Reticulocyte Hemoglobin Research Articles

KADAR HEMOGLOBIN RETIKULOSIT DI ANEMIA DAN NONANEMIA AKIBAT DEFISIENSI BESI ABSOLUT DI GAGAL GINJAL TERMINAL TERKAIT HEMODIALISIS (Reticulocyte Hemoglobin Level of Absolute Iron Deficiency Anemia and NonAbsolute Iron Deficiency Anemia In End State Renal Disease Undergoing Maintenance Hemodialysis)

Absolute Iron Deficiency Anemia (IDA) is one of the complications in the End State Renal Disease (ESRD) patients undergoingmaintenance hemodalysis, with an incidence of 76.4%. If this condition is not properly addressed, it can lead to impaired cardiac functionand increased mortality. The incidence of this case is between 30−45%. The determination of the iron status in ESRD patients wqs setby the Perhimpunan Nefrologi Indonesia 2011 using serum ferritin and transferrin saturation, but they do not provide a meaningfulchange in the value of the initial state of the iron deficiency. This condition should be examined with other parameters combination aswell as those influenced by diurnal variation and infection-inflammation condition. Reticulocyte hemoglobin (Ret-He) parameter canbe used as a marker of bone marrow iron availability because these reticulocytes are young erythrocytes released from the bone marrowinto the circulation. These conditions were circulated only within a short time about 1-2 days before becoming mature erythrocytes. Theaim of this study was to determine the Ret-He level diferentiation between absolute IDA and non absolute IDA states in ESRD patientswhom underwent maintenance hemodialysis. This research was conducted in the Laboratory of Clinical Pathology-RSHS-Bandung fromSeptember 2012 to June 2013. The study design was cross-sectional. All subjects were ESRD patients undergoing hemodialysis maintenancefor at least three (3) months and consisted of absolute IDA and non-absolute IDA based on the results of the ferritin and transferrinsaturation calculations according to the criteria of Pernefri 2011 Reticulocyte hemoglobin levels were checked using a fluorescenceflowcitometry principle in the automated hematology analyzer. In this study it was found that the Ret-He mean in the absolute IDA was26.1 pg/cell and 35.9 pg/cell in non absolute IDA. Statistical analysis was performed using Independent T-test. A total of 61 undergoingmaintenance hemodialysis subjects participating in this study comprised patients with absolute IDA and non-absolute IDA who met theinclusion and exclusion criteria. It can be concluded that the Ret-He level in statistical analysis showed absolute IDA which was meaningfullower than nonabsolute IDA in ESRD patients undergoing maintenance hemodialysis (p<0.001).

Reticulocyte hemoglobin content in a large sample of the general Dutch population and its relation to conventional iron status parameters

BackgroundNo full consensus exists on which iron status parameters to use for iron status assessment. In this study, we assessed the usefulness of measurement of the hemoglobin content of reticulocytes (CHr) in the general population. MethodsThe following iron status parameters were assessed in 1024 adults: CHr, reticulocytes, hemoglobin (Hb), ferritin, serum iron, transferrin, transferrin saturation and mean corpuscular volume (MCV). Mean parameter values and correlation coefficients for CHr and other parameters were calculated. In addition, mean CHr levels in subgroups based on low and normal values of other iron status parameters were compared. ResultsMean CHr values in men were 31.81 (SD = 1.50) pg and in women 31.32 (SD = 1.51) pg. A positive correlation was observed between CHr and Hb, ferritin, serum iron, transferrin saturation and MCV; a negative correlation was observed between CHr and transferrin. CHr levels were lower in subjects with low values of Hb, ferritin, serum iron and MCV compared to subjects with normal values for these parameters. ConclusionMean CHr values in this population were comparable to values reported in small healthy control groups. Associations with other parameters were in agreement with associations reported in literature. CHr measurement might have additional value in iron status assessment.

The Role of Reticulocyte Hemoglobin Content in the Management of Iron Deficiency Anemia in Patients on Hemodialysis

Background: The objectives of this study were to correlate reticulocyte Hemoglobin Content (CHr) with Hemoglobin (Hb), ferritin, and Transferrin Saturation (TSAT) in Patients on Hemodialysis (HD) and to determine the Hb response with intravenous iron supplementation in anemic HD patients with adequate ferritin and TSAT yet low CHr. Methods: This was a prospective, randomized controlled trial involving patients on HD. Patients with baseline results that fulfilled the randomization criteria (CHr 400 ng/mL and/or TSAT > 20%) were then randomized to group A and B. Group A patients received a total of 1 g of intravenous iron and group B served as the control. Results: One hundred and twenty - one patients were enrolled in this study. There was a significant correlation between CHr and TSAT, ferritin, and Hb. A total of 12 patients were randomized to group A and B. There was a significant increase in Hb level observed in group A with median change from baseline of 1g/dL (IQR: - 0.5 to 2.8) at the end of the trial compared to the control group. Conclusions: There was a significant correlation between CHr, Hb, ferritin, and TSAT. Intravenous iron supplement improved Hb level in patients on HD with adequate serum ferritin and/or TSAT levels yet low CHr.

Overview of Anemia among Systemic Lupus Erythematosus Patients in Reproductive Age Women based on Reticulocyte Hemoglobin Equivalent (RET-He) Level and Reticulocyte Count

Background: Anemia is a common manifestation found among patients with Systemic Lupus Erythematosus (SLE). It may be caused by iron-deficiency, autoimmune hemolytic, and chronic inflammation. Each anemia has different therapy approachments. Without adequatemanagement, anemia may lead to poor prognosis. By identifying the etiology of anemia, appropriate management could be conducted. Reticulocyte Hemoglobin Equivalent (RET-He) and reticulocyte count test may distinguish anemia based on its etiology. This study aimed to give scientific portrayed of the proportion of anemia based on its etiology among patients with SLE using RET-He and reticulocyte count.Method: This study involved women diagnosed with SLE underwent outpatient treatment in Rheumatology Clinic, Dr. Hasan Sadikin General Hospital during SeptemberOctober 2016. Data were collected from blood exam using 35-parameters hematology Sysmex by calculating levels of hemoglobin, RET-He, and reticulocyte count.Results: Seventy four female patients were volunteered as subject in this study with median of age was 29.5 (16-70) years old. Thirty four (46%) of 74 subjects weresuffering from anemia and 12 (35%) of them were between 25-34 years old. Proportion of iron-deficiency anemia, autoimmune hemolytic anemia, and chronic inflammatory anemia were 14 ( 41%), 13 (38%), and 7 (21%), respectively.Conclusion: Based on hemoglobin, RET-He, and reticulocyte count, iron-deficiency anemia is the most common anemia among patients with SLE in repoductive age.Keyword: Age, Anemia, Reticulocyte, RET-He, Systemic Lupus Erythematosus (SLE)

Stability of New Erythrocyte and Reticulocyte Parameters in Testing for Anemia on the Sysmex XN 9000.

New erythrocyte and reticulocyte parameters provide improved classification of anemia and monitoring of erythropoeitic activity. Parameters available on the Sysmex XN analyzers include the percentage of microcytic red blood cells (%Micro-R), percentage of macrocytic red blood cells (%Macro-R), percentage of hypochromic red blood cells (%Hypo-He), percentage of hyperchromic red blood cells (%Hyper-He), reticulocyte hemoglobin content (Ret-He), and immature reticulocyte fraction (IRF). However, use of these parameters is limited by specimen stability. To verify the stability of the new erythrocyte and reticulocyte parameters during prolonged storage, 20 blood specimens were analyzed on the Sysmex XN-9000 hematology analyzer. The specimens included healthy patients (60%) and patients with anemia (40%). The specimens were stored at room temperature (RT) and at 4° to 8°C. Analysis was performed after 12, 24, 48, and 72 hours of storage. Reticulocyte parameters IRF and Ret-He were precise and stable for at least 72 hours after collection when stored at RT and 4° to 8°C. The volume-dependent parameters, %Macro-R and %Micro-R, were stable for less than 12 hours after collection at RT (mean [SD%], 6.55 [3.19%] and -20.70 [10.37%], respectively). Storage at 4° to 8°C showed a reduction in osmotic swelling. However, %Macro-R and %Micro-R were stable for less than 12 hours after collection (mean [SD%], 4.89 [2.02%] and -17.17 [8.38%], respectively). Similarly, %Hypo-He showed a mean (SD%) increase of 0.73 (4.05%) and %Hyper-He showed a decrease of -0.70 (9.72%) at less than 12 hours after storage at 4° to 8°C. New reticulocyte parameters stored at RT and 4° to 8°C are suitable for testing on the Sysmex XN analyzer.

Diagnostic Test Equivalent Hemoglobin Reticulocyte in Iron Deficiency Anemia

BaCKGROUND: Diagnosing iron deficiency anemia (IDA) is easy, but also can be complicated in condition with inflammation. A new modality for diagnostic which isn’t influenced with inflammation is needed. The aim of this study is to find the cut-off point and evaluate the accuracy of reticulocyte hemoglobin equivalent (Ret-He) to diagnose IDA using ferritin as the gold standard.METHODS: This study was an observational study with cross-sectional analytical design continued with the diagnostic test conducted in anemic individuals with age 18 years old or above.RESULTS: Eighty-seven patients (41 men and 46 women) were included in this study with mean of hemoglobin 7.42 g/dL, serum iron 42.71 mg/dL, total iron-binding capacity (TIBC) 242.82 mg/dL, ferritin 799 ug/L and Ret-He 23.63 pg. Ret-He with cut-off value 25 pg showed a sensitivity 97.2% (95% CI 83.79-99.85%), specificity 66.67% (95% CI 51.97-78.85%), positive predictive value 67.30% (95% CI 52.77-79.28%) and negative predictive value 97.14% (95% CI 83.38-99.85%).CONCLUSION: Ret-He showed the best sensitivity for detection of IDA and was suggested as the screening test for IDA.KEYWORDS: IDA, Ret-He, diagnostic test

Reticulocyte Haemoglobin Content Declines More Markedly in Preterm than in Term Infants in the First Days after Birth

Background: Reticulocyte haemoglobin content, i.e., the reticulocyte equivalent (Ret-H_e), seems to be a promising parameter for the detection of iron deficiency (ID) in neonates because it can be obtained as part of a reticulocyte count, with no additional blood loss and at no extra cost. Due to the short life span of reticulocytes, Ret-H_e reflects current iron availability for erythropoiesis more accurately than other common erythrocyte indices. Objective: We aimed to evaluate postnatal changes in Ret-H_e within the first days after birth in term and preterm infants with the hypothesis that preterm infants experience a more pronounced postnatal reduction in Ret-H_e when compared to term infants. Methods: We conducted retrospective analyses of clinically indicated blood samples. Paired t test and mixed regression modelling were used. Results: In total, 805 blood samples obtained from 207 term and 295 preterm infants were analysed. Ret-H_e decreased by 1.5 pg per day (regression coefficient [95% CI] -1.5 [-1.8 to -1.2] pg, p < 0.0001). This drop was more significant in preterm infants (regression coefficient -2.2 [-2.6 to -1.8] pg, p < 0.0001) than in term infants (regression coefficient -0.8 [-1.3 to -0.2] pg, p < 0.01, p_interaction < 0.0001). Conclusion: Ret-H_e declined within the first days after birth. The observed changes with postnatal age were more pronounced in preterm than in term infants. Further studies are needed to evaluate if these changes are due to developing ID or other causes.

Reticulocyte Hemoglobin Content Helps Avoid Iron Overload in Hemodialysis Patients: A Retrospective Observational Study

Anemia in patients suffering from end-stage renal failure is currently treated with Erythropoiesis-Stimulating Agents (ESA). This treatment needs sufficient iron supplementation to avoid an inadequate dosage of ESA. Nowadays modern analytical instruments allow to accurately calculate the content of Hemoglobin (Hb) in reticulocytes (CHr), that can be used as a guide for prescribing patients with the appropriate amount of iron. Patients, undergoing hemodialysis, were retrospectively selected from the database and were divided in two groups: group A received intravenous (IV) iron and subcutaneously ESA, and their dosages were adjusted on the basis of the following parameters: Hb, Mean corpuscular haemoglobin (MCH), CHr with consequent MCH/CHr ratio and reticulocyte count determined by the ADVIA 120 Hematology System of Siemens; group B patients were administered IV iron and ESA monitoring iron storage, Hb and ferritin. The aforementioned parameters and the administered amount of iron and ESA were monitored at baseline, four and eight months from the begining of the study. For ESA supplementation, no difference was observed between the groups at the various observed times. Despite similar Hb levels, the patients of group A needed significant lower doses of IV iron (-57.8%) avoiding risks of organ toxicity and obtaining consequent cost saving of nearly 1 €/patient/month. The use of CHr and its related parameters allows the avoidance of overdosage of IV iron, which can potentially damage organs, and the reduction of health care direct and indirect costs.

Effect of Low-Dose Ferrous Sulfate vs Iron Polysaccharide Complex on Hemoglobin Concentration in Young Children With Nutritional Iron-Deficiency Anemia

Iron-deficiency anemia (IDA) affects millions of persons worldwide, and is associated with impaired neurodevelopment in infants and children. Ferrous sulfate is the most commonly prescribed oral iron despite iron polysaccharide complex possibly being better tolerated. To compare the effect of ferrous sulfate with iron polysaccharide complex on hemoglobin concentration in infants and children with nutritional IDA. Double-blind, superiority randomized clinical trial of infants and children aged 9 to 48 months with nutritional IDA (assessed by history and laboratory criteria) that was conducted in an outpatient hematology clinic at a US tertiary care hospital from September 2013 through November 2015; 12-week follow-up ended in January 2016. Three mg/kg of elemental iron once daily as either ferrous sulfate drops or iron polysaccharide complex drops for 12 weeks. Primary outcome was change in hemoglobin over 12 weeks. Secondary outcomes included complete resolution of IDA (defined as hemoglobin concentration >11 g/dL, mean corpuscular volume >70 fL, reticulocyte hemoglobin equivalent >25 pg, serum ferritin level >15 ng/mL, and total iron-binding capacity <425 μg/dL at the 12-week visit), changes in serum ferritin level and total iron-binding capacity, adverse effects. Of 80 randomized infants and children (median age, 22 months; 55% male; 61% Hispanic white; 40 per group), 59 completed the trial (28 [70%] in ferrous sulfate group; 31 [78%] in iron polysaccharide complex group). From baseline to 12 weeks, mean hemoglobin increased from 7.9 to 11.9 g/dL (ferrous sulfate group) vs 7.7 to 11.1 g/dL (iron complex group), a greater difference of 1.0 g/dL (95% CI, 0.4 to 1.6 g/dL; P < .001) with ferrous sulfate (based on a linear mixed model). Proportion with a complete resolution of IDA was higher in the ferrous sulfate group (29% vs 6%; P = .04). Median serum ferritin level increased from 3.0 to 15.6 ng/mL (ferrous sulfate) vs 2.0 to 7.5 ng/mL (iron complex) over 12 weeks, a greater difference of 10.2 ng/mL (95% CI, 6.2 to 14.1 ng/mL; P < .001) with ferrous sulfate. Mean total iron-binding capacity decreased from 501 to 389 μg/dL (ferrous sulfate) vs 506 to 417 μg/dL (iron complex) (a greater difference of -50 μg/dL [95% CI, -86 to -14 μg/dL] with ferrous sulfate; P < .001). There were more reports of diarrhea in the iron complex group than in the ferrous sulfate group (58% vs 35%, respectively; P = .04). Among infants and children aged 9 to 48 months with nutritional iron-deficiency anemia, ferrous sulfate compared with iron polysaccharide complex resulted in a greater increase in hemoglobin concentration at 12 weeks. Once daily, low-dose ferrous sulfate should be considered for children with nutritional iron-deficiency anemia. clinicaltrials.gov Identifier: NCT01904864.

Association of plasma CD40L with acute chest syndrome in sickle cell anemia

Platelet activation and platelet-derived cytokines contribute to the vascular inflammation and increased thrombotic activity known to occur in patients with sickle cell anemia (SCA). CD40 ligand (CD40L), a platelet-associated pro-inflammatory molecule that promotes endothelial cell activation, is elevated in the circulation of SCA patients. We sought to evaluate the association of CD40L and inflammation with sickle-related clinical complications and laboratory variables in SCA patients. Soluble CD40L, thrombospondin (TSP)-1 and tumor necrosis factor (TNF)-α were determined in the platelet-poor plasma of healthy individuals and steady-state SCA patients by ELISA. Lifetime clinical complications were verified by detailed review of patients’ medical records. We found that plasma CD40L was associated with acute chest syndrome (ACS), and that SCA patients with a lifetime history of ACS (ACS+) presented significantly higher plasma CD40L and TSP-1 than patients who had never experienced ACS (ACS−). In the ACS+ group, both platelet-derived proteins (CD40L and TSP-1) correlated with mean corpuscular volume, mean corpuscular hemoglobin and reticulocyte hemoglobin, while in the ACS− group, CD40L correlated with low red blood cell counts, hemoglobin, hematocrit and lactate dehydrogenase, and TSP-1 correlated with reticulocyte percentage and white blood cell count. As expected, CD40L and TSP-1 correlated with platelet counts in both groups. These data highlight the possible role of platelet activation in ACS and suggest that plasma sCD40L, together with TSP-1, may represent a potential marker of susceptibility to ACS in SCA.

Timing-adjusted iron dosing enhances erythropoiesis-stimulating agent-induced erythropoiesis response and iron utilization

BackgroundWe recently demonstrated, using an index of recently synthesized hemoglobin, reticulocyte hemoglobin (Ret-Hb), that iron administration remarkably improves hemoglobin (Hb) synthesis during the period of high activation of erythropoiesis induced by the administration of a continuous erythropoietin receptor activator (CERA). We aimed to investigate whether repetition of iron dosing sustains effective erythropoiesis and suppresses iron storage.MethodsIn a 3-month comparison of monthly CERA administration, 104 hemodialysis patients were randomized into two groups that received 40 mg iron intravenously 3 times; the first-week iron group [n = 51], given iron in the first week after CERA administration, during the period of high activation of erythropoiesis, and the third-week iron group [n = 53], given iron in the third week at the time of mild erythropoiesis activation.ResultsInitial mean CERA dosages were 123.5 ± 67.5 μg/month and did not differ between the groups. Hb levels were not different between the groups throughout the study. One-week increases in Ret-Hb levels after CERA administration were higher, during the first and the third month, in the group given iron in the first week compared with the third-week iron group (241.9 ± 63.3 vs. 196.2 ± 82.8 mg/dL, P = 0.004; 227.2 ± 83.5 vs. 187.9 ± 88.7 mg/dL, P = 0.037, respectively). The increase in ferritin levels was suppressed 3 months later in the first-week iron group compared with that of the third-week iron group (22.3 ± 64.0 vs. 69.0 ± 76.6 ng/mL, P = 0.002). Hepcidin levels decreased 1 week after CERA administration in both groups and were not different between the groups.ConclusionsTiming-adjusted iron administration increased the levels of recently produced Hb and iron utilization and suppressed the ferritin levels. The iron administration timing deserves consideration when optimizing the efficiency of erythropoiesis-stimulating agents in patients undergoing hemodialysis.Trial registrationUMIN000016375. Registered 29 January 2015.

Reticulocytic indices in assessing erythropoiesis effectiveness in multiple myeloma.

e19510 Background: The purpose of the study was to analyze changes in reticulocytic indices and their role in assessing the effectiveness of erythropoiesis in patients with multiple myeloma. Methods: Thestudy included 10 patients with primary multiple myeloma (MM) and 16 patients with recurrent MM, stage II-III. Parameters of the peripheral blood were studied: Hb, RBC, MCV, MCH, RBC-He (red cell hemoglobin content), RET (number and percentage), IRF (immature reticulocyte fraction), high (HFR), median (MFR) and low (LFR) fluorescence reticulocytes, RET-He (reticulocyte hemoglobin content), RPI (reticulocyte production index). Results: Anemia was found in21 (80.8%) patients before treatment: grade I in 30.8%, II in 46.1%, III in 3.8%; normocytic hypochromic anemia – 6, normocytic normochromic – 15. Anemia detection rate in primary MM was 60.0%, recurrent – 93.7%. RET levels in grade I-II anemia were close to the norm, but IRF was increased due to MFR increase by 3.7 times and HFR – by 4.7 times. Grade III anemia: RET number decreased by 1.6 times due to IRF reduction by 2 times, in particular MFR and HFR fractions. As a result, RET-He was decreased to varying degrees in all cases. Patients with complete or partial remission showed no significant changes in erythrocyte parameters, but had RET level increased by 2.5 times, IRF – by 9 times due to MFR increase by 6.5 times and HFR by 30.8 times, RPI - by 2.0 times. The data showed the effectiveness of erythropoiesis during anticancer therapy. We did not observe signs of increasing anemia syndrome in patients with stabilization or patients resistant to treatment, as well as in patients with initial grade III anemia. Hb, RBC, RET and RPI were unchanged, but the ratio of fractions changed: the number of mature ones - LFR increased by 1.4 times and young ones - HFR decreased by 2.5 times, RBC-He were increased and RET-He doubled compared to the levels before treatment, which indicated the activation of processes of erythrokaryocyte hemoglobinization. Conclusions: RET, IRF, RET-He and RPI indices adequately reflect the process of recovery of erythropoiesis and its effectiveness in real time which is extremely important in tumor therapy monitoring.

Canine reticulocyte hemoglobin content (RET-He) in different types of iron-deficient erythropoiesis.

Reticulocyte hemoglobin content (RET-He) is a diagnostic marker for iron deficiency (ID) in people and dogs. The aim of our study was to evaluate the clinical utility of RET-He in the diagnosis of different causes of iron-deficient erythropoiesis (IDE). Canine CBCs were separated into 2 groups according to RET-He values, <20.9pg or ≥20.9pg. Erythrocyte and reticulocyte variables were compared between dogs with decreased and normal RET-He values. Additional data for a subgroup of dogs were collected, and dogs with low RET-He values were categorized as having ID, inflammatory disorders (INFL), portosystemic shunt (PSS), miscellaneous diseases (MISC), or combinations of these diseases (ID+INFL, ID+PSS). Hematologic variables were compared between dogs of the different disease groups. Overall, 10.3% (1084/10,553) of canine CBCs showed decreased RET-He values. Significant differences between dogs with decreased and normal RET-He values were found for all erythrocyte and reticulocyte variables. The majority (68.9%, 747/1084) of dogs with low RET-He values was anemic; 28.9% (216/747) of those anemic dogs had microcytosis and hypochromasia. In the subgroup of dogs, 8.9% (205/2306) had low RET-He values. According to their diagnosed diseases, anemic dogs (138/205) could be categorized as ID (17/138; 12.3%), INFL (16/138; 11.6%), PSS (30/138; 21.7%), ID+INFL (63/138; 45.7%), ID+PSS (8/138; 5.8%), and MISC (4/138; 2.9%). Distribution in nonanemic dogs (67/205) was similar, except for a lower number of dogs with PSS. Low RET-He values indicate IDE even in dogs with other CBC variables within the RIs.

Evaluation of the Efficiency of the Reticulocyte Hemoglobin Content on Diagnosis for Iron Deficiency Anemia in Chinese Adults.

Our aim was to evaluate the cut-off value and efficiency of using reticulocyte hemoglobin content as a marker to diagnose iron deficiency anemia in Chinese adults. 140 adults who needed bone marrow aspiration for diagnosis at the hematology department of the Peking Union Medical College Hospital were enrolled according to the inclusive and exclusive criteria. Venous blood samples were collected to detect complete blood count, including hemoglobin, reticulocyte hemoglobin content, hematocrit, mean cellular volume, corpuscular hemoglobin concentration, hemoglobin content, free erythrocyte protoporphyrin; iron indexes of serum ferritin, serum transferrin receptor, and unsaturated iron-binding capacity; and inflammation markers of C-reactive protein and α-acid glycoprotein. Bone marrow samples were obtained for the bone marrow iron staining, which was used as the standard for the evaluation of iron status in this study. Subjects were divided into three groups according to hemoglobin levels and bone marrow iron staining results: the IDA (iron deficiency anemia) group, the NIDA (non-iron deficiency anemia) group, and the control group. The differences of the above-mentioned indexes were compared among the three groups and the effect of inflammation was also considered. The cut-off value of reticulocyte hemoglobin content was determined by receiver operation curves. The IDA group (n = 56) had significantly lower reticulocyte hemoglobin content, mean cellular volume, corpuscular hemoglobin concentration, hemoglobin content, and serum ferritin; and higher free erythrocyte protoporphyrin, unsaturated iron-binding capacity, and serum transferrin receptor (p < 0.05) compared with the NIDA group (n = 38) and control group (n = 46). Hematocrit, serum ferritin, and unsaturated iron-binding capacity were significantly affected by inflammation while reticulocyte hemoglobin content and other parameters were not. The cut-off value of reticulocyte hemoglobin content for diagnosing iron deficiency anemia was 27.2 pg, with a sensitivity of 87.5% and a specificity of 92.9%. The cut-off values for mean cellular volume, serum ferritin, and serum transferrin receptor were 76.6, 12.9, and 4.89 mg/L, respectively. Reticulocyte hemoglobin content had the largest area under the curve of 0.929, while those for mean cellular volume, serum ferritin, serum transferrin receptor were 0.922, 0.887, and 0.900, respectively. Reticulocyte hemoglobin content has a high sensitivity and specificity in the diagnosis of iron deficiency anemia, and its comprehensive diagnostic efficacy is better than other traditional indicators—such as serum ferritin and serum transferrin receptor.

Iron deficiency and red cell indices in patients with heart failure.

To investigate the prevalence of iron deficiency (ID) in heart failure (HF) patients with normal vs. abnormal red cell indices (RCI), the associations between iron parameters and RCI, and prognostic consequences of ID independently of RCI. We analysed clinical data of 1821 patients with HF [mean age 66 ± 13 years; 71% men; New York Heart Association class I/II/III/IV (11%/39%/44%/6%); left ventricular ejection fraction >45%: 19%]. Iron deficiency (ferritin <100 µg/L or ferritin 100-299 µg/L with transferrin saturation <20%) was common irrespective of the presence of anaemia (haemoglobin <12 g/dL in women and <13 g/dL in men) or low RCI, from 75% in anaemic subjects with low mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and MCH concentration (MCHC), to 36% in non-anaemic subjects with MCV, MCH, and MCHC above the lower limit of normal. After adjustment for clinical variables, iron parameters remained independently associated with haemoglobin, MCV, MCH, MCHC, mean reticulocyte haemoglobin content (CHR), and red cell distribution width (RDW). In multivariable Cox proportional hazard regression models there was a trend towards higher mortality in patients with vs. without ID when adjusted for relevant HF prognosticators and MCH or MCHC (but not haemoglobin, CHR or RDW). Patients with HF should be routinely screened for ID irrespective of the presence of anaemia or abnormal RCI. The detrimental impact of ID on long-term survival in HF is partially independent of RCI.

Treatment of Iron Deficiency Anaemia in Patients with Inflammatory Bowel Disease

In spite of the fact that anemia is the most widely recognized systemic sign of inflammatory bowel disease (IBD), among the expansive range of extraintestinal malady complexities experienced in IBD, including joint inflammation and osteopathy, it has for the most part gotten little thought. In any case, as far as recurrence, as well as to its potential impact on hospitalization rates and on the personal satisfaction and work, sickliness is, in fact, a huge and expensive intricacy of IBD. Frailty is multifactorial in nature, the most predominant etiological structures being iron deficiency anemia (IDA) and anemia of a chronic disease. In a condition related to irritation, for example, IBD, the assurance of iron status utilizing normal biochemical parameters alone is insufficient. A more exact evaluation might be achieved utilizing new iron lists including reticulocyte hemoglobin content, the rate of hypochromic red cells or zinc protoporphyrin. While oral iron supplementation has generally been a backbone of IDA treatment, it has likewise been connected to a broad gastrointestinal reactions and conceivable infection compounding. Be that as it may, numerous doctors are as yet hesitant to administer iron intravenously, in spite of the wide accessibility of an assortment of new IV arrangements with enhanced safety profiles, and in spite of the proposals of worldwide master rules. We present a review of the pathophysiologic mechanisms of IDA in IBD, improved diagnostic and therapeutic strategies, efficacy, and safety of iron replacement in IBD.

Diagnostic accuracy of reticulocyte hemoglobin content in Thai patients with microcytic red cells as a test for iron deficiency anemia

Background: Reticulocyte hemoglobin content (CHr) is helpful for early diagnosis of iron deficiency anemia (IDA). However, its use is limited in thalassemia carriers. Objectives: To determine the accuracy of CHr and reticulocyte count as a test for iron deficiency anemia in Thai patients with microcytic red cells given the high prevalence of thalassemia carriers in Thailand. Methods: Thai patients with adult microcytic anemia (mean corpuscular volume ?80 fL) were prospectively enrolled. We conducted an automated complete blood count, reticulocyte count (with CHr), ferritin, and hemoglobin analysis. IDA was defined by a ferritin reference level Results: We included 168 patients (53 with IDA, 50 with anemia of inflammation (AI), 49 with thalassemia traits, and 16 with thalassemia diseases) and 99 healthy controls. The CHr in patients with IDA and thalassemia disease were significantly less than those in patients with AI and thalassemia trait (P Conclusions: CHr combined with additional information about reticulocyte count and MCHC is useful for diagnosis of IDA in Thais. Keywords: Diagnostic test, iron deficiency, microcytic anemia, reticulocyte hemoglobin content

Markers of iron status in chronic kidney disease.

Anemia is one of the main comorbidities related to chronic kidney disease (CKD). Until the advent of erythropoiesis stimulating agents (ESA), endogenous erythropoietin deficiency has been thought to be the main culprit of anemia in CKD patients. The use of ESAs has shed new light on the physiology of CKD anemia, where iron homeostasis plays an increasingly important role. Disorders of iron homeostasis occurring in CKD turn the anemia management in those patients into a complex multifactorial therapeutic task, where ESA and Iron dose must be properly balanced to achieve the desired outcome without exposing the patients to the risk of serious adverse events. This review covers diagnostic markers traditionally used for quantifying iron status in CKD patients, such as serum ferritin and transferrin saturation, new ones, such as reticulocyte hemoglobin content and percent hypochromic red cells (HRC), as well as experimental ones, such as hepcidin and soluble transferrin receptor (sTfR). Each marker is presented in terms of their diagnostic performance, followed by biological and analytical variability data. Advantages and disadvantages of each marker are briefly discussed. Although serum ferritin and transferrin saturation are easily available, they exhibit large biological variability and require caution when used for diagnosing iron status in CKD patients. Reticulocyte hemoglobin content and the percentage of HRC are more powerful, but their widespread use is hampered by the issue of sample stability in storage. sTfR and hepcidin show promise, but require further investigation as well as the development of standardized, low-cost assay platforms.

Reticulocyte hemoglobin equivalent as a potential marker for diagnosis of iron deficiency.

Evaluation of parameters relating to serum ferritin and iron is critically important in the diagnosis of iron deficiency anemia (IDA). The recent development of automated systems for hematology analysis has made it possible to measure reticulocyte hemoglobin equivalent (RET-He), which is thought to reflect iron content in reticulocytes, in the same sample used for complete blood count tests. If RET-He is, indeed, capable of evaluating iron deficiency (ID), it would be useful for immediate diagnosis of IDA. In the present study, we examined the usefulness of RET-He for diagnosis of ID. Blood samples were obtained from 211 patients. Anemia was defined as hemoglobin (Hb) level of <12g/dL. Iron deficiency was defined as serum ferritin level of <12ng/mL. Patients were classified into four groups: IDA, ID, control, and non-ID with anemia. Patients in the IDA group had significantly lower RET-He levels than those in the control group. RET-He correlated with serum ferritin in the IDA and ID groups. The area under the curve for RET-He was 0.902, indicating that RET-He facilitates the diagnosis of ID with high accuracy. RET-He changed in parallel with changes in Hb during iron administration for 21 IDA patients. Our results indicate that RET-He may be a clinically useful marker for determining ID in the general population.

Primerjava eritrocitnih in retikulocitnih parametrov pri ugotavljanju pomanjkanja železa

Background: Te increased prevalence of iron defciency anemia represents a global public health issue which can be reduced by early diagnosis of pre-iron defcient states. Clinical utility of biochemical indices for iron defciency diagnosis is limited due to the influence of inflammation. Erythrocyte and reticulocyte indices, reticulocyte hemoglobin content, and percentage of hypochromic red cells have been extensively used in diagnosing different iron-defcient conditions. Te aim of our study was to compare the utility of erythrocyte and reticulocyte indices provided by different hematology analyzers for the diagnosis of iron defciency.Methods: 186 people, 25 patients with iron defciency anemia, 103 patients with chronic kidney disease, and 58 healthy donors were included in our study. Teir whole blood samples were analyzed using two different automated analyzers, XN-1000, Sysmex and Advia 120, Siemens Bayer Diagnostics, to compare reticulocyte and erythrocyte indices.Results: Linear correlation between indices for hemoglobin reticulocyte content (Ret-He and CHr) has been confrmed while correlation between both erythrocyte indices (Hypo-He and %HYPO) can be described by 2nd degree polynomial. Cut-off value for the diagnosis of iron defciency for Ret-He was established at &lt; 28.2 pg and for Hypo-He at &gt; 1.6 % and showed high diagnostic sensitivity (RetHe = 76 %; Hypo-He = 72 %) and specifcity (100 %).Conclusions: Reticulocyte indices Ret-He and CHr are directly comparable and can be used for latent iron defciency evaluation. Although erythrocyte indices Hypo-He and %HYPO are not exchangeable, both can be used for long-term iron defciency evaluation. Additionally, we determined reference intervals for Hypo-He and Ret-He.