Reticulocyte Hemoglobin Content: A New Way to Predict Iron Deficiency!

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Because iron deficiency can exist for some time before it causes anemia, hemoglobin is a poor predictor of iron deficiency. For example, a person might have a hemoglobin within the normal range at the time of examination, develop iron deficiency anemia afterwards and not see a physician in time to correct the deficiency before irreversible neurocognitive impairments have occurred. In pediatric cases a child with chronic iron deficiency can die of an enlarged heart. Often creating a mystery for parents and loved ones.

In a recent conversation with Iron Disorders Institute’s Executive Director Cheryl Garrison, I learned of a test that might be a real life and money saver for people struggling with iron deficiency. The test is called the reticulocyte hemoglobin or CHr test.

Some time ago, Iron Disorders Institute published an article about CHr where investigators at Children’s Hospital Boston reported reticulocyte hemoglobin content (CHr) to be more accurate in the detection of early iron deficiency in infants than the standard hemoglobin measurement. Lead investigator Christina Ullrich, M.D.evaluated reticulocyte hemoglobin content in 202 healthy 9-12 month old infants. Her aim was to compare the current method of detection using hemoglobin with CHr and further to evaluate a low CHr as a predictor for subsequent development of anemia. Using a 27.5 pg cutoff, CHr correctly identified 83% of the iron-deficient infants, compared with only 26% identified by the current screening standard using a hemoglobin value less than 11.0 g/dL.

Reticulocyte hemoglobin content (CHr) is a direct measure of iron in the reticulocyte. Reticulocytes are red blood cells that have been recently released from the bone marrow where they are made (within 1-2 days). Reticulocyte hemoglobin content is therefore more dependent on current iron stores and a more sensitive indicator of iron deficiency than total hemoglobin level. It is a better measure of iron available for red cell production than direct iron measures such as transferrin saturation or serum ferritin and may therefore be useful in conditions such as renal failure where iron sores may be present but unavailable to the developing red cell precursor.

By looking at only the hemoglobin in the reticulocytes, one is able to have a real-time assessment of iron stores in the bone marrow. A low CHr not only has a higher sensitivity than hemoglobin for iron deficiency in children, but also transferrin saturation percentage and serum ferritin for evaluating the iron deficiency status of hemodialysis patients.

These findings are promising, especially since achieving and maintaining iron balance is vital to normal growth, development and quality of life, and a better method of screening for iron deficiency brings us a step closer to preventing this treatable condition. As for me, I want to know if I’m iron deficient before the symptoms begin to plague me!

4 comments (Add your own)

1. Cho Myint wrote:
I agree with you.

Mon, July 14, 2014 @ 8:32 AM

2. Dr.Shaikh Badiuzzaman wrote:
1) How can we differentiate thalassaemia or beta thalassaemia minor and iron deficiency anaemia by reticulocyte hemoglobin content?

2) If ret-he is low, then, can we say that it is due to iron deficiency? Why not it is also due to copper or pyridoxal or vitamin c deficiency? Because those nutrients are also required for iron turn over for hemoglobinization.

Fri, May 6, 2016 @ 11:30 AM

3. Dr. Fareeha Zaheer wrote:
Is haemoglobin concentration highest in reticulocyte? As compared to other erythroblast forms of RBC..??

Tue, October 11, 2016 @ 8:09 AM

4. Cathy wrote:
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