Evaluation of the hypochromic erythrocyte and reticulocyte hemoglobin content provided by the Sysmex XE-5000 analyzer in diagnosis of iron deficiency erythropoiesis
Abstract
Background:
Iron deficiency represents the most frequent cause of anemia. To diagnose iron deficiency some biochemical tests such as serum ferritin and the transferring saturation percent (TSAT%) are usually used. Recently, some hematological parameters such as mean reticulocyte hemoglobin content (CHr or Ret-He) and percentage of hypochromic RBCs (Hypo% or %Hypo-He) were proposed as alternative to biochemical tests. In this study, the analytic performance and the diagnostic efficiency of these two parameters provided by Sysmex XE5000 analyzer on iron deficiency patients with or without anemia (IDA and ID, respectively) were evaluated.
Methods:
One hundred and sixty-four healthy adults, 58 with IDA, 21 with iron depleted stores (ID), 23 with β-thalassemia trait, and 24 with non iron deficiency anemia were selected. The gold standard used to define iron deficiency was the coexistence of serum ferritin below 15 μg/L (12 in women) and TSAT <16%.
Results:
For %Hypo-He, the best cut-off value for both IDA and ID is 0.9% while for Ret-He is 30.6 pg. For both parameters the performance was better to diagnose IDA (AUC, 0.96 and 0.98) than ID (AUC, 0.93 and 0.95). The Ret-He behavior was always slightly better than that of %Hypo-He.
Conclusions:
The use of these two parameters is useful to detect iron deficiency conditions if the hemoglobin synthesis has already been compromised.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. De Maeyer E, Adiels-Teyman M. The prevalence of anemia in the world. World Health Stat Q 1985;38:303–16.Suche in Google Scholar
2. Cook JD, Skikne BS. Iron deficiency: definition and diagnosis. J Intern Med 1989;226:349–55.10.1111/j.1365-2796.1989.tb01408.xSuche in Google Scholar PubMed
3. Thomas DW, Hinclhiffe RF, Briggs C, MC Dougall IC, Littlewood T, Cavill I. Guideline for the laboratory diagnosis of functional iron deficiency. Br J Haematol 2013;161:639–48.10.1111/bjh.12311Suche in Google Scholar PubMed
4. Finch CA, Bellotti V, Stray S, Lipschitz DA, Cook JD, Pippard MJ, et al. Plasma ferritin determination as a diagnostic tool. West J Med 1986;145:657–63.Suche in Google Scholar
5. Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL. Prevalence of iron deficiency in the United States. J Am Med Assoc 1997;277:973–6.10.1001/jama.1997.03540360041028Suche in Google Scholar PubMed
6. Locatelli F, Aljama P, Barany P, Canaud B, Carrera F, Eckardt KU, et al. Revised European best practice guidelines for the management of anaemia in patients with chronic renal failure. Nephrol Dial Transplant 2004;19(suppl 2):ii1–ii47.10.1093/ndt/gfh1031Suche in Google Scholar
7. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for anemia in chronic kidney disease. Am J Kidney Dis 2006;47(suppl 3):s11–145.10.1053/j.ajkd.2006.03.011Suche in Google Scholar PubMed
8. UK Renal Association. Clinical Practice Guidelines Module 2: complications. UK Renal Association 2007. Available at: www.renal.org/guidelines.Suche in Google Scholar
9. Chung M, Chan JA, Moorthy D, Hadar N, Ratichek SJ, Concannon TW, et al. Biomarkers for assessing and managing iron deficiency anemia in late-stage chronic kidney disease: future research needs. Agency for Health Care research and quality. Rockville, MD: US Department of Health and Human Services, 2013.Suche in Google Scholar
10. Brugnara C. A haematological “gold standard” for iron-deficient states (editorials)? Clin Chem 2002;48:981–2.10.1093/clinchem/48.7.981Suche in Google Scholar
11. MacDougall IC, Cavill I, Hulme B, Bain B, McGregor E, McKay P, et al. Detection of functional iron deficiency during erythropoietin treatment: a new approach. Br Med J 1992;304:225–6.10.1136/bmj.304.6821.225Suche in Google Scholar PubMed PubMed Central
12. NICE. Anaemia management in people with chronic kidney disease. Clinical guideline 114. London: National Institute for Health and Clinical Excellence, 2011.Suche in Google Scholar
13. Tessitore N, Solero GP, Lippi G, Bassi A, Faccini GB, Bedogna V, et al. The role of iron status markers in predicting response to intravenous iron in haemodialysis patients on maintenance erythropoietin. Nephrol Dial Transplant 2001;16:1416–23.10.1093/ndt/16.7.1416Suche in Google Scholar PubMed
14. Chuang CL, Liu RS, Wei YH, Huang TP, Tarng DC. Early prediction of response to intravenous iron supplementation by reticulocyte haemoglobin content and high-fluorescence reticulocyte count in haemodialysis patients. Nephrol Dial Transplant 2003;18:370–7.10.1093/ndt/18.2.370Suche in Google Scholar PubMed
15. Bovy C, Gothot A, Delanaye P, Warling X, Krzesinski JM, Beguin Y. Mature erythrocyte parameters as new markers of functional iron deficiency in haemodialysis: sensitivity and specificity. Nephrol Dial Transplant 2007;22:1156–62.10.1093/ndt/gfl765Suche in Google Scholar PubMed
16. Buttarello M, Pajola R, Novello E, Rebeschini M, Cantaro S, Oliosi F, et al. Diagnosis of iron deficiency in patients undergoing hemodialysis. Am J Clin Pathol 2010;133:949–54.10.1309/AJCPQAX0JFHFS0OASuche in Google Scholar PubMed
17. Franck S, Linssen J, Messinger M, Thomas L. Potential utility of Ret-Y in the diagnosis of iron- restricted erythropoiesis. Clin Chem 2004;50:1240–2.10.1373/clinchem.2004.030254Suche in Google Scholar PubMed
18. Clinical and Laboratory Standards Institute (CLSI). Defining, establishing, and verifying reference intervals in the clinical laboratory; approved guideline-third edition. Wayne, PA: C28-A3, 2008.Suche in Google Scholar
19. Camaschella C. Iron-deficiency anemia. N Engl J Med 2015;372:1832–43.10.1056/NEJMra1401038Suche in Google Scholar PubMed
20. Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood 2006;107:1747–50.10.1182/blood-2005-07-3046Suche in Google Scholar PubMed PubMed Central
21. Fishbane S, Kowalsky EA, Imbriano LJ, Maesaka JK. The evaluation of iron status in hemodialysis patients. J Am Soc Nephrol 1996;7:2654–7.10.1681/ASN.V7122654Suche in Google Scholar PubMed
22. Urrechaga E, Borque L, Escanero JF. Potential utility of the new Sysmex XE 5000 red blood cell extended parameters in the study of disorders of iron metabolism. Clin Chem Lab Med 2009;47:1411–6.10.1515/CCLM.2009.301Suche in Google Scholar PubMed
23. Urrechaga E, Borque L, Escanero JF. Erythrocyte and reticulocyte indices in the assessment of erythropoiesis activity and iron availability. Int J Lab Hem 2013;35:144–9.10.1111/ijlh.12013Suche in Google Scholar PubMed
24. Noronha JF, Grotto HZ. Measurement of reticulocyte and red blood cell indices in patients with iron deficiency anemia and β-thalassemia. Clin Chem Lab Med 2005;43:195–7.10.1515/CCLM.2005.033Suche in Google Scholar PubMed
25. Thomas C, Thomas L. Biochemical markers and hematologic indices in the diagnosis of functional iron deficiency. Clin Chem 2002;48:1066–76.10.1093/clinchem/48.7.1066Suche in Google Scholar
26. Katodritou E, Terpos E, Zervas K, Speletas M, Kapetanos D, Kartsios C, et al. Hypochromic erythrocytes(%): a reliable marker for recognozing iron-restricted erythropoiesis and predicting response to erythropoietin in anemic patients with myeloma and lymphoma. Ann Hematol 2007;86:369–76.10.1007/s00277-007-0258-xSuche in Google Scholar PubMed
27. Brugnara C, Schiller B, Moran J. Reticulocyte hemoglobin equivalent (Ret-He) and assessment of iron-deficient states. Clin Lab Haematol 2006;28:303–8.10.1111/j.1365-2257.2006.00812.xSuche in Google Scholar PubMed PubMed Central
28. Garzia M, Di Mario A, Ferraro E, Tazza L, Rossi E, Luciani G, et al. Reticulocyte haemoglobin equivalent; an indicator of reduced iron availability in chronic kidney diseases during erythropoietin therapy. Lab Hematol 2007;13:6–11.10.1532/LH96.06037Suche in Google Scholar PubMed
29. Maconi M, Cavalca L, Danise P, Cardarelli F, Brini M. Erythrocyte and reticulocyte indices in iron deficiency in chronic kidney disease: comparison of two methods. Scand J Clin Lab Invest 2009;69:365–70.10.1080/00365510802657673Suche in Google Scholar PubMed
©2016 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Editorial
- Biomarkers, inflammation and cancer: where to go?
- Review
- Analysis, detection and quantitation of mixed cryoglobulins in HCV infection: brief review and case examples
- Mini Reviews
- Calcitonin measurement and immunoassay interference: a case report and literature review
- Exosomal non-coding RNAs: a promising cancer biomarker
- Opinion Paper
- Towards a new paradigm in laboratory medicine: the five rights
- EFLM Recommendation
- Recommendation for the review of biological reference intervals in medical laboratories
- IFCC Position Paper
- Assuring the quality of interpretative comments in clinical chemistry
- General Clinical Chemistry and Laboratory Medicine
- The effect of centrifugation speed and time on pre-analytical platelet activation
- An assessment of clinical laboratory performance for the determination of manganese in blood and urine
- Evaluation of antiphospholipid antibody assays using latent class analysis to address the lack of a reference standard
- Evaluation of the hypochromic erythrocyte and reticulocyte hemoglobin content provided by the Sysmex XE-5000 analyzer in diagnosis of iron deficiency erythropoiesis
- Cancer Diagnosis
- Identifying risk in the use of tumor markers to improve patient safety
- Association between Echinococcus granulosus infection and cancer risk – a pilot study in Cyprus
- Dynamic change of the systemic immune inflammation index predicts the prognosis of patients with hepatocellular carcinoma after curative resection
- Aberrant methylation of tumour suppressor genes WT1, GATA5 and PAX5 in hepatocellular carcinoma
- Cardiovascular Diseases
- High homocysteine and low folate plasma concentrations are associated with cardiovascular events but not bleeding during warfarin treatment
- Hemolysis and Coagulation
- Hemolysis rates in blood samples: differences between blood collected by clinicians and nurses and the effect of phlebotomy training
- Letters to the Editor
- Harmonisation of the laboratory testing process: need for a coordinated approach
- Pseudohyperkalemia due to severe leukocytosis: case presentation
- When obtaining a blood sample from the right arm was not the right thing to do: a case of elevated parathyroid hormone levels 27 years after thyroidectomy
- Raising awareness of assay compatibility with heparinized plasma
- Improved protocol for extraction of genomic DNA from formalin-fixed paraffin-embedded tissue samples without the use of xylene
- Effect of refrigeration, centrifugation, acidification, heat treatment and storage on urine calcium, magnesium and phosphate
- Letter in response to: Identifying risk in the use of tumor markers to improve patient safety
- Letter to the Editor in reply to Dayyani and Morgenstern’s comment on the article “Identifying risk in the use of tumor markers to improve patient safety”
- Level of red cell distribution width is affected by various factors
- Red blood cell distribution: an index without additional cost in estimating the prognosis of acute pancreatitis
- Testing of total 25(OH)vitamin D: agreement and discrepant cases between Cobas® 8000 and Liaison® XL methods
- Expression profiling and ontology analysis of circulating long non-coding RNAs in septic acute kidney injury patients
Artikel in diesem Heft
- Frontmatter
- Editorial
- Biomarkers, inflammation and cancer: where to go?
- Review
- Analysis, detection and quantitation of mixed cryoglobulins in HCV infection: brief review and case examples
- Mini Reviews
- Calcitonin measurement and immunoassay interference: a case report and literature review
- Exosomal non-coding RNAs: a promising cancer biomarker
- Opinion Paper
- Towards a new paradigm in laboratory medicine: the five rights
- EFLM Recommendation
- Recommendation for the review of biological reference intervals in medical laboratories
- IFCC Position Paper
- Assuring the quality of interpretative comments in clinical chemistry
- General Clinical Chemistry and Laboratory Medicine
- The effect of centrifugation speed and time on pre-analytical platelet activation
- An assessment of clinical laboratory performance for the determination of manganese in blood and urine
- Evaluation of antiphospholipid antibody assays using latent class analysis to address the lack of a reference standard
- Evaluation of the hypochromic erythrocyte and reticulocyte hemoglobin content provided by the Sysmex XE-5000 analyzer in diagnosis of iron deficiency erythropoiesis
- Cancer Diagnosis
- Identifying risk in the use of tumor markers to improve patient safety
- Association between Echinococcus granulosus infection and cancer risk – a pilot study in Cyprus
- Dynamic change of the systemic immune inflammation index predicts the prognosis of patients with hepatocellular carcinoma after curative resection
- Aberrant methylation of tumour suppressor genes WT1, GATA5 and PAX5 in hepatocellular carcinoma
- Cardiovascular Diseases
- High homocysteine and low folate plasma concentrations are associated with cardiovascular events but not bleeding during warfarin treatment
- Hemolysis and Coagulation
- Hemolysis rates in blood samples: differences between blood collected by clinicians and nurses and the effect of phlebotomy training
- Letters to the Editor
- Harmonisation of the laboratory testing process: need for a coordinated approach
- Pseudohyperkalemia due to severe leukocytosis: case presentation
- When obtaining a blood sample from the right arm was not the right thing to do: a case of elevated parathyroid hormone levels 27 years after thyroidectomy
- Raising awareness of assay compatibility with heparinized plasma
- Improved protocol for extraction of genomic DNA from formalin-fixed paraffin-embedded tissue samples without the use of xylene
- Effect of refrigeration, centrifugation, acidification, heat treatment and storage on urine calcium, magnesium and phosphate
- Letter in response to: Identifying risk in the use of tumor markers to improve patient safety
- Letter to the Editor in reply to Dayyani and Morgenstern’s comment on the article “Identifying risk in the use of tumor markers to improve patient safety”
- Level of red cell distribution width is affected by various factors
- Red blood cell distribution: an index without additional cost in estimating the prognosis of acute pancreatitis
- Testing of total 25(OH)vitamin D: agreement and discrepant cases between Cobas® 8000 and Liaison® XL methods
- Expression profiling and ontology analysis of circulating long non-coding RNAs in septic acute kidney injury patients