PB1965 CLINICAL UTILITY OF RETICULOCYTE HEMOGLOBIN EQUIVALENT TO DIFFERENTIATE BETWEEN FUNCTIONAL IRON DEFICIENCY ANEMIA AND TRUE ANEMIA AND DIFFERENT FROM ANEMIA OF OTHER CAUSES OF CHRONIC DISEASE.

Abstract

Background:Iron Restricted Erythropoiesis can be: 1.Absolute iron deficiency2. Iron sequestration [impaired iron trafficking]3. Functional iron deficiency [FID]4. Heriditary conditions with impaired iron transport & utilization.Anaemia of chronic disease [ACD] is defined as hypoproliferative anaemia of no apparent cause.Ret He is hemoglobin content equivalent of reticulocytes.Monitors iron supply during erythropoiesis over last 2‐3 days, increases within 2‐4 days of iron therapyAims:To compare Ret He and % Hypo values with standard biochemical markers of iron metabolism: serum iron, TIBC, Transferrin saturation, serum ferritin, sTfR [Soluble Transferrin Receptor] levels and to assess in diagnosing iron deficiency.Methods:[n = 120] analysed [15 M: 10 F ratio,age 10 – 87 yrs]CBC samples [K2 EDTA] analysed on Sysmex XN1000 series.Ret He and Hypo He % identified in the reticulocyte channel by Fluorescence flowcytometry using polymethine dyePatients with Haemoglobin < 10 g/dl tested[1]:Normal patients [n = 25] 20.8 %. [2]: IDA Patients [n = 45] 37.5 %. [3]: CKD Patients on haemodialysis treated with variety of erythropoietin doses [n = 12] 10 %. [4]: CKD Patients [n = 7] 5.8 %. [5]: ACD Patients [n = 31] 25.8 %.Ret‐He: Sensitivity: 97.87 %,Specificity: 96.15 %,PPV: 98.92 %,NPV: 92.59 %Results:20 % Normal patients Ret He 33 pgIn 5% of ACD,IDA co‐existented so differentiate ACD and ACD/IDA as iron supplementation is beneficial for ACD/IDA patients but deleterious for ACD patients. 37 % IDA Patients Ret He was < 23.6 pg.3.3 %patients of thalassemia with IDA, Ret‐He: 19.5pg.STfR elevated in IDA cases, but was normal in ACD &FID casesHypo He % in FID [> 5%],IDA [>10%] ACD [<5 %]. Hypo He % measure is time average marker of iron restricted erythropoiesis [20‐120 days].10% CKD patients on erythropoietin doses Ret‐He < 25.5 pg presents FIDNormal Range for Ret He: 31‐35 pg. Summary/Conclusion:Serum Iron, TIBC, % T Sat. Screens anemia but Ret He detects & gives expended information at cellular levels so assess true status of iron and predictor of marrow iron stores imageDetects IDA, FID, ACD which helps differential diagnosis Ret He < 23.6 pg. suggest classical iron deficiency & also predicts FID in those receiving ESA [erythropoietin stimulating agent] therapy. Indicates a non responder to rHuEPO/ ESA or FID