarial parasite (MP), biochemical profiles, bone marrow examination, radiological investigations and other ancillary investigations were recorded.
Results: The regenerative group showed the highest mean IRF (16.88 ± 10.28), followed by infiltrative cases (14.01 ± 9.12). The hypo-proliferative group had significantly lower values (2.42 ± 1.84). A one-way ANOVA confirmed these differences to be statistically significant (p < 0.001). ROC analysis demonstrated fair-to-good discriminative capacity (AUC = 0.739), and cut-off exploration highlighted that thresholds in the 6.5–7.0% range offer an optimal balance of sensitivity and specificity while maintaining high negative predictive value.
Conclusion: IRF is an effective early indicator of bone marrow erythropoietic activity. It should be a regular part of diagnostic work-up for pancytopenia to prevent invasive procedures for evaluation of pancytopenia.
Keywords: Bone marrow, Immature reticulocyte fraction, Pancytopenia
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