Brugnara C, Zelmanovic D, Sorette M, Ballas S K, Platt O
Department of Pathology, The Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Am J Clin Pathol. 1997 Aug;108(2):133-42. doi: 10.1093/ajcp/108.2.133.
Traditional reticulocyte counts provide only a partial estimate of the erythropoietic bone marrow activity and do not account for qualitative variations of reticulocyte cellular indexes and hemoglobin content in particular. We have studied a new integrated parameter, reticulocyte hemoglobin (retHb), that quantifies in grams per liter the hemoglobin contained in the circulating reticulocyte compartment and is obtained by multiplying the absolute reticulocyte count and the reticulocyte cell hemoglobin content. In 50 normal control subjects, retHb values were 1.76 +/- 0.59 g/L. The retHb values were lower in patients double heterozygous for HbS and HbC (SC disease) (3.33 +/- 1.52 g/L, n = 13) compared with homozygous HbS disease (SS) with concomitant alpha-thalassemia (5.27 +/- 1.51 g/L and 5.48 +/- 1.06 g/L for 12 patients with 3 alpha-genes and 3 patients with 2 alpha-genes, respectively) and to SS disease with no alpha-thalassemia (6.47 +/- 3.05, n = 20). The hemoglobin contained in the red blood cell pool (rbcHb) also can be calculated by subtracting retHb from the total hemoglobin. The ratio between the two pools (rbcHb/retHb, normal value 76.6 +/- 21.9, n = 50) provides a rough estimate of red blood cell survival. It was 9.8 +/- 4.1 in SS disease, 16.2 +/- 10.1 and 14.7 +/- 5.0 in SS disease with 3 and 2 normal alpha-genes, respectively, and 36.6 +/- 17.8 in SC disease with no alpha-thalassemia. We also studied retHb in patients receiving hydroxyurea therapy for SS disease, intravenous or oral iron for iron deficiency, or recombinant human erythropoietin (r-HuEPO) therapy. All these conditions are characterized by changes in reticulocyte counts and marked variations in reticulocyte cellular hemoglobin contents, which can be integrated into the retHb parameter. Measurement of retHb and the rbcHb/retHb ratio may provide an estimate of the reduction in red blood cell survival and the severity of hemolysis in various anemias and allow more precise monitoring of the response to hydroxyurea, iron, r-HuEPO, or other therapies.
传统的网织红细胞计数仅能部分评估红系造血骨髓活性，尤其无法反映网织红细胞细胞指数和血红蛋白含量的质量变化。我们研究了一个新的综合参数——网织红细胞血红蛋白（retHb），它以克每升为单位量化循环中网织红细胞部分所含的血红蛋白，通过将绝对网织红细胞计数与网织红细胞细胞血红蛋白含量相乘得出。在50名正常对照受试者中，retHb值为1.76±0.59克/升。与伴有α地中海贫血的纯合子HbS病（SS）（12名有3个α基因的患者和3名有2个α基因的患者，retHb值分别为5.27±1.51克/升和5.48±1.06克/升）以及无α地中海贫血的SS病（6.47±3.05，n = 20）相比，HbS和HbC双杂合子患者（SC病）的retHb值更低（3.33±1.52克/升，n = 13）。红细胞池中的血红蛋白（rbcHb）也可通过从总血红蛋白中减去retHb来计算。两个池之间的比值（rbcHb/retHb，正常值76.6±21.9，n = 50）可粗略估计红细胞存活情况。在SS病中该比值为9.8±4.1，在有3个和2个正常α基因的SS病中分别为16.2±10.1和14.7±5.0，在无α地中海贫血的SC病中为36.6±17.8。我们还研究了接受羟基脲治疗的SS病患者、接受静脉或口服铁剂治疗的缺铁患者或接受重组人促红细胞生成素（r-HuEPO）治疗的患者的retHb。所有这些情况的特点都是网织红细胞计数发生变化，网织红细胞细胞血红蛋白含量有显著差异，而这些都可整合到retHb参数中。测量retHb和rbcHb/retHb比值可估计各种贫血中红细胞存活的降低情况以及溶血的严重程度，并能更精确地监测对羟基脲、铁剂、r-HuEPO或其他治疗的反应。
