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Reticulocyte Hemoglobin

Reticulocytes are immature red cells that circulate in peripheral blood for only 1 to 2 days. Measurement of reticulocyte hemoglobin content provides an indication of the amount of iron immediately available for incorporation into erythrocyte hemoglobin. The amount of hemoglobin in reticulocytes also corresponds to the amount that will be present in mature red cells. Lower than normal hemoglobin content is an indication of inadequate iron supply relative to demand.

Hematology analyzers report reticulocyte hemoglobin as either CHr or Ret-Hb. This parameter is particularly important in assessing the iron status of patients receiving recombinant human erythropoietin (r-HuEPO), in whom the cellular requirements for iron are increased. Functional iron deficiency can hamper the effectiveness of r-HuEPO therapy.

The Kidney Disease Outcomes Quality Initiative (KDOQI) has included reticulocyte hemoglobin measurement in its guidelines for assessing the initial iron status of patients with chronic kidney disease on hemodialysis, as well as for monitoring IV iron and r-HuEPO replacement therapy. Studies have shown that reticulocyte hemoglobin <30 pg more accurately predicts functional iron deficiency than the combined use of ferritin <100 ng/mL and transferrin saturation <20%, particularly in patients on chronic hemodialysis who are receiving erythropoietin.

Reticulocyte hemoglobin is reported with the reticulocyte count. Reference range is 30 to 38 pg. A value below 30 pg indicates iron deficient erythropoiesis. 

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