Schaefer R M, Schaefer L
Department of Internal Medicine, University of Muenster, Germany.
Kidney Int Suppl. 1999 Mar;69:S44-8. doi: 10.1046/j.1523-1755.1999.055suppl.69044.x.
The management of recombinant human erythropoietin (rHuEPO) treatment in hemodialysis patients requires close monitoring of iron status, because the pharmacologically stimulated erythropoiesis is particularly dependent on a continuous supply of iron. Parameters commonly measured to assess iron status are serum ferritin and the transferrin saturation. Both are indirect measures of iron availability for hemoglobin synthesis and frequently do not permit an assessment of the adequacy of iron supply to the erythron. Using flow cytometry, cell volume and hemoglobin concentration can be measured in individual red blood cells and reticulocytes. Based on these techniques, two parameters have proved to be particularly useful in identifying iron-deficient erythropoiesis. (a) The percentage of hypochromic erythrocytes (defined as red blood cells with a hemoglobin concentration of less than 28 g/dl) has been shown to detect insufficient marrow iron supply with a fairly good accuracy. (b) More recently, determination of the content of hemoglobin in reticulocytes (CHr) has been suggested by a number of authors to be even more sensitive in detecting iron-deficient erythropoiesis. For those who have access to an H*3 hematology analyzer, both indices can be determined at the time of a routine blood count at a minimal incremental cost.
血液透析患者重组人促红细胞生成素（rHuEPO）治疗的管理需要密切监测铁状态，因为药物刺激的红细胞生成特别依赖于铁的持续供应。评估铁状态常用的参数是血清铁蛋白和转铁蛋白饱和度。这两者都是血红蛋白合成中铁可用性的间接指标，且常常无法评估向红细胞系供应铁的充足程度。使用流式细胞术，可以测量单个红细胞和网织红细胞的细胞体积和血红蛋白浓度。基于这些技术，有两个参数已被证明在识别缺铁性红细胞生成方面特别有用。（a）低色素红细胞百分比（定义为血红蛋白浓度低于28 g/dl的红细胞）已被证明能以相当高的准确性检测骨髓铁供应不足。（b）最近，许多作者提出测定网织红细胞血红蛋白含量（CHr）在检测缺铁性红细胞生成方面更为敏感。对于能够使用H*3血液分析仪的人来说，在进行常规血细胞计数时可以以最低的增量成本测定这两个指标。
