Advances in Clinical and Experimental Medicine
2016, vol. 25, nr 3, May-June, p. 425–431
Publication type: original article
The Content of Reticulocyte Hemoglobin and Serum Concentration of the Soluble Transferrin Receptor for Diagnostics of Anemia in Chronically Hemodialyzed Patients
1 Analytical Laboratory SP ZOZ Team Municipal Hospital, Chorzów, Poland
2 Statistical Division, Department of Instrumental Analysis, Medical University of Silesia, Sosnowiec, Poland
3 Department of Medical and Molecular Biology, School of Medicine with the Division of Dentistry, Medical University of Silesia, Zabrze, Poland
Background. Chronic renal disease constitutes a serious worldwide clinical problem. An important issue arising early during the treatment of renal failure is anemia. Patients in the end-stage of renal disease chronically treated with hemodialysis frequently suffer from anemia with iron deficiency.
Objectives. The aim of the study was to evaluate the usefulness of determining the reticulocyte hemoglobin content and serum concentration of soluble transferrin receptor in the detection of anemia caused by iron deficiency in comparison with the classic markers of iron circulation in serum in chronic dialysis patients with ESRD.
Material and Methods. 66 sets of hematologic results and iron turnover rates were analyzed, sampled from hemodialyzed patients (test group), as well as 34 sets of the same results taken from healthy people (control group). Statistically significant variables were found and a stepwise backward discriminant analysis was performed for them.
Results. The results showed that dialyzed patients have a significantly lower serum concentration of hemoglobin, CHr, HCT, TSAT, Fe and TIBC and significantly higher serum concentration of sTfR, ferritin and C-reactive protein compared to the control group. Based on the results of discriminant analysis, we proposed a scheme for assessing the risk of anemia.
Conclusion. The concentrations of hemoglobin, soluble transferrin receptor, iron in the serum and C-reactive protein turned out to be the most useful for diagnostic purposes. Moreover, the concentration of soluble transferrin receptor confirmed its high diagnostic value in the detection of iron deficiency-based anemia in patients undergoing dialysis for chronic renal failure at the end-stage compared to conventional iron turnover ratios in the serum.
anemia, hemodialysis patients, reticulocyte hemoglobin content, soluble transferrin receptor
- Silverberg D: Outcomes of anaemia management in renal insufficiency and cardiac disease. Nephrol Dial Transplant 2003, Suppl 2, ii7–12.
- Silverberg D, Wexler D, Blum M, Wollman Y, Iaina A: The cardio-renal anaemia syndrome: Does it exist? Nephrol Dial Transplant 2003, Suppl 8, viii7–12.
- González-Costello J, Comín-Colet J: Iron deficiency and anaemia in heart failure: Understanding the FAIR-HF trial. Eur J Heart Fail 2010, 12, 1159–1162.
- Beutler E, Waalen J: The definition of anemia: What is the lower limit of normal of the blood hemoglobin concentration? Blood 2006, 107, 1747–1750.
- Formanowicz D, Formanowicz P: Transferrin changes in haemodialysed patients. Int Urol Nephrol 2012, 44, 907–919.
- Brugnara C, Schiller B, Moran J: Reticulocyte hemoglobin equivalent (Ret He) and assessment of iron-deficient states. Clin Lab Haematol 2006, 28, 303–308.
- Mitsuiki K, Harada A, Miyata Y: Assessment of iron deficiency in chronic hemodialysis patients: Investigation of cutoff values for reticulocyte hemoglobin content. Clin Exp Nephrol 2003, 7, 52–57.
- Mitsuiki K, Harada A, Miyata Y: Reticulocyte hemoglobin content in hemodialysis patients with acute infection. Clin Exp Nephrol 2004, 8, 257–262.
- SECTION II. Targets for anaemia treatment. Nephrol Dial Transplant 2004, 19 Suppl 2, ii6–ii15.
- Satirapoj B, Supasyndh O, Choovichian P: A comparative study of efficacy and safety of the lyophilized powder alpha-erythropoietin and the liquid form alpha-erythropoietin for hemoglobin maintenance in patients with hemodialysis treatment. J Med Assoc Thai 2014, 97, 899–906.
- Grote Beverborg N, Verweij N, Klip IT, van der Wal HH, Voors AA, van Veldhuisen DJ, Gansevoort RT, Bakker SJ, van der Harst P, van der Meer P: Erythropoietin in the General Population: Reference Ranges and Clinical, Biochemical and Genetic Correlates. PLoS One 2015, 10, e0125215. DOI: 10.1371/journal.pone.0125215.
- Rubab Z, Amin H, Abbas K, Hussain S, Ullah MI, Mohsin S: Serum hepcidin levels in patients with end-stage renal disease on hemodialysis. Saudi J Kidney Dis Transpl 2015, 26, 19–25.
- Formanowicz D, Formanowicz P: Transferrin changes in haemodialysed patients. Int Urol Nephrol 2012, 44, 907–919. DOI: 10.1007/s11255-011-9947-4.
- Ishida JH, Johansen KL: Iron and infection in hemodialysis patients. Semin Dial 2014, 27, 26–36. DOI: 10.1111/ sdi.12168.
- Al-Ghananim RT, Nalbant D, Schmidt RL, Cress GA, Zimmerman MB, Widness JA: Reticulocyte hemoglobin content during the first month of life in critically ill very low birth weight neonates differs from term infants, children, and adults. J Clin Lab Anal 2015. DOI: 10.1002/jcla.21859.
- Fishbane S, Shapiro W, Dutka P, Valenzuela OF, Faubert J: A randomized trial of iron deficiency testing strategies in hemodialysis patients. Kidney Int 2001, 60, 2406–2411.
- Karagülle M, Gündüz E, Sahin Mutlu F, Olga Akay M: Clinical significance of reticulocyte hemoglobin content in the diagnosis of iron deficiency anemia. Turk J Haematol 2013, 30, 153–156. DOI: 10.4274/Tjh.2012.0107.
- Baillie FJ, Morrison AE, Fergus I: Soluble transferrin receptor: A discriminating assay for iron deficiency. Clin. Lab Haematol 2003, 25, 353–357.
- Means RT, Allen J, Sears DA, Schuster SJ: Serum soluble transferrin receptor and the prediction of marrow aspirate iron results in a heterogeneous group of patients. Clin Lab Haematol 1999, 21, 161–167.
- Nagral A, Mehta AB, Gomes AT, Ellis G, Jackson BF, Sabin CA, McIntyre N: Serum soluble transferrin receptor in the diagnosis of iron deficiency in chronic liver disease. Clin Lab Haematol 1999, 21, 93–97.
- Vendt N, Talvik T, Leedo S, Tomberg K, Kool P, Tillmann V, Grünberg H: The reference limits and cut-off value for serum soluble transferrin receptors for diagnosing iron deficiency in infants. Int J Lab Hematol 2009, 31, 440–446.
- Tarng DC, Huang TP: Determinants of circulating soluble transferrin receptor level in chronic haemodialysis patients. Nephrol Dial Transplant 2002, 17, 1063–1069.
- Sedlackova T, Racek J, Rajdl D, Kielberger L, Eiselt J, Malanova L, Babuska V: Relationship between hepcidin and ferritin in haemodialysed patients. Wien Klin Wochenschr 2013, 125, 448–452. DOI: 10.1007/s00508-013-0388-1.