Diagnosis of Iron-Deficiency Anemia in Chronic Kidney Disease

Bahrainwala, Jehan; Berns, Jeffrey S.

doi:10.1016/j.semnephrol.2016.02.002

Cited by 35 publications

(41 citation statements)

References 17 publications

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“…In contrast, SF is significantly elevated (nearly 28 times) in patients with inflammation. This result, in accordance with other studies [7,17], makes CHr a more accurate and convenient indicator to diagnosis IDA independently, without the assistance of inflammation parameters. …”

Section: Discussionsupporting

confidence: 92%

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

Cai

Ren

et al. 2017

Nutrients

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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.

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Section: Discussionsupporting

confidence: 92%

“…Fortunately, several studies have indicated that reticulocyte hemoglobin content (CHr) seems to be a good predictor of IDA [7,8,9]. Reticulocytes are made in the bone marrow and released into the bloodstream, where they circulate for about one or two days before developing into mature red blood cells.…”

Section: Introductionmentioning

confidence: 99%

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

Cai

Ren

et al. 2017

Nutrients

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“…Anaemia develops during the course of the disease and worsens as the underlying CKD progresses [7]. Traditionally, most i.v.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Reported Rates of Severe Hypersensitivity Reactions Associated with Ferric Carboxymaltose and Iron (III) Isomaltoside 1000 in Europe Based on Data from EudraVigilance and VigiBase™ between 2014 and 2017

Ehlken¹,

Nathell²,

Gohlke³

et al. 2018

Drug Saf

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IntroductionHypersensitivity reactions (HSRs) are among the known adverse events of intravenous (i.v.) iron products. Of these, particularly severe HSRs such as anaphylaxis are of great clinical concern due to their life-threatening potential.MethodsThis was a retrospective pharmacoepidemiological study with a case-population design evaluating the number of reported severe HSRs following administration of the two i.v. iron products—ferric carboxymaltose and iron (III) isomaltoside 1000—in relation to exposure in European countries from January 2014 to December 2017. Exposure to both products was estimated using IQVIA MIDAS sales data in European countries. Information on spontaneously reported severe HSRs was obtained from and analysed separately for the two established safety surveillance databases EudraVigilance and VigiBase™ using the MedDRA® Preferred Terms anaphylactic reaction, anaphylactic shock, anaphylactoid reaction and anaphylactoid shock associated with administration of either product.ResultsBetween 2014 and 2017, the reporting rate of severe HSRs per 100,000 defined daily doses (100 mg dose equivalents of iron) varied from 0.3 to 0.5 for ferric carboxymaltose and from 2.4 to 5.0 for iron (III) isomaltoside 1000. The reporting rate ratio for iron (III) isomaltoside 1000 versus ferric carboxymaltose was between 5.6 (95% CI 3.5–9.0) and 16.2 (95% CI 9.4–27.8).ConclusionsFindings suggest that iron (III) isomaltoside 1000 is associated with a higher reporting rate of severe HSRs related to estimated exposure than ferric carboxymaltose in European countries. Future research investigating the occurrence of severe HSRs associated with i.v. ferric carboxymaltose and iron (III) isomaltoside 1000 is needed to broaden the evidence for benefit-risk assessment.

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“…Številne raziskave so potrdile njuno uporabnost pri spremljanju zdravljenja hemodializnih bolnikov. Uporabo %HYPO v kombinaciji s parametrom CHr/Ret-He priporočajo tudi smernice za zdravljenje AKLB (5,7,14,24,25). Med parametroma Hypo-He in %HYPO smo tako kot druge raziskave potrdili polinomsko povezavo drugega reda.…”

Section: Razpravljanjeunclassified

Primerjava eritrocitnih in retikulocitnih parametrov pri ugotavljanju pomanjkanja železa

Jarc

Zupan²,

Ponikvar³

et al. 2017

SlovMedJour

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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 < 28.2 pg and for Hypo-He at > 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.

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Diagnosis of Iron-Deficiency Anemia in Chronic Kidney Disease

Cited by 35 publications

References 17 publications

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

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

Evaluation of the Reported Rates of Severe Hypersensitivity Reactions Associated with Ferric Carboxymaltose and Iron (III) Isomaltoside 1000 in Europe Based on Data from EudraVigilance and VigiBase™ between 2014 and 2017

Primerjava eritrocitnih in retikulocitnih parametrov pri ugotavljanju pomanjkanja železa

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