The percent of hypochromic erythrocytes and the reticulocyte hemoglobin content may provide insights into the iron status of a patient.
The percent of hypochromic erythrocytes is normally less than 2.5%. An increase to greater than 10% is seen in iron deficiency anemia. The window of change is 90 days since this is how long erythrocytes usually circulate (less with a hemolytic anemia).
A low reticulocyte hemoglobin (< 28 pg per erythrocyte) in a patient with iron deficiency has a window of 2 to 3 days.
Percent Hypochromic
Reticulocyte Hemoglobin
Interpretation for a Patient with Iron Deficiency
increased
low
typical iron deficiency
increased
normal
recent treatment of iron deficiency
normal
low
early in the evolution of iron deficiency
normal
normal
iron replete; can occur with borderline iron stores
Recent blood transfusion can sometimes mask these parameters if they are borderline or if multiple units are given. The transfusion of one or two units may not mask true iron deficiency; it could result in a bimodal red cell volume distribution.
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