Reticulocyte hemoglobin in the evaluation of erythropoietic activity and iron availability

Abstract

The clinical laboratory plays a central role and impacts each of the Patient Blood Management (PBM) pillars: from detecting anemia and iron deficiency to reducing blood loss, an strategy to enable efficiency and thereby to improve patient care.

Perioperative iron deficiency and anemia are common in patients presenting for surgery, increase surgical risk, perioperative blood transfusions and can delay surgery date. Those conditions are independently associated with increased mortality and prolonged hospital stay after surgery. Rapid and effective diagnosis and treatment of iron deficiency is a key component of PBM Program.

Reticulocyte hemoglobin (Hb), a parameter for diagnosis and management of iron deficient erythropoiesis, can assist in early detection of iron deficiency, latent, absolute or functional and iron restricted erythropoiesis. The main concepts of Reticulocyte Hb are:

• Hematology parameter which reflects the Hb content of reticulocytes
• Is readily available from a routine EDTA blood sample analysis in the laboratory, without additional sampling.
• Provides an early assessment of the available iron that was utilized in erythropoiesis over the previous 2-4 days.
• -Reflects the bioavailability of iron for erythropoiesis, comparable to transferrin saturation, with the advantage that is not affected by the acute-phase reaction
• Is useful in the diagnosis of patients at risk for latent and/or functional iron deficiency.

Reticulocyte Hb allows obtaining a fast and accurate picture of the erythropoiesis status, guiding the clinicians in their selection of the best and most efficient therapy for every patient. Is also an early indicator of the response to iron therapy. Measuring Reticulocyte Hb as a routine preoperative parameter could thus be a valuable, quite inexpensive option for a strategic adoption of PBM, contributing to reducing costs and improve outcomes of the patients undergoing surgery.