Biomarkers of Hypochromia: The Contemporary Assessment of Iron Status and Erythropoiesis

Abstract

Iron status is the result of the balance between the rate of erythropoiesis and the amount of the iron stores. Direct consequence of an imbalance between the erythroid marrow iron requirements and the actual supply is a reduction of red cell hemoglobin content, which causes hypochromic mature red cells and reticulocytes. The diagnosis of iron deficiency is particularly challenging in patients with acute or chronic inflammatory conditions because most of the biochemical markers for iron metabolism (serum ferritin and transferrin ) are affected by acute phase reaction. For these reasons, interest has been generated in the use of erythrocyte and reticulocyte parameters, available on the modern hematology analyzers. Reported during blood analysis routinely performed on the instrument, these parameters can assist in early detection of clinical conditions (iron deficiency, absolute, or functional; ineffective erythropoiesis, including iron restricted or thalassemia), without additional cost. Technological progress has meant that in recent years modern analyzers report new parameters that provide further information from the traditional count. Nevertheless these new parameters are exclusive of each manufacturer, and they are patented. This is an update of these new laboratory test biomarkers of hypochromia reported by different manufactures, their meaning, and clinical utility on daily practice.

Optimización de la hemoglobina preoperatoria en cirugía ortopédica mayor utilizando hierro intravenoso con o sin eritropoyetina. Estudio epidemiológico

“…Rev Esp Anestesiol Reanim. 2015. http://dx.doi.org/10.1016/j.redar.2014.07.011 relacionados con la tipocromía, proporcionan información valiosa sobre el déficit funcional de hierro 37 sin coste adicional.…”

Primerjava eritrocitnih in retikulocitnih parametrov pri ugotavljanju pomanjkanja železa

“…V zahtevnejših primerih lahko izvedemo tudi biopsijo kostnega mozga (KM) in barvanje zalog železa v njem (6). Za potrditev pomanjkanja železa ob kroničnem vnetju smernice priporočajo uporabo eritrocitnih in retikulocitnih parametrov in določanje C-reaktivnega proteina (CRP) (4,7,8). Glede na velikost in obarvanost eritrocitov, ki ju določa-jo klasični eritrocitni parametri (PVE, PHE, PKHE), v klinični praksi ločimo hipokromno mikrocitno SDA in normokromno normocitno AKLB.…”

“…Taka delitev je tudi zaradi velikega vpliva predanalitičnih dejavnikov le delno uporabna, zato se danes v diagnostiki anemij priporoča uporaba novih eritrocitnih in retikulocitnih parametrov (9)(10)(11)(12). Ker pa gre za novejše parametre, katerih imena in načini določanja so lahko patentno zaščiteni, je njihovo določanje odvisno od vrste analizatorja (7,13). Pri diagnosticiranju pomanjkanja železa se najdlje uporabljata parametra koncentracija hemoglobina v retikulocitih (CHr) in delež hipokro-mnih eritrocitov s koncentracijo hemoglobina, nižjo od 280 g/L (%HYPO), ki sta na voljo na hematoloških analizatorjih proizvajalca Siemens.…”

Iron status and choice of iron therapy during pregnancy: advantages and disadvantages

“…erythropoietic stress with insufficient iron supply, synthesis of Hb molecules is severely impaired which leads to the production of erythrocytes with low Hb concentration (hypochromic red blood cells/HRBC). 13,36 New automated blood cell analysers can provide information about individual cell characteristics, including the quantity of HRBC and the percentage of HRBC of total red cells. These data are helpful in the diagnosis of IDA, β-thalassemia (β-thal) carriers, and anaemia of chronic disease (ACD).…”