Biochemical markers and haematologic indices in the diagnosis of iron-restricted erythropoiesis and monitoring of r-HuEPO therapy
Year: 2004
Type: article
Abstract: Classical iron deficiency (ID) is not a challenge for the laboratory and physicians. The diagnosis is associated with microcytic hypochromic anemia and low serum ferritin. Anemia that accompanies infection, inflammation, and cancer, commonly termed anemia of chronic disorders (ACD) has apparently normal or increased iron stores. However, 20% of these patients have iron-restricted erythropoiesis (functional ID), an imbalance between iron requirements of the erythroid marrow and the actual iron supply. Functional ID leads to a reduction of red cell hemoglobinization, which causes hypochromic microcytic anemia. The early diagnosis of functional ID is based on the measurement of heamoglobin content of reticulocytes. This index can be estimated measuring the CHr with the Bayer Advia analyzer or the Ret-Y, using the Sysmex XE analyzer series. A CHr < 28 pg or a Ret-Y < 1630 are sensitive indicators of functional ID. For the assessment of iron status and the detection of advancing iron deficiency in patients with ID, ACD and the combined state of functional ID/ACD a diagnostic plot was developed. The plot indicates the correlation between the ratio sTfR/log ferritin (ferritin index), a marker of iron supply for erythropoiesis, and the CHr or Ret-Y. The diagnostic plot shows a good selectivity to assess the iron status of disease specific anemias like classical ID, end stage renal failure, cancer related anemia and anemia of infection and inflammation. Therapeutic implications of the diagnostic plot are to differentiate patients who should be administered with oral iron, with r-HuEPO or a combination of r-HuEPO and iron. The therapy can be monitored using the CHr, the Ret-Y, the sTfR or the diagnostic plot. An increase of CHr > 1 pg, of sTfR > 20% or an upward movement of the patient data point in the diagnostic plot indicates response to iron or r-HuEPO.
DOI: 10.2298/jmh0403235t
Authors: Lothar Thomas, Christian Thomas
Institution: Krankenhaus Nordwest
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2097402372