CLINICAL UTILITY OF NEW DIAGNOSTIC APPROACHES (RETICULOCYTE HEMOGLOBIN CONTENT AND HYPOCHROMIC RED CELLS) FOR IRON DEFICIENCY STATES
Keywords:
tissue iron status, absolute and functional iron deficiency, reticulocyte hemoglobin content, hypochromic red cellsAbstract
Background. Classical iron deficiency does not represent a particular diagnostic challenge for the clinicians. However, in several more complicated clinical conditions, classical biochemical indices such as serum iron, transferrin saturation and ferritin may not be informative enough to reflect transient iron-deficient states and functional iron deficiency. It is defined as an imbalance between iron needs of the erythroid marrow and the iron supply. Two hematological parameters, the proportions of hypochromic red cells (hypoE) and reticulocyte hemoglobin content (CHr), have major value in this setting.
Conclusions. CHr and hypoE provide a useful new approach to the diagnosis of iron-deficient states. CHr is an early marker of functional iron deficiency, as reticulocytes exist in the circulation for only 1–2 days. Because erythrocytes have a lifespan about 120 days, the hypoE is able to provide information over a several month period and is a late indicator of iron-restricted erythropoiesis. With these new parameters identification of iron deficiency could be improved in some clinical conditions such as erythropoietin therapy, anemia of chronic disease, iron deficiency of early childhood and in the illicit use of erythropoietin for blood doping of competitive athletes. We have already introduced both new methods in clinical practice with cooperation between Department of hematology and Institut for Clinical Chemistry and Biochemistry.
Downloads
References
Andoljšek D. Bolezni krvi in krvotvornih organov. In: Kocjančič A, Mrevlje F. Interna medicina, druga, dopolnjena izdaja. Ljubljana: EWO, 1998: 1037– 131.
Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL. Prevalence of iron deficiency in the United States. JAMA 1997; 27: 973–6.
Brugnara C. A hematologic »gold standard« for iron-deficient states? Clin Chem 2002; 48: 981–2.
Brugnara C. Iron deficiency and erythropoiesis: new diagnostic approaches. Clin Chem 2003; 49: 1573–8.
Van Wyck DB, Bailie G, Aronof G. Just the FAQs: frequently asked questions about iron and anemia in patients with chronic kidney disease. Am J Kidney Dis 2002; 39: 426–32.
Kaltwasser JP, Gottschalk R. Erythropoietin and iron. Kidney Int 1999; 55: 49–56.
Worwood M. Laboratory determination of iron status. In: Brock JH, Halliday JW, Pippard MJ, Powell LW. Iron metabolism in health and disease. London, WB Saunders, 1994: 449–76.
Fernandez-Rodriguez AM, Guindeo-Casasus MC, Molero-Labarta T et al. Diagnosis of iron deficiency in chronic renal failure. Am J Kidney Dis 1999; 34: 508–13.
Nissenson AR. Achieving target hematocrit in dialysis patients: New concepts in iron management. Am J Kidney Dis 1997; 30: 907–11.
Macdougal IC, Cavill I, Hulme B et al. Detection of functional iron deficiency during erythropoietin treatment: a new approach. BMJ 1992; 304: 225–6.
Brugnara C, Chambers LA, Malynn E, Goldberg MA, Kruskall MS. Red cell regeneration induced by subcutaneous recombinant erythropoietin: irondeficient erythropoiesis in iron-replet subjects. Blood 1993; 81: 956–64.
Brugnara C, Colella GM, Cremins JC et al. Effect of subcutaneous recombinant human erythropoietin in normal subjects: development of decreased reticulocyte hemoglobin content in iron-deficient erythropoiesis. J Lab Clin Med 1994; 123: 660–7.
Brugnara C, Laufer MR, Friedman AJ, Bridges K, Platt O. Reticulocyte hemoglobin content (CHr): early indicator of iron deficiency and response to therapy. Blood 1994; 83 (10): 3100–1.
Fishbane S, Galgano C, Langley RC Jr, Canfield W, Maesaka JK. Reticulocyte hemoglobin content in the evaluation of iron status of hemodialysis patients. Kidney Int 1997; 52 (1): 217–22.
Brugnara C, Zurakowski D, DiCanzio J, Boyd T, Platt O. Reticulocyte hemoglobin content to diagnose iron deficiency in children. JAMA 1999; 281 (23): 2225–30.
NCCLS. Methods for reticulocyte Counting (Flow Cytometry and Supravital Dyes; Approved Guideline. NCCLS document 1997; H44-A, 17 (15).
Tessitore N, Solero GP, Lippi G et al. The role of iron status markers in predicting response to intravenous iron in haemodialysis patients on maintenance erythropoietin. Nephrol Dial Transplant 2001; 16: 1416–23.
Fishbane S, Shapiro W, Dutka P, Valenzuela OF, Faubert J. A randomized trial of iron deficiency testing strategies in hemodialysis patients. Kidney Int 2001; 60: 2406–11.
Parisotto R, Gore CJ, Emslie KR et al. A novel method utilizing markers of altered erythropoiesis for the detection of recombinant human erythropoietin abuse in athletes. Haematologica 2000; 85: 564–72.
Ashenden MJ. A strategy to deter blood doping in sport. Haematologica 2002; 87: 225–34.
Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL. Prevalence of iron deficiency in the United States. JAMA 1997; 277: 973–6.
Lozoff B, Jimenez E, Wolf A. Long-term developmental outcome of infants with iron deficiency. N Engl J Med 1991; 325: 687-94.
Lozoff B, Jimenez E, Hagen J, Mollen E, Wolf AW. Poorer behavioral and developmental outcome more than 10 years after treatment for iron deficiency in infancy. Pediatrics 2000; 105: E51.
Vansteenkiste J, Pirker R, Massuti B et al. Double-blind, placebo-controlled, randomized phase III trialo of darbepoetin alfa in lung cancer patients receiving chemotherapy (Comment). J Nat Cancer Inst 2002; 94: 1211–20.
Thomas C, Thomas L. Biochemical and hematologic indices in the diagnosis of functional iron deficiency. Clin Chem 2002; 48: 1066–76.
Downloads
Issue
Section
License
The Author transfers to the Publisher (Slovenian Medical Association) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Slovenian Medical Association) has the right to transfer the rights of acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
