The hemoglobin content in reticulocytes (equivalent to the MCH in red cells) serves as an indicator of iron deficiency. The measurement of reticulocyte hemoglobin content is particularly useful in chronic renal dialysis patients who are anemic, as this can help decide whether to administer iron and/or erythropoietin. It is also useful in monitoring response to iron therapy.


Types of iron deficiency seen in hemodialysis patients treated with erythropoietin:

(1) relative: iron stores adequate but the response to erythropoietin is faster than the ability of the body to mobilize iron from the iron stores

(2) absolute: iron stores are depleted

Reticulocyte Hemoglobin Content


Recommended Action

> 27 picograms per cell

normal iron stores

erythropoietin may help if anemic

26 - 27 picograms per cell


continue to monitor

< 26 picograms per cell

iron deficient

treat with iron; repeat reticulocyte hemoglobin content in 2 days

less than mature red cell hemoglobin content

acute onset of iron deficiency

treat with iron



• pico = 10^(-12)



• A patient who responds to iron therapy will show an increase in the reticulocyte hemoglobin content and absolute reticulocyte count by 4-7 days after therapy is started. During this time the other red cell indices will be unchanged, and it may take a month for the hemoglobin of whole blood to increase.

• If the reticulocyte hemoglobin content and absolute reticulocyte count do not increase after 2 weeks of oral iron replacement therapy, then the patient is not responding and iron dextran is administered intravenously. A rise after intravenous iron begins after 2 days (48 hours) and peaks at 4 days.


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