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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Usefulness of Reticulocyte Haemoglobin Equivalent in the Evaluation of Iron Deficiency Status: A Cross-sectional Study
Correspondence Address :
Plot No-1, VGP Pushpa Nagar Extension, Medavakkam, Chennai,
Tamil Nadu, India.
E-mail: dr.dinieins@gmail.com
Introduction: Iron deficiency is the most frequent cause of nutritional anaemia. Evaluation of parameters like serum ferritin and iron is critically important for evaluation of the iron status of patients and diagnosis of Iron Deficiency Anaemia (IDA). But in inflammatory disorders, ferritin concentration may be normal or increased due to the acute phase response, resulting in inaccurate interpretation of the iron status. Similarly, the serum iron levels may be high in cases of thalassaemia with combined iron deficiency. Reticulocyte Haemoglobin equivalent (RET-He) which correlates to the iron content in reticulocytes is effective, convenient and provides useful information for the immediate diagnosis and treatment of iron deficient states.
Aim: To evaluate the diagnostic performance of RET-He level by comparing it with the iron status of the patients.
Materials and Methods: This cross-sectional study was done in Department of Pathology at Tagore Medical College and Hospital, Chennai, Tamil Nadu, India, from December 2020 to November 2021. The complete blood count, RET-He, serum iron and serum ferritin levels of 406 patients with microcytic hypochromic anaemia and dimorphic anaemia were reviewed and RET-He levels were compared with the serum iron and ferritin levels. The p-value was calculated using Statistical Package for Social Sciences (SPSS) IBM software version 28.0. The sensitivity of RET-He and serum ferritin levels in evaluating iron deficiency was calculated.
Results: Low RET-He was observed in 394 cases, low serum iron in 401 cases and reduced serum ferritin in 376 cases. Total 34 cases of IDA with concomitant inflammation showed low RET-He and serum iron, despite normal to high serum ferritin levels. Five cases of iron deficiency with concomitant haemoglobin defect also showed low RET-He levels and serum ferritin, whereas the serum iron was raised. Low RET-He was observed in 17 cases of dual deficiency anaemia i.e., iron deficiency along with vitamin B12/folate deficiency.
Conclusion: It was concluded that measurement of the reticulocyte haemoglobin content provides useful information for the diagnosis, treatment and monitoring of iron deficient states.
Dual deficiency anaemia, Erythropoiesis, Microcytic hypochromic anaemia, Serum ferritin
Iron deficiency is the most frequent cause of nutritional anaemia. Evaluation of parameters like serum ferritin and iron is critically important for evaluation of the iron status of patients and diagnosis of Iron Deficiency Anaemia (IDA). But in inflammatory disorders, ferritin concentration may be normal or increased due to the acute phase response, resulting in inaccurate interpretation of the iron status. The recent automated haematology analysers measure Reticulocyte haemoglobin equivalent (RET-He) in the same sample used for complete blood count tests, which correlates to the iron content in reticulocytes. It is a reliable marker of cellular haemoglobin content and provides information about the current availability of iron in erythropoiesis (1),(2). Studies show that the reticulocyte haemoglobin content is effective, convenient method and helps in the immediate diagnosis and treatment of iron deficient states (3),(4).
In this study, the diagnostic performance of RET-He provided by Sysmex XN1000 analyser was evaluated by comparing it with the iron status of the patients. The RET-He is not used widely as a routine test and its significance is largely under-rated. This study emphasises on the use of RET-He in determination of iron deficiency in various conditions like inflammation, dual deficiency and concomitant haemoglobin defect. The RET-He is not affected by inflammation, its determination is fully automated and can be performed on the same sample as for Complete Blood Count (CBC), hence may alleviate the need for invasive procedures like bone marrow aspiration. Inclusion of RET-He in routine CBC can help in identifying early iron deficiency states and quicker monitoring of iron therapy. The aim of this study was to evaluate the diagnostic performance of RET-He level by comparing it with the iron status of the patients.
This cross-sectional study was done in Department of Pathology at Tagore Medical College and Hospital, Chennai, Tamil Nadu, India, from December 2020 to November 2021. The CBC, RET-He, serum iron and serum ferritin levels of 406 patients with microcytic hypochromic anaemia and dimorphic anaemia were reviewed.
Inclusion criteria: Patients above 12 years of age and all samples, with peripheral blood picture of microcytic hypochromic anaemia and dimorphic anaemia were included in the study.
Exclusion criteria: Post-transfusion samples and paediatric samples (ages <12 years) were excluded.
Procedure
The complete blood count of these samples were reviewed and RET-He was done in Sysmex XN 1000 analyser. The RET-He levels were compared with the corresponding serum iron and ferritin levels. C-Reactive Protein (CRP) levels were done in cases of IDA with concomitant inflammation. Soluble Transferrin Receptor (sTFR) Assay was done in cases of iron deficiency with concomitant haemoglobin defect as the serum iron is raised in cases of haemoglobin defect.
STATISTICAL ANALYSIS
The p-value of significance was calculated by using Statistical Package for Social Sciences (SPSS) IBM software version 28.0. A paired samples t-test was done. The sensitivity of RET-He and serum ferritin levels in evaluating iron deficiency was calculated.
In this study, 389 cases of microcytic hypochromic anaemia (Haemoglobin <11 mg/dL, mean corpuscular volume <80 fL) and 17 cases of dimorphic anaemia were evaluated for low RET-He (<29 pg) and low Iron status of the patient (serum iron <65 μg/dL, serum ferritin <100 ng/mL). The mean age group of the patients were 48.6 years (ranging from 16 to 88 years) with 266 females and 123 males.
Low RET-He was observed in 394 cases, low serum iron in 401 cases and reduced serum ferritin in 376 cases. Total 34 cases of IDA with concomitant inflammation (confirmed by raised CRP levels) showed low RET-He and serum iron, despite normal to high serum ferritin levels. Five cases of iron deficiency with concomitant haemoglobin defect also showed low RET-He levels and serum ferritin, whereas the serum iron was raised. The low iron status was confirmed by Soluble Transferrin Receptor (sTFR) Assay in these five cases. Low RET-He was also observed in 17 cases of dual deficiency anaemia i.e., iron deficiency along with vitamin B12/folate deficiency. The comparison between RET-He level, serum iron and serum ferritin levels is shown in (Table/Fig 1). The sensitivity of RET-He and serum ferritin is tabulated in (Table/Fig 2). The p-value of RET-He was significant, in all the scenarios as depicted in (Table/Fig 3).
Iron Deficiency (ID) is one the most common cause of nutritional anaemia. Diagnosis of IDA depends on the applied biomarkers of ID, and Transferrin Saturation Coefficient (TSAT) or ferritin when used alone may lead to diagnostic difficulties, especially in cases of inflammation (5). The RET-He provides information about the current availability of iron in erythropoiesis. The RET-He is independent of the acute phase and can be determined within a few minutes by a blood count (4),(8).
Due to the approximately 120 day lifetime of erythrocytes, iron deficiency and changes in the iron status of erythropoiesis can first be recognised at a relatively late stage using classical haematological parameters, such as haemoglobin, mean corpuscular volume, mean cellular haemoglobin content and also with determination of hypochromic erythrocytes. Reticulocytes which are the precursors of mature erythrocytes, enter the peripheral blood from bone marrow. They usually mature within 2 days to mature erythrocytes. Hence, the estimation of reticulocyte number provides a timely information about erythropoiesis. As the haemoglobin content of reticulocytes reflects the actual iron metabolism of erythropoiesis, it provides an assessment of the quality of the cells. Thereby any changes in the iron status of erythropoiesis can be detected earlier rather than the haemoglobin content of mature erythrocytes, i.e. the mean cellular haemoglobin content (1),(6).
The evaluation of RET-He can be carried out as a routine preoperative marker of latent anaemia to identify at risk patients. In perioperative cases, patients with iron deficiency can be treated proactively at an early stage, hence preventing complications and extended hospital stays (1). The RET-He can be also be used as a routine screening test to detect early iron deficiency in blood donors. This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation (7). Studies indicate that for ID and IDA in children, RET-He can efficiently be used as a single screening parameter without the consideration of other iron parameters (8).
The RET-He is a real time indicator of iron supply (haemoglobinization) to the developing RBC’s and the earliest marker of response to iron therapy (9). It is useful in screening of iron deficiency, diagnosis of iron deficiency anaemia, and diagnosis of functional iron deficiency anaemia in acute or chronic diseases or inflammation and helps to monitor iron therapy (10). It may improve the targeting of iron supplementation programs in resource-limited countries (11),(12),(13),(14).
Limitation(s)
Limited availability of data for RET-He levels after commencement of iron therapy. Out of the 406 cases studied, the RET-He levels after iron therapy was available only in 24 cases. The RET-He levels showed corresponding increase with the raise in haemoglobin and serum iron levels. However, the duration of iron therapy varied in each case and regular monitoring was not possible due to various factors like patient non compliance, missed review visits. Hence, the data has not been included in this study. Specificity could not be calculated as the negative cases (non iron deficient) were not included in the study.
Diagnosis of IDA depends on biochemical parameters such as TSAT, hepcidin or ferritin which when used alone may lead to diagnostic difficulties. Using RET-He to evaluate iron deficient state in patients with anaemia contributes in improving the diagnosis of IDA and early iron deficiency, especially in the presence of confounding factors like inflammation, combined iron deficiency and thalassaemia, where RET-He is highly preferred. In the present study, RET-He associates significantly with the iron status of patients. Hence, it is concluded that measurement of the reticulocyte haemoglobin content provides useful information for the diagnosis, treatment and monitoring of iron deficient states. It is easy to analyse, less time consuming and less expensive.
DOI: 10.7860/JCDR/2022/56493.16491
Date of Submission: Mar 24, 2022
Date of Peer Review: Apr 08, 2022
Date of Acceptance: May 19, 2022
Date of Publishing: Jun 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No
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