The relevance of reticulocyte hemoglobin content measurement in assessing functional iron Deficiency

Abstract

The diagnosis of iron deficiency or functional iron deficiency (FID) is considered to be mostly challenging in patients with acute or chronic inflammatory conditions, because most of the biochemical parameters for iron metabolism (such as ferritin and transferrin saturation) are influenced by acute inflammatory response. For that a recently introduced method to quantify reticulocyte haemoglobin content (CHr), looks to add to the battery of tests for the determination of body ‘iron status’ and could provide additional information for FID in patients suffering from anaemia of chronic diseases (ACD) and chronic renal failure(CRF). Subjects and Methods: The aims of this study were to estimate the value of the CHr in normal adult population, and compare the levels with conventional iron indices. This study included 60 normal healthy age matching control, 100 patients with iron deficiency, 60 patients with ACD and 100 patients with CRF before the start of dialysis. The methods employed for the blood examinations in the laboratory were as follows: CBC including CHr, microscopic blood film examination, erythrocyte sedimentation rate, colorimetric method for serum iron, iron binding capacity(TIBC), and estimation of transferrin saturation(TAST), serum ferritin(SF), and C-reactive protein(CRP). Result: The results showed that the normal range for CHr in healthy adult subject was with mean of 30.93 ± 1.3 pg pg and a range of 28.8-33.1pg. There was a high significant correlation between CHr and haematological parameters (and with biochemical parameters of iron status were high in three different group of patients. On the other hand, there was weak correlation between CHr and ferritin in ACD and CRF groups. There was also an inverse correlation between CHr and CRP in both ACD and CRF patients. This finding indicates that CHr value, unlike SF, is independent of the inflammatory processes and remains a true indicator of the body iron status. Conclusion: CHr was a useful parameter for the diagnosis of simple iron deficiency or FID in patients suffering from ACD and anaemia associated with CRF on haemodialysis and treated with r-HuEPO.