Letter to the Editor
Reticulocyte hemoglobin content and iron therapy in CKD
Concentración de hemoglobina reticulocitaria y ferroterapia en la ERC
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"lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699521001053?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251423000354?idApp=UINPBA000064" "url" => "/20132514/0000004200000006/v1_202303262115/S2013251423000354/v1_202303262115/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Reticulocyte hemoglobin content and iron therapy in CKD" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "736" "paginaFinal" => "737" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Javier Deira, Cristina García de la Vega, Elena Davín, María José Arcos" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Javier" "apellidos" => "Deira" "email" => array:1 [ 0 => "javierlorenzo.deira@salud-juntaex.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Cristina" "apellidos" => "García de la Vega" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Elena" "apellidos" => "Davín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "María José" "apellidos" => "Arcos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital San Pedro de Alcántara, Cáceres, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Hematología, Hospital San Pedro de Alcántara, Cáceres, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Concentración de hemoglobina reticulocitaria y ferroterapia en la ERC" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the review entitled, "<span class="elsevierStyleItalic">Iron therapy in the management of anaemia in non-dialysis chronic kidney disease: the perspective of the S.E.N. [Sociedad Española de Nefrología (Spanish Society of Nephrology)] anaemia group"</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. In this manuscript, the authors provide an update on the management of iron deficiency in patients with chronic kidney disease (CKD).</p><p id="par0010" class="elsevierStylePara elsevierViewall">It is clearly shown that the diagnosis and treatment of absolute iron deficiency is simple and that there is a broad consensus on that matter<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a>. The same does not apply to functional iron deficiency. In such clinical situation, caused in most cases by inflammation, there is an increase in hepcidin synthesis (due to IL-6) in the liver<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>. Hepcidin blocks ferroportin, the only cell channel that exists for exporting cellular iron into the bloodstream, thereby reducing suitable availability of iron in the bone marrow. This leads to deficient haemoglobin synthesis in the reticulocytes<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>. Unlike mean corpuscular haemoglobin, whose value diminishes after several weeks, bone marrow iron deficiency may be estimated in a few days based on reticulocyte haemoglobin content (CHr)<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>. Therefore, all the guidelines recommend the percentage of hypochromic red blood cells or CHr as the best laboratory parameters for the diagnosis of functional iron deficiency (1B)<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Inexplicably, the authors<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> state that we must continue to use the classic markers (serum ferritin and transferrin saturation - TSAT), suggesting that the <span class="elsevierStyleItalic">new markers are less accessible, more expensive and somewhat unreliable</span>. We cannot convey this concept, since following the widespread introduction of automated cell counters, most laboratories can now measure number, volume and CHr and thus detect iron deficiency at an early stage<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>. Moreover, not only are red blood cell markers not expensive, they are also the most rewarding option in comparison to the different tests that assess FID and response to treatment in patients with CKD on haemodialysis or not<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>. Finally, these markers are very reliable. Mast et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> demonstrated, in patients undergoing a bone marrow examination for other reasons, that their predictive value for iron deficiency is higher than the classic parameters (serum ferritin or TSAT). We have also seen the excellent correlation between CHr and the classic markers<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>, which is why we believe that at this point in time they are accessible, cost-effective and very reliable and that their use should be recommended in accordance with the guidelines<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a>.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-04-07" "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Iron replacement therapy in the management of anaemia in non-dialysis chronic renal failure patients: Perspective of the Spanish Nephrology Society Anaemia Group" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 7 | 15 |
| 2024 October | 57 | 36 | 93 |
| 2024 September | 58 | 32 | 90 |
| 2024 August | 71 | 65 | 136 |
| 2024 July | 51 | 30 | 81 |
| 2024 June | 46 | 40 | 86 |
| 2024 May | 52 | 30 | 82 |
| 2024 April | 55 | 47 | 102 |
| 2024 March | 44 | 31 | 75 |
| 2024 February | 50 | 45 | 95 |
| 2024 January | 36 | 14 | 50 |
| 2023 December | 28 | 24 | 52 |
| 2023 November | 42 | 37 | 79 |
| 2023 October | 43 | 63 | 106 |
| 2023 September | 52 | 51 | 103 |
| 2023 August | 40 | 34 | 74 |
| 2023 July | 44 | 39 | 83 |
| 2023 June | 54 | 48 | 102 |
| 2023 May | 68 | 46 | 114 |
| 2023 April | 57 | 57 | 114 |
| 2023 March | 58 | 71 | 129 |
| 2023 February | 1 | 0 | 1 |
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