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Carlo Brugnara - One of the best experts on this subject based on the ideXlab platform.
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measuring Reticulocyte Hemoglobin Content as a marker for iron deficiency and response to therapy represents a paradigm shift in care
Blood, 2020Co-Authors: Michael Auerbach, Carlo Brugnara, Steve StaffaAbstract:It is estimated anemia affects over 30% of the world's population, with iron deficiency (ID) the overwhelmingly most common cause. Whether absolute due to blood loss and/or iron sequestration to underlying morbidity, the need for repletion especially in females, is a formidable medical issue. The diagnosis of iron deficient erythropoiesis has been traditionally based on the biochemical parameters ferritin and percent transferrin saturation (TSAT), mean cell volume and Hemoglobin (Hb) concentration. In recent years, Reticulocyte Hb Content has emerged as a parameter helpful in identifying iron deficient erythropoiesis and informing a need, or lack thereof, for replacement. 556 consecutive, non-selected patients referred for diagnosis and/or treatment of anemia were included in this diagnostic study to compare the performance of Reticulocyte Hemoglobin equivalent (RET-He) versus traditional biochemical markers for diagnosis and treatment of IDA. CBC, serum ferritin, iron and TSAT were performed as clinically indicated. RET-He was measured with a Sysmex XN-450 analyzer on the residual CBC sample. 556 patients were studied at baseline and 150 were subsequently treated with intravenous (IV) iron. 240/556 were seen at follow-up, with 57 treated and 183 not treated with IV iron. At baseline, ret-He, positively correlated with Hb (Spearman correlation (rho)=0.365, P Despite the limitations of the biochemical markers outlined above, we performed ROC analysis assessing the value of RET-He in identifying iron deficiency as defined by serum ferritin IV iron administration was associated with significant increases in Hb, MCV, MCH, RET-He, serum ferritin, iron and TSAT, whereas in the no-IV iron cohort, there was a small reduction in RET-He and small increases in MCV and MCH, with no significant variations in Hb and in the other parameters. Serum ferritin was below 30 ng/mL in 18/57 (32%) of the patients requiring IV iron and in 19/183 (10.4%) of those not requiring iron at visit 1. These values changed to 4/57 (7%) (P=0.002) and 23/183 (13%) (P=0.623) at visit 2, respectively. Regression analysis for Hb response following IV iron showed that baseline RET-He values are predictive of Hb response, with every unitary increase in RET-He corresponding to a blunting of the Hb change by -0.19 g/dl (95% CI: -0.27, -0.11; P 1.0 g/dl, with sensitivity of 84% and specificity of 78%. The Figure presents data for the 21/57 patients who had RET-He The present data show that an abnormally low ret-He value ( Download : Download high-res image (155KB) Download : Download full-size image Figure 1 . Disclosures Auerbach: AMAG: Research Funding; Sysmex: Research Funding. Brugnara: American Journal of Hematology: Other; Sysmex America Inc.: Consultancy.
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Reticulocyte Hemoglobin equivalent ret he and assessment of iron deficient states
Clinical and Laboratory Haematology, 2006Co-Authors: Carlo Brugnara, B Schiller, J MoranAbstract:Direct measurement of the Reticulocyte Hemoglobin Content provides useful information for the diagnosis and treatment of iron-deficient states. We have examined direct measurements of Reticulocyte and red cell Hemoglobin Content on the Sysmex XE 2100 (Ret He and RBC He respectively) and the Bayer ADVIA 2120 (CHr and CH respectively) analyzers. Good agreement was found between Ret He and CHr (Y = 1.04X − 1.06; r2 = 0.88) and between the RBC He and CH parameters (Y = 0.93X + 1; r2 = 0.84 n = 200) in pediatric patients and in normal adults (Ret He and CHr; Y = 1.06X − 0.43; r2 = 0.83; n = 126; RBC He and CH; Y = 0.94X + 1; r2 = 0.87; n = 126). In 1500 blood samples from patients on chronic dialysis, Ret He was compared with traditional parameters for iron deficiency (serum iron <40 μg/dl, Tsat <20%, ferritin <100 ng/ml, Hemoglobin <11 g/dl) for identifying iron-deficient states. Receiver operator characteristic (ROC) curve analysis revealed values of the area under the curve for Ret He of 0.913 (P < 0.0001). With a Ret He cutoff level of 27.2 pg, iron deficiency could be diagnosed with a sensitivity of 93.3%, and a specificity of 83.2%. Ret He is a reliable marker of cellular Hemoglobin Content and can be used to identify the presence of iron-deficient states.
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screening healthy infants for iron deficiency using Reticulocyte Hemoglobin Content
JAMA, 2005Co-Authors: Christina Ullrich, C C Armsby, Sarah Rieber, Sarah Wingerter, Carlo Brugnara, David E Shapiro, Henry H BernsteinAbstract:ContextCurrent clinical practice relies on Hemoglobin to detect iron deficiency, which misses infants not yet anemic and places them at higher risk for neurocognitive impairment. Reticulocyte Hemoglobin Content (CHr) has never been compared with Hemoglobin for screening healthy infants.ObjectivesTo evaluate CHr for detecting iron deficiency without anemia in healthy 9- to 12-month-old infants and to compare CHr with Hemoglobin in screening for iron deficiency in this population. A secondary objective was to explore the association between CHr and subsequent development of anemia.Design, Setting, and PatientsA prospective observational cohort study of 202 healthy 9- to 12-month-old infants from an urban, hospital-based, primary care clinic in Boston, Mass, who were screened for iron deficiency between June 2000 and April 2003, and followed up for a median of 5.6 months.Main Outcome MeasuresIron deficiency (transferrin saturation <10%) and anemia (Hemoglobin <11 g/dL).ResultsOf 202 infants enrolled, 23 (11.4%) had iron deficiency and 6 (3%) had iron deficiency and anemia. Iron-deficient and non–iron-deficient infants had significantly different values for all measured hematological and biochemical markers for iron deficiency. Optimal CHr cutoff for detecting iron deficiency was 27.5 pg (sensitivity, 83% and specificity, 72%); a Hemoglobin level of less than 11 g/dL resulted in a sensitivity of 26% and a specificity of 95%. Reticulocyte Hemoglobin Content was more accurate overall than Hemoglobin was for detecting iron deficiency (area under the receiver operating characteristic curve, 0.85 vs 0.73; P = .007). A CHr of less than 27.5 pg without anemia at initial screening was associated with subsequent anemia when screened again in the second year of life (risk ratio, 9.1; 95% confidence interval, 1.04-78.9; P = .01).ConclusionsA CHr of less than 27.5 pg is a more accurate hematological indicator of iron deficiency compared with Hemoglobin of less than 11 g/dL in these healthy 9- to 12-month-old infants. Further studies are warranted to determine whether CHr should be the preferred screening tool in the early detection of iron deficiency in infants.
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an algorithm using Reticulocyte Hemoglobin Content chr measurement in screening adolescents for iron deficiency
Journal of Adolescent Health, 2005Co-Authors: Nava Stoffman, Carlo Brugnara, Elizabeth R WoodsAbstract:Abstract Purpose To evaluate whether the use of an algorithm including Reticulocyte Hemoglobin Content (CHr), a new hematologic parameter, in addition to the screening complete blood count (CBC), improves detection of iron deficiency and iron deficiency anemia in healthy adolescents. Methods After initiation of an algorithm using CHr in addition to CBC results for identifying iron-deficient patients in a primary care hospital-based adolescent clinic, we reviewed results of all hematological tests performed in the clinic during an 8-month period. Electronic medical records were screened for health status and inclusion criteria. We determined the number of patients with low hematocrit values, low mean cell volume (MCV), and low CHr. To evaluate the impact of the protocol, we calculated the percentage of cases in which the CHr results suggested a management plan different from that which would have been formulated using the CBC results only. Results A total of 381 patients (mean age 16.8 ± 3.1 years) were included in the study. Anemia was diagnosed by the Centers for Disease Control (CDC) guidelines in 63 patients (16.5%), low MCV in 170 patients (44.6%), and a low CHr in 80 (21%) patients. In 68% of anemia cases, a normal CHr suggested that iron deficiency was not the cause of the anemia. Although low MCV values were found in 38 (60.4%) of all anemic cases, mean MCV was significantly ( p Conclusions The use of an algorithm including CHr to screen for iron deficiency anemia may increase the accuracy of diagnosis, enabling early detection and treatment of iron deficiency in adolescents without the need for additional costly iron studies.
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iron deficiency and erythropoiesis new diagnostic approaches
Clinical Chemistry, 2003Co-Authors: Carlo BrugnaraAbstract:Iron deficiency anemia is one of the most common diseases worldwide. In the majority of cases, the presence of hypochromic microcytic anemia and biochemical evidence for depletion of body iron stores makes the diagnosis relatively straightforward. However, in several clinical conditions, classic biochemical indices such as serum iron, transferrin saturation, and ferritin may not be informative or may not change rapidly enough to reflect transient iron-deficient states (functional iron deficiency), such as the ones that develop during recombinant human erythropoietin (r-HuEPO) therapy. The identification and treatment of iron deficiency in settings such as r-HuEPO therapy, anemia of chronic disease, and iron deficiency of early childhood may be improved by the use of red cell and Reticulocyte cellular indices, which reflect in almost real time the development of iron deficiency and the response to iron therapy. In the anemia of chronic disease, measurements of plasma cytokines and iron metabolism regulators such as hepcidin (when available) may be helpful in the characterization of the pathophysiologic basis of this condition. The ratio of serum transferrin receptor (sTfR) to serum ferritin (R/F ratio) has been shown to have excellent performance in estimating body iron stores, but it cannot be used widely because of the lack of standardization for sTfR assays. The combination of hematologic markers such as Reticulocyte Hemoglobin Content, which decreases with iron deficiency, and R/F ratio may allow for a more precise classification of anemias.
Johannes J M L Hoffmann - One of the best experts on this subject based on the ideXlab platform.
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assessment of iron restricted erythropoiesis in chronic renal disease evaluation of abbott cell dyn sapphire mean Reticulocyte Hemoglobin Content mchr
Scandinavian Journal of Clinical & Laboratory Investigation, 2019Co-Authors: Eloisa Urrechaga, Johannes J M L HoffmannAbstract:We studied the performance of mean Reticulocyte Hemoglobin Content (MCHr), measured on Abbott CELL-DYN Sapphire analyzer for the detection of functional iron deficiency. Patients with anemia and wi...
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Reticulocyte Hemoglobin Content mchr in the assessment of iron deficient erythropoiesis in inflammatory bowel disease
Digestive and Liver Disease, 2018Co-Authors: Eloisa Urrechaga, Johannes J M L Hoffmann, Antonio Bernal, Juan Arevalo, Jose Luis CabriadaAbstract:Abstract Background In conditions associated with inflammation, biochemical parameters alone could be inadequate for assessing iron status. We investigated the potential utility of mean Reticulocyte Hemoglobin Content (MCHr) in the assessment of the erythropoiesis status in inflammatory bowel disease (IBD). Methods We recruited 124 anemic outpatients with IBD. Serum iron, transferrin and ferritin were tested. Complete blood counts were performed on a CELL-DYN Sapphire analyzer (Abbott Diagnostics). Differences among groups were assessed using analysis of variance, considering P Receiver operating characteristic analysis was used to assess the diagnostic performance of MCHr for detecting iron deficient erythropoiesis. The reference used as an indicator of insufficient iron availability was transferrin saturation Results Overall, 47.6% of the patients had iron deficiency anemia (IDA) and 31.5% anemia of chronic disease (ACD), while the others (20.9%) had mixed anemia. Patients with ACD or mixed anemia showed functional iron deficiency: normal or high ferritin and low MCHr. The area under curve was 0.858 (95% CI 0.742–0.942), considering a cut off 30.3 pg, the sensitivity was 82.2%, specificity 83.3%. Conclusions MCHr provides information on iron availability in IBD patients. It is a reliable test to assess iron supply for erythropoiesis.
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Reticulocyte Hemoglobin Content mchr in the detection of iron deficiency
Journal of Trace Elements in Medicine and Biology, 2017Co-Authors: Eloisa Urrechaga Igartua, Johannes J M L Hoffmann, Silvia Izquierdoalvarez, Jesus F EscaneroAbstract:Abstract Background Blood Hemoglobin (Hb) concentration within the reference interval does not exclude iron deficiency (ID): individuals with normal stores lose iron during a long period before their Hb falls below of the level that is defined as anemia. The process entails a decrease of storage iron, shown by serum ferritin below reference range, followed by iron depletion, eventually leading to iron restricted erythropoiesis; consequence of an imbalance between erythropoietic iron requirements and too low supply is a reduction of Hb synthesis in Reticulocytes. Objective We study the potential utility of mean Reticulocyte Hemoglobin Content (MCHr), reported by CELL-DYN Sapphire (Abbott Diagnostics) analyzer, in the detection of ID in non-anemic adults. Methods 207 patients with Hb within the reference range were enrolled. ID was defined as Hb > 120 g/L (women), >130 g/L (men) and serum ferritin t -test was applied to detect deviations between groups, statistical significance P Results 68 patients (33%) suffered ID, median MCHr in this group was 26.9 pg, statistically different from the normal group, MCHr 30.9 pg (P ROC analysis (gold standard Ferritin Area under curve AUC 0.851 (95% CI 0.770–0.912) at cut off 30.0 pg, with sensitivity 84.1% and specificity 71.1%. Kappa 0.667 (95% CI 0.527–0.858). Conclusion Due to their short lifespan Reticulocytes and derived parameters reflect current erythropoiesis status, before Hb and erythrocyte indices drop. MCHr had the best AUC and diagnostic value compared to erythrocyte indices. MCHr is a reliable test for the investigation of ID and could improve the detection of iron deficient adults.
Yasuji Miyata - One of the best experts on this subject based on the ideXlab platform.
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Reticulocyte Hemoglobin Content in hemodialysis patients with acute infection
Clinical and Experimental Nephrology, 2004Co-Authors: Koji Mitsuiki, Atsumi Harada, Yasuji MiyataAbstract:Background Reticulocyte Hemoglobin Content (CHr) has recently become available as a direct marker of the iron status in hemodialysis patients undergoing recombinant human erythropoietin (rHuEPO) therapy. This study evaluated the stability of CHr in hemodialysis patients with acute infectious disease.
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assessment of iron deficiency in chronic hemodialysis patients investigation of cutoff values for Reticulocyte Hemoglobin Content
Clinical and Experimental Nephrology, 2003Co-Authors: Koji Mitsuiki, Atsumi Harada, Yasuji MiyataAbstract:Background. Recently, the usefulness of Reticulocyte Hemoglobin Content (CHr) as a ferrokinetic marker in hemodialysis patients who receive recombinant human erythropoietin (rHuEPO) has been reported. However, a definite index for iron deficiency has not been established. In this study, a CHr cutoff value was investigated. Methods. We retrospectively selected 27 hemodialysis patients by the following criteria: (1) hematocrit (Ht) values less than 30%, (2) patients receiving a stable dose of rHuEPO for at least 3 months, (3) patients who had not received iron supplements for at least 3 months, and had begun receiving iron supplements, (4) the doses of rHuEPO and iron supplements were unchanged for 8 weeks following the start of iron administration. The iron supplement was administered at a dose of 40 mg/week, and Ht, CHr, transferrin saturation (TSAT), and serum ferritin were measured. The difference between the peak Ht value obtained at weeks 4–8 and Ht at baseline was calculated (ΔHt). Patients with a ΔHt of 3% or more were categorized as iron-deficient at baseline (group 1; n = 17). Patients with a ΔHt of less than 3% were categorized as iron-sufficient at baseline (group 2; n = 10). Each parameter was compared between the groups. Results. Significant negative correlations between ΔHt and CHr at baseline, and ΔHt and TSAT at baseline were observed. CHr and TSAT were significantly lower in group 1 than in group 2 at baseline. CHr was less than 32 pg in all patients in group 1, and greater than 32 pg in nine of the ten patients in group 2. If the CHr cutoff value was 32 pg, sensitivity was 100% and specificity was 90%. Conclusions. It is considered that 32 pg is appropriate for the CHr cutoff value.
Eloisa Urrechaga - One of the best experts on this subject based on the ideXlab platform.
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assessment of iron restricted erythropoiesis in chronic renal disease evaluation of abbott cell dyn sapphire mean Reticulocyte Hemoglobin Content mchr
Scandinavian Journal of Clinical & Laboratory Investigation, 2019Co-Authors: Eloisa Urrechaga, Johannes J M L HoffmannAbstract:We studied the performance of mean Reticulocyte Hemoglobin Content (MCHr), measured on Abbott CELL-DYN Sapphire analyzer for the detection of functional iron deficiency. Patients with anemia and wi...
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Reticulocyte Hemoglobin Content mchr in the assessment of iron deficient erythropoiesis in inflammatory bowel disease
Digestive and Liver Disease, 2018Co-Authors: Eloisa Urrechaga, Johannes J M L Hoffmann, Antonio Bernal, Juan Arevalo, Jose Luis CabriadaAbstract:Abstract Background In conditions associated with inflammation, biochemical parameters alone could be inadequate for assessing iron status. We investigated the potential utility of mean Reticulocyte Hemoglobin Content (MCHr) in the assessment of the erythropoiesis status in inflammatory bowel disease (IBD). Methods We recruited 124 anemic outpatients with IBD. Serum iron, transferrin and ferritin were tested. Complete blood counts were performed on a CELL-DYN Sapphire analyzer (Abbott Diagnostics). Differences among groups were assessed using analysis of variance, considering P Receiver operating characteristic analysis was used to assess the diagnostic performance of MCHr for detecting iron deficient erythropoiesis. The reference used as an indicator of insufficient iron availability was transferrin saturation Results Overall, 47.6% of the patients had iron deficiency anemia (IDA) and 31.5% anemia of chronic disease (ACD), while the others (20.9%) had mixed anemia. Patients with ACD or mixed anemia showed functional iron deficiency: normal or high ferritin and low MCHr. The area under curve was 0.858 (95% CI 0.742–0.942), considering a cut off 30.3 pg, the sensitivity was 82.2%, specificity 83.3%. Conclusions MCHr provides information on iron availability in IBD patients. It is a reliable test to assess iron supply for erythropoiesis.
Jose Luis Cabriada - One of the best experts on this subject based on the ideXlab platform.
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Reticulocyte Hemoglobin Content mchr in the assessment of iron deficient erythropoiesis in inflammatory bowel disease
Digestive and Liver Disease, 2018Co-Authors: Eloisa Urrechaga, Johannes J M L Hoffmann, Antonio Bernal, Juan Arevalo, Jose Luis CabriadaAbstract:Abstract Background In conditions associated with inflammation, biochemical parameters alone could be inadequate for assessing iron status. We investigated the potential utility of mean Reticulocyte Hemoglobin Content (MCHr) in the assessment of the erythropoiesis status in inflammatory bowel disease (IBD). Methods We recruited 124 anemic outpatients with IBD. Serum iron, transferrin and ferritin were tested. Complete blood counts were performed on a CELL-DYN Sapphire analyzer (Abbott Diagnostics). Differences among groups were assessed using analysis of variance, considering P Receiver operating characteristic analysis was used to assess the diagnostic performance of MCHr for detecting iron deficient erythropoiesis. The reference used as an indicator of insufficient iron availability was transferrin saturation Results Overall, 47.6% of the patients had iron deficiency anemia (IDA) and 31.5% anemia of chronic disease (ACD), while the others (20.9%) had mixed anemia. Patients with ACD or mixed anemia showed functional iron deficiency: normal or high ferritin and low MCHr. The area under curve was 0.858 (95% CI 0.742–0.942), considering a cut off 30.3 pg, the sensitivity was 82.2%, specificity 83.3%. Conclusions MCHr provides information on iron availability in IBD patients. It is a reliable test to assess iron supply for erythropoiesis.