Percentage of hypochromic erythrocytes and reticulocyte hemoglobin equivalent predictors of response to intravenous iron in hemodialysis patients

Urrechaga, Eloísa; Boveda, O.; Aguayo, Francisco J.; Hera, Patricia de la; Muñoz, Rosa Inés; Gallardo, Isabel; Escanero, Jesús F.

doi:10.1111/ijlh.12496

Cited by 20 publications

(24 citation statements)

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“…The sensitivity, however, was poorer when compared to reported diagnostic iron studies (sensitivity of 90.0%), soluble transferrin receptor (sensitivity of 86%), and recent studies of Ret‐He . Ret‐He has been widely studied, within numerous population groups including pregnancy . The reported diagnostic Ret‐He cutoff values vary from 27 to 32 pg according to the study population and diagnostic inclusion criteria .…”

Section: Discussionmentioning

confidence: 91%

“…In contrast to the Ret‐He, the %Hypo‐He reflects the iron status of the RBC over the circulating life span (120 days). While the %Micro‐R has not been well researched as a marker of ID, studies have demonstrated the clinical utility of the %Hypo‐He in several patient groups with ID . For example, the %Hypo‐He is the most recognized parameter for identifying functional ID (iron stores are normal/increased with inadequate iron supply to erythrocytes) in patients with chronic renal failure treated with erythropoietin‐stimulating agents .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The clinical utility of new reticulocyte and erythrocyte parameters on the Sysmex XN 9000 for iron deficiency in pregnant patients

Levy

Schapkaitz

2018

Int J Lab Hematology

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

The clinical utility of new reticulocyte and erythrocyte parameters on the Sysmex XN 9000 for iron deficiency in pregnant patients

Levy

Schapkaitz

2018

Int J Lab Hematology

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“…Sysmex introduced another measure of hypochromia, %Hypo‐He, which defines red cells with MCH <17 pg. In a previously mentioned study, Urrechaga et al demonstrated the reliability of %Hypo‐He in predicting response to iron supplementation at a diagnostic threshold of 2.4% . Several other studies demonstrate the utility of %HRC and %Hypo‐He in diagnosing iron deficiency and predicting response to intravenous iron treatment in CKD patients …”

Section: Methods Of Iron Quantificationmentioning

confidence: 94%

“…43,44 In a study of 504 subjects with different anemia etiologies, a diagnostic threshold of 25 pg was established to identify iron deficiency (<25 pg) from other forms of anemia. 44 Furthermore, in a study of 40 dialysis patients, Urrechaga et al 45 found RetHe to be a reliable predictor of response to intravenous iron supplementation at a diagnostic threshold of 30.8 pg.…”

Section: Reticulocyte Hemoglobin Content (Equivalent)mentioning

confidence: 99%

Markers of iron status in chronic kidney disease

Gawęda

2017

Hemodialysis International

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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 ESA’s 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, as well as experimental ones, such as hepcidin and soluble transferrin receptor. 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 hypochromic red cells are more powerful, but their widespread use is hampered by the issue of sample stability in storage. Soluble transferrin receptor and hepcidin show promise, but require further investigation as well as the development of standardized, low-cost assay platforms.

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“…This indicates that a patient with Ret‐He >27.0 pg is unlikely to have IDA, while allowing for iron supplementation to be initiated in patients with Ret‐He ≤27.0 pg. Given that iron is necessary for effective erythropoiesis, timely and accurate testing of iron status is essential, particularly in certain disease populations . Ret‐He is used as a useful parameter for the monitoring of iron treatment .…”

Section: Discussionmentioning

confidence: 99%

Reticulocyte hemoglobin equivalent in a thalassemia‐prevalent area

Kadegasem

Songdej

Lertthammakiat

et al. 2019

Pediatrics International

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Background Reticulocyte hemoglobin equivalent (Ret‐He), a direct measure of the hemoglobin (Hb) in the young red blood cells, has been reported to be useful in the diagnosis of iron deficiency anemia (IDA) but may have some limitations in thalassemia trait. This study evaluated the differences in Ret‐He in school‐aged children, and assessed the diagnostic value of Ret‐He in identifying IDA in a thalassemia‐prevalent area. Methods Blood samples underwent complete blood count analysis, including Ret‐He, ferritin, serum iron and total iron binding capacity. Blood samples also underwent Hb typing and a molecular study for α‐thalassemia. Receiver operating characteristic analysis was performed to determine the predictive capacity of Ret‐He in the diagnosis of IDA. ID was defined as serum ferritin <30 ng/mL and/or transferrin saturation (TSAT) <16%; IDA was defined as serum ferritin <12 ng/mL and/or TSAT <16% with low Hb for age. Normal healthy children (normal controls: NC) had normal iron study, without the thalassemia trait. Results Ninety‐eight children with a mean age of 12.9 ± 0.6 years were included. Ret‐He in the thalassemia trait group (26.7 ± 2.4 pg), ID group (29.0 ± 2.9 pg), IDA group (25.4 ± 2.7 pg), ID + thalassemia trait group (26.6 ± 2.8 pg), and the IDA + thalassemia trait group (24.6 ± 2.3 pg) was significantly lower than in the NC group (30.8 ± 1.7 pg; P < 0.001, 0.01, 0.006, 0.002 and <0.001, respectively). Ret‐He had an area under the curve of 0.904 in diagnostic ability for IDA, while a cut‐off ≤27 pg had a sensitivity of 91.7% and a specificity of 81%. Conclusion Ret‐He was lowest in subjects with IDA + thalassemia trait. A Ret‐He cut‐off ≤27 pg was suggestive of IDA in the present study.

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Percentage of hypochromic erythrocytes and reticulocyte hemoglobin equivalent predictors of response to intravenous iron in hemodialysis patients

Abstract: % Hypo-He and Ret-He are reliable parameters for the study of erythropoiesis status in HD patients.

Cited by 20 publications

References 30 publications

The clinical utility of new reticulocyte and erythrocyte parameters on the Sysmex XN 9000 for iron deficiency in pregnant patients

The clinical utility of new reticulocyte and erythrocyte parameters on the Sysmex XN 9000 for iron deficiency in pregnant patients

Markers of iron status in chronic kidney disease

Reticulocyte hemoglobin equivalent in a thalassemia‐prevalent area

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