AJ Journal of Medical Sciences

Abstract

Background: In patients with chronic kidney disease, normochromic normocytic anemia mainly develops due to decreased renal synthesis of erythropoietin. Patients with chronic renal failure show abnormal hematological parameters, lower indices and the degree of changes depends on the severity of chronic renal failure. Methods: New generation cell counters provide reticulocyte count, more accurately by fluorescent method. This also provides reticulocyte parameters such as absolute reticulocyte count (RET), reticulocyte hemoglobin content (RET-He), and reticulocyte parameters like, immature reticulocyte fraction (IFR), low fluorescence reticulocytes (LFR), medium fluorescence reticulocyte (MFR), and high fluorescence reticulocyte (HFR). These parameters provide insight into functional anemia and response to therapy. Results: Most cases in this study had normal reticulocyte hemoglobin, in spite of anemia suggesting a functioning marrow in end stage renal disease. Four cases had a low reticulocyte count at 0.3% to 0.5%, out of which only two cases had low RET-He too. Low RET-He levels thus suggests an early parameter to know a declining marrow response likely due to iron deficiency. Hence these cases can be evaluated for iron studies to confirm the associated functional iron deficiency. Conclusion: Our study emphasizes on the value of evaluation of RET-He levels even in cases of mild anemia in renal failure patients thus aiding in diagnosis of iron deficiency and therapy.