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Erythropoiesis Activity, Iron Availability and Reticulocyte Hemoglobinization during Treatment with Hemodialysis and in Subjects with Uremia by Marianne Schoorl , Margreet Schoorl, Menso J Nubé, Piet CM Bartels

In hemodialysis subjects correction of anemia is facilitated by combined supplementation of intravenous iron and recombinant human erythropoietin. Reticulocyte hemoglobin content (RET-He) is considered to be an actual indicator reflecting functional iron availability for erythropoiesis. In the present study, interdependence between bio- chemical analytes reflecting iron status and hemocytometric parameters indicating the degree of hemoglobinization of reticulocytes and red blood cells, respectively, is established. Participants of the study were reference sub- jects (n=75), subjects with iron deficiency anemia (n=52), subjects with uremia (n=19) and subjects undergoing hemodialysis treatment (n=43). If compared with the reference subjects the results for RBC counts and MCHC are statistically significantly decreased in case of subjects with hemodialysis and uremia, whereas increased results are established with regard to RDW-sd values. Significantly increased results for absolute reticulocyte counts and immature reticulocyte fractions (IRF) are also observed in case of subjects with hemodialysis and uremia. Slightly increased values for the ZPP/heme ratio in combination with elevated reticulocyte count reflect increased activity of erythropoiesis. At a definite MCV value, decreased levels for the hemoglobin content of reticulocytes (RET-He) and hemoglobin content of red blood cells (RBC-He) are observed in case of subjects treated with hemodialysis and in subjects with uremia if compared with identical MCV values of the group of reference subjects. For the ratio of RET-He and RBC-He obviously decreased results are demonstrated in case of subjects with iron defi- ciency anemia (1.02 ± 0.08, mean ± SD), hemodialysis (1.05 ± 0.05) and uremia (1.02 ± 0.10) if compared with the group of reference subjects (1.11 ± 0.02). From the combined interpretation of the MCV values within the reference range and decreased values for RET-He and RET-He/RBC-He ratios, respectively, a decreased degree of hemoglobinization is concluded in the case of subjects with hemodialysis or uremia. The conclusion implicating the presumption of reduced functional availability of iron for hemoglobin synthesis is supported by the detection of increased results for sTfR concentrations and ZPP/heme ratios.

DOI: Clin. Lab. 2006;52:621-629