Iron deficiency anemia in childhood is a serious public health problem worldwide. Reticulocyte hemoglobin content (Ret-He) is a novel biomarker of iron deficiency adopted for adults but there is a lack of reference intervals for Ret-He in infants. The aim of this study was to provide data from healthy infants. Swedish infants (n=456), born at term after normal pregnancies were included. Ret-He was measured at birth (umbilical cord sample), 48-72h, 4 months, and 12 months. Reference intervals were calculated as 2 standard deviations from the mean of Ret-He. Reference intervals for newborn Ret-He were 27.4 to 36.0pg/L (N=376) in the cord sample, 28.1-37.7pg/L (N=253) at 48-72h, 25.6-33.4pg/L (N=341) at four months and 24.9-34.1pg/L (N=288) at 12 months. Ret-He was significantly lower among iron-deficient infants, at 4 months mean difference (95% CI) 4.2pg/L (6.1 to 2.4) and at 12 months mean difference (95% CI) 3.4pg/L (5.0 to 1.8). This longitudinal study presents Ret-He reference intervals based on non-anemic and non-iron-deficient infants and constitutes a step towards standardizing Ret-He as a pre-anemia biomarker of iron deficiency in children.
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