The Role of Reticulocyte Hemoglobin Content in the Management of Iron Deficiency Anemia in Patients on Hemodialysis

Abstract

Background: The objectives of this study were to correlate reticulocyte Hemoglobin Content (CHr) with Hemoglobin (Hb), ferritin, and Transferrin Saturation (TSAT) in Patients on Hemodialysis (HD) and to determine the Hb response with intravenous iron supplementation in anemic HD patients with adequate ferritin and TSAT yet low CHr. Methods: This was a prospective, randomized controlled trial involving patients on HD. Patients with baseline results that fulfilled the randomization criteria (CHr < 29 pg, Hb < 9.5 g/dL, ferritin > 400 ng/mL and/or TSAT > 20%) were then randomized to group A and B. Group A patients received a total of 1 g of intravenous iron and group B served as the control. Results: One hundred and twenty - one patients were enrolled in this study. There was a significant correlation between CHr and TSAT, ferritin, and Hb. A total of 12 patients were randomized to group A and B. There was a significant increase in Hb level observed in group A with median change from baseline of 1g/dL (IQR: - 0.5 to 2.8) at the end of the trial compared to the control group. Conclusions: There was a significant correlation between CHr, Hb, ferritin, and TSAT. Intravenous iron supplement improved Hb level in patients on HD with adequate serum ferritin and/or TSAT levels yet low CHr.