Haematology Laboratory, Hospital Galdakao - Usansolo, Galdakao, Vizcaya, Spain.
Int J Lab Hematol. 2013 Apr;35(2):144-9. doi: 10.1111/ijlh.12013. Epub 2012 Oct 4.
Consequence of the imbalance between the erythroid marrow iron requirements and the actual supply is a reduction in red cell hemoglobin content, which causes hypochromic mature red cells and reticulocytes. Sysmex XE 5000 analyzer (Sysmex Corporation, Kobe, Japan) reports reticulocyte hemoglobin equivalent (Ret-He) and the percentages of erythrocyte subsets, including the hypochromic fraction (%Hypo-He). We study the value of these parameters of hemoglobinization in the evaluation of erythropoiesis and iron availability.
Ninety healthy subjects, 85 patients with chronic kidney disease (CKD) and 65 patients on dialysis (HD) receiving therapy and 91 patients with iron deficiency (IDA) were analyzed. Pearson's correlation, t-test for independent, and receiver operating characteristic (ROC) curve analysis were utilized.
The results in the IDA group reflected the state of iron depletion (low ferritin), low iron availability (low MCH and high percentage of hypochromic red cells (%Hypo-He)), and iron-restricted erythropoiesis (low Ret-He). In the HD and CKD, the reticulocyte percentage showed the increased erythropoiesis, maintained due to treatment (Ret-He over 30 pg) and good iron availability, MCH within reference range and %Hypo-He slightly increased. The results of ROC curves analysis for the diagnosis of iron deficiency (gold standard sTfR > 21 nm) were as follows: Ret-He area under curve (AUC) 0.935 cutoff 29.8 pg, sensitivity 90.7%, specificity 83.1%. % Hypo-He AUC 0.925 cutoff 3.5%, sensitivity 87.3%, specificity 88.0%.
Percentage of hypochromic red cells and Ret-He provide information about individual cell characteristics, so the hypochromic cells are detected and quantitated improving the evaluation of erythropoiesis and iron status.
红细胞骨髓铁需求与实际供应之间失衡的后果是红细胞血红蛋白含量降低，导致低色素成熟红细胞和网织红细胞。希森美康 XE-5000 分析仪（Sysmex 公司，神户，日本）报告网织红细胞血红蛋白等效物（Ret-He）和红细胞亚群的百分比，包括低色素部分（%Hypo-He）。我们研究了这些血红蛋白化参数在评估红细胞生成和铁可用性方面的价值。
分析了 90 名健康受试者、85 名慢性肾脏病（CKD）患者和 65 名接受治疗的血液透析（HD）患者以及 91 名缺铁（IDA）患者。采用 Pearson 相关分析、独立 t 检验和受试者工作特征（ROC）曲线分析。
IDA 组的结果反映了缺铁状态（低铁蛋白）、低铁可用性（低 MCH 和高比例的低色素红细胞（%Hypo-He））和铁受限的红细胞生成（低 Ret-He）。在 HD 和 CKD 中，网织红细胞百分比显示红细胞生成增加，由于治疗（Ret-He 超过 30 pg）和良好的铁可用性而维持，MCH 在参考范围内，%Hypo-He 略有增加。ROC 曲线分析用于诊断缺铁（金标准 sTfR > 21nm）的结果如下：Ret-He 曲线下面积（AUC）0.935 截止值 29.8pg，敏感性 90.7%，特异性 83.1%。%Hypo-He AUC 0.925 截止值 3.5%，敏感性 87.3%，特异性 88.0%。
低色素红细胞百分比和 Ret-He 提供了关于单个细胞特征的信息，因此可以检测和定量低色素细胞，从而改善对红细胞生成和铁状态的评估。
