Nephrology Dialysis Transplantation, Vol 14, Issue 3 659-665, Copyright © 1999 by Oxford University Press
P Cullen, J Soffker, M Hopfl, C Bremer, R Schlaghecken, T Mehrens, G Assmann and R Schaefer
non-specific increase in serum ferritin, iron deficiency may be overlooked
leading to failure of erythropoietin treatment. A reticulocyte haemoglobin
content <26 pg and a percentage of hypochromic red cells >2.5
have been proposed as markers of iron-deficient erythropoiesis in such
subjects, but it is unclear which parameter is superior. Methods.
We measured haematocrit, reticulocyte haemoglobin content,
ferritin and the percentage of hypochromic red cells over 10-150 days in 36
chronic haemodialysis patients in a university hospital. Transferrin
saturation was also measured in a subset of 25 patients; iron deficiency
was defined as a transferrin saturation <15%. Results.
The diagnostic sensitivity and specificity of a reticulocyte
haemoglobin content <26 pg in detecting iron deficiency were 100%
and 73% respectively, compared with 91% and 54% for a percentage of
hypochromic red cells >2.5. Paradoxical reticulocyte haemoglobin
concentrations occurred on follow-up in five patients receiving 4000 U
erythropoietin per haemodialysis (HD). In three patients, reticulocyte
haemoglobin content exceeded 26 pg despite a persistent lack of iron. In a
fourth, iron gluconate (62.5 mg i.v./HD) increased transferrin saturation
to 27% and reduced the percentage of hypochromic red cells from 12 to 4,
while reticulocyte haemoglobin remained >30 pg. In the final
patient, iron gluconate increased transferrin saturation from 8 to 30% and
reduced the percentage of hypochromic red cells from 40 to below 5, but
reticulocyte haemoglobin content remained ⩽26 pg throughout.
Conclusions. The reticulocyte haemoglobin content is
superior to the percentage of hypochromic red cells in detecting iron
deficiency in haemodialysis patients. However, reticulocyte haemoglobin may
not change as predicted during treatment with erythropoietin and iron, when
the percentage of hypochromic red cells may provide a truer picture of
functional iron status. Keywords: erythropoietin;
haemodialysis; hypochromic red cell; reticulocyte
ORIGINAL ARTICLES
Hypochromic red cells and reticulocyte haemoglobin content as markers of iron-deficient erythropoiesis in patients undergoing chronic haemodialysis
Institut fur Klinische Chemie und Laboratoriumsmedizin, Zentrallaboratorium, D-48129 Munster, Germany; Medizinische Klinik und Poliklinik, Innere Medizin D, Westfalische Wilhelms-Universitat, Munster, Germany; Corresponding author
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  D. Bolignano, G. Coppolino, A. Romeo, L. De Paola, A. Buemi, A. Lacquaniti, G. Nicocia, L. Lombardi, and M. Buemi Neutrophil gelatinase-associated lipocalin (NGAL) reflects iron status in haemodialysis patients Nephrol. Dial. Transplant., November 1, 2009; 24(11): 3398 - 3403. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Schaefer and R. M. Schaefer A primer on iron therapy Nephrol. Dial. Transplant., September 1, 2007; 22(9): 2429 - 2431. [Full Text] [PDF]
|
|
|
|
|
|
W. H. Horl, I. C. Macdougall, J. Rossert, and R. M. Schaefer OPTA-therapy with iron and erythropoiesis-stimulating agents in chronic kidney disease Nephrol. Dial. Transplant., June 1, 2007; 22(suppl_3): iii2 - iii6. [Full Text] [PDF]
|
|
|
|
 |
|
 W. H. Horl Clinical Aspects of Iron Use in the Anemia of Kidney Disease J. Am. Soc. Nephrol., February 1, 2007; 18(2): 382 - 393. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Besarab More than a Decade of Experience and Still No Consensus: Controversies in Iron Therapy Clin. J. Am. Soc. Nephrol., September 1, 2006; 1(Supplement_1): S1 - S3. [Full Text] [PDF]
|
|
|
|
|
|
J. B. Wish Assessing Iron Status: Beyond Serum Ferritin and Transferrin Saturation Clin. J. Am. Soc. Nephrol., September 1, 2006; 1(Supplement_1): S4 - S8. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Thomas and L. Thomas Biochemical Markers and Hematologic Indices in the Diagnosis of Functional Iron Deficiency Clin. Chem., July 1, 2002; 48(7): 1066 - 1076. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Tessitore, G. P. Solero, G. Lippi, A. Bassi, G. B. Faccini, V. Bedogna, L. Gammaro, G. Brocco, G. Restivo, P. Bernich, et al. The role of iron status markers in predicting response to intravenous iron in haemodialysis patients on maintenance erythropoietin Nephrol. Dial. Transplant., July 1, 2001; 16(7): 1416 - 1423. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Petrarulo and V. Giancaspro Intravenous ascorbic acid in haemodialysis patients with functional iron deficiency Nephrol. Dial. Transplant., October 1, 2000; 15(10): 1717 - 1718. [Full Text] [PDF]
|
|