Red blood cell indices versus serum ferritin as surrogate markers of iron deficiency during pregnancy

Ochuwa Adiketu Babah; Chisom Florence Chieme; Ajibola Ibraheem Abioye; Samuel Olusegun Spaine; Titilope Adenike Adeyemo; Bosede Bukola Afolabi

doi:10.1371/journal.pone.0334098

Peer Review History

Original SubmissionMarch 28, 2025
28 Mar 2025 Author Response Attachments Attachment Submitted filename: PLOS ONE - RESPONSE TO EDITORIAL COMMENTS.pdf https://doi.org/10.1371/journal.pone.0334098.r001
12 Jul 2025 Decision Letter - Oluyinka Iyiola, Editor PONE-D-25-15616 Red blood cell indices versus serum ferritin as surrogate markers of iron deficiency during pregnancy PLOS ONE Dear Dr. Babah, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Aug 26 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: A paragraph incorporating the role of ferritin and red cell indices in Fe metabolism should be added to elucidate the importance of these parameters. An explanation for the main observation that the red cell indices cannot replace ferritin estimation should also be given. Reviewer #2: -The units (g/dl) for should be g/dL in the abstract, table 1 -In the abstract conclusion, the red blood cels versus serum ferritin should be discussed - The unit of serum ferritin (ng/mL) should be consistent throughout and not changed to µg/mL at the discussion section -The first reference in the Reference section should be rewritten by closing up the gaps ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. 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Attachments Attachment Submitted filename: IVON SWAT - PLOS ONE - CBC VS FERRTIN FOR IDA DIAGNOSIS (2).docx https://doi.org/10.1371/journal.pone.0334098.r002
Revision 1
21 Jul 2025 Author Response PONE-D-25-15616 Red blood cell indices versus serum ferritin as surrogate markers of iron deficiency during pregnancy PLOS ONE Dear Dr Oluyinka Ajibola Iyiola, Academic Editor, PLOS One. Thank you for the valuable time you and the reviewers have spent to critically appraise this manuscript. We have addressed the review comments and provided a summary as a point-by-point response below. Page numbers cited are of the manuscript with tracked changes. Thank you. Best regards, Ochuwa A. Babah Corresponding Author Journal Requirements When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Response Thank you. The manuscript title page has been formatted according to journal requirements by using Asterix to indicate the corresponding author and by providing only email address for the corresponding author. Page 1. 2. When completing the data availability statement of the submission form, you indicated that you will make your data available on acceptance. We strongly recommend all authors decide on a data sharing plan before acceptance, as the process can be lengthy and hold up publication timelines. Please note that, though access restrictions are acceptable now, your entire data will need to be made freely accessible if your manuscript is accepted for publication. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If you are unable to adhere to our open data policy, please kindly revise your statement to explain your reasoning and we will seek the editor's input on an exemption. Please be assured that, once you have provided your new statement, the assessment of your exemption will not hold up the peer review process. Response Thank you. We have rephrased our data sharing statement as follows: The dataset analysed for this study can be accessed on Open Science Framework at: https://osf.io/enx7z This statement is now in the manuscript on Page 19. 3. Thank you for stating the following financial disclosure: Bill & Melinda Gates Foundation (Investment ID INV-017271) Grant for IVON TRIAL, the research in which this study was nested. Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. Response Done. Now on Page 19 of the manuscript. 4. Please amend your list of authors on the manuscript to ensure that each author is linked to an affiliation. Authors’ affiliations should reflect the institution where the work was done (if authors moved subsequently, you can also list the new affiliation stating “current affiliation:….” as necessary). Response Thank you. We have cross checked the manuscript and hereby confirm that this is in order. 5. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. Response Thank you. This is not applicable as none of the reviewers recommended any specific citation. 6. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Response Thank you. We have checked and confirm our references to be in order. Reviewer #1 A paragraph incorporating the role of ferritin and red cell indices in Fe metabolism should be added to elucidate the importance of these parameters. An explanation for the main observation that the red cell indices cannot replace ferritin estimation should also be given. Response Thank you. We have expanded the discussion section based on the comment above. We added on Page 13, last paragraph that: Ferritin is an intracellular protein which stores in the body cells; it is thus used to assess iron stores in the body. The red blood cell indices indirectly assess iron content of the body by determining the quality of the red blood cells in terms of haemoglobin content or the size of the cells. Haemoglobin contains a Heme and a globin moiety. Heme contains iron, depicting a crucial role of iron in erythropoiesis. This study has shown indirect assessment of iron content of the body using red blood cell indices like MCH. MCHC, MCV and RDW to diagnose iron deficiency during pregnant to be inferior to the use of serum ferritin. Reviewer #2 The units (g/dl) for should be g/dL in the abstract, table 1 Response Thank you. We have replaced on g/dl in the manuscript with g/dL. Abstract Page 2, last paragraph; Page 10, second paragraph; Table 1 on Page 11 In the abstract conclusion, the red blood cells versus serum ferritin should be discussed. Response Thank you for the suggestion. Done. Page 3, paragraph 2 (abstract conclusion). The unit of serum ferritin (ng/mL) should be consistent throughout and not changed to µg/mL at the discussion section. Response Thank you. The typographical error has been corrected. Page 17, Paragraph 2. The first reference in the Reference section should be rewritten by closing up the gaps. Response This has been done. Thank you. Page 19, Reference 1. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0334098.r003
24 Sep 2025 Decision Letter - Tiruneh Adane, Editor Red blood cell indices versus serum ferritin as surrogate markers of iron deficiency during pregnancy PONE-D-25-15616R1 Dear Dr. Babah, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. 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Reviewer #1: (No Response) Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: (No Response) Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: (No Response) Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) Reviewer #2: The authors had addressed all review comments but there is still the need to close up the gap between fact- and sheets of Reference 1 in the Reference Section ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes: Katherine Olabanjo OLUFOLABO ******** https://doi.org/10.1371/journal.pone.0334098.r004
Formally Accepted
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