Reticulocyte Hemoglobin Content

 

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	Interpretation	Recommended Action
> 27 picograms per cell	normal iron stores	erythropoietin may help if anemic
26 - 27 picograms per cell	borderline	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

 

where:

• pico = 10^(-12)

 

Interpretation:

• 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.