Reticulocyte indices in patients with end stage renal disease on hemodialysis

The diagnosis of iron deficiency anaemia in haemodialysis patients is difficult. Two states of deficiency occur, storage (absolute) and functional iron deficiency. Conventional measures, lack precision in assessing both storage and functional iron deficiency. This study investigated the accuracy of reticulocyte indices in comparison to the conventional haematological measures in the identification of haemodialysis patients with iron deficiency. A cross-sectional study of 72 haemodialysis patients was performed. Mean haemoglobin was 9.6 +/- 0.16 g/dl. Mean haemoglobin content of reticulocytes (CHr) was normally distributed and correlated with MCV, MCH and red cell ferritin. Mean haemoglobin concentration of reticulocytes (CHCMr) correlated with MCH. CHr and CHCMr had positive predictive values of 0.61 and 0.54 respectively. A low CHr or CHCMr identified 5 and 4 and 17 and 21 further patients with iron deficiency with normal serum ferritin or transferrin saturation respectively. Reticulocyte measures provide a direct measure of adequacy of haemoglobin synthesis in haemodialysis patients. In this study their usefulness was somewhat limited, but requires further investigation.