Clinical utility of the new parameter, reticulocyte hemoglobin equivalent (RET-He), in the diagnosis of iron-deficiency in dialysis patients

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  • Miwa Naoko
    Department of Blood Purification, Kidney Center, Tokyo Women's Medical University
  • Tsuchiya Ken
    Department of MedicineIV, Kidney Center,Tokyo Women's Medical University
  • Kimata Naoki
    Department of Blood Purification, Kidney Center, Tokyo Women's Medical University
  • Hamaguchi Yukio
    Sysmex Corporation, Reagent Development Div.
  • Nitta Kosaku
    Department of MedicineIV, Kidney Center,Tokyo Women's Medical University
  • Akiba Takashi
    Department of Blood Purification, Kidney Center, Tokyo Women's Medical University

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Other Title
  • 透析患者におけるｒｅｔｉｃｕｌｏｃｙｔｅ　ｈｅｍｏｇｌｏｂｉｎ　ｅｑｕｉｖａｌｅｎｔ（ＲＥＴ‐Ｈｅ）測定の臨床的有用性
  • 透析患者におけるreticulocyte hemoglobin equivalent(RET-He)測定の臨床的有用性
  • トウセキ カンジャ ニ オケル reticulocyte hemoglobin equivalent RET He ソクテイ ノ リンショウテキ ユウヨウセイ

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Abstract

The evaluation of iron status in dialysis patients provides information essential to the planning of adequate rHuEPO treatment. Iron status of the patients can be determined from the recently available measurement of reticulocyte hemoglobin equivalent (RET-He). RET-He is measured by automated fluorescent flow cytometry using a polymethine dye, which in the reticulocyte channel, also measures the mean value of the forward light scatter histogram of mature red blood cells and reticulocytes. These values equate with reticulocyte hemoglobin concentration. In this study, to clarify the accuracy of RET-He in diagnosing iron deficiency in dialysis patients, we initially compared RET-He with such iron parameters as serum ferritin levels, transferrin saturation, and concentration of reticulocyte hemoglobin (CHr) which have been established as indicators of functional iron deficiency. Secondly, we investigated the changes in RET-He during iron supplementation for iron-deficient patients to determine whether this marker is a prospective and reliable indicator of iron sufficiency. The participants in this study were 217 HD patients. Iron deficiency was defined as a TSAT of less than 20% or serum ferritin of less than 100ng/mL. Conventional parameters of red blood cells and RET-He were measured using a Sysmex XE-2100 automated blood cell counter. CHr was measured by an ADVIA120 autoanalyzer. RET-He showed a mean value of 32.4pg and good correlation (r=0.873) between RET-He and CHr was obtained in dialysis patients. ROC curve analysis demonstrated a value of 0.765 and the cutoff value was 33.1pg. Iron supplements given to the patients with low TSAT or ferritin, RET-He responded within 2 weeks. RET-He is a new parameter, equivalent value to CHr, and is easily measurable using widely available and commonly used blood cell counters, and is a sensitive and specific marker of iron status in dialysis patients.

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