Evaluation of the reticulocyte production Index in the pediatric population

Abstract

Objectives: Since hematologic values vary with age in children, we evaluated the agreement between the "traditional" reticulocyte production index (RPI) and an RPI by age (RPI/A)-adjusted normal values.

Methods: A retrospective, observational, and analytical study was performed on CBCs of children with anemia younger than 18 years. The agreement and clinical repercussions of the RPI values were analyzed with an RPI/A developed with theoretical values for different ages.

Results: A total of 5,503 tests were analyzed and no systematic error between the two indices was found; however, there were significant proportional differences at higher values that resulted in lower RPI/A in children younger than 15 days and higher RPI/A in children aged 15 days and older. No agreement was observed at any age. The proportion of arregenerative anemia diagnosed using RPI/A was higher in children younger than 15 days and lower in those 15 days and older.

Conclusions: RPI is not an adequate tool for evaluating the erythropoietic capacity of bone marrow in the pediatric population. The disagreement between the results can be explained by the difference in normal hematologic values between children and adults.