Starring in the roles of a lifetime

Don’t settle for lesser imitations; insist on the anemia markers that were born to play this role.

Managing Renal Anemia

The early and accurate detection of both absolute and functional iron deficiency in hemodialysis patients is critical because it is the most common cause of suboptimal response to erythropoietin (EPO) therapy. Once iron deficiency is detected, it is easily corrected which improves response to erythropoietin therapy, thus maintaining higher hemoglobin levels at reduced cost.
The response to intravenous iron therapy, producing either an increased erythropoietic response at a constant dose of EPO or a reduction in EPO requirements, is the best criterion of iron-deficient erythropoiesis, and can be regarded as the gold standard.
Since traditional indices of iron status, including ferritin and transferrin saturation (TSat), are limited in predicting iron-deficient erythropoiesis during EPO therapy, the usefulness of additional parameters, especially those allowing direct estimates of bone marrow iron availability, have been extensively researched. The value of measuring the % hypochromic red cells and reticulocyte hemoglobin content is widely accepted and has been incorporated into the European Best Practice Guidelines.
Together, these two parameters are now recommended for the management of anemia in patients with chronic renal failure. Siemens offers the only hematology systems that incorporate both of these powerful markers into the routine hematology laboratory.

% Hypo

This parameter provides a three-month history of the red cell population as it relates to hemoglobin concentration. It can, therefore, be used to monitor the sustained status of erythropoietin activity, as well as the patient’s ability to capture and utilize iron effectively.

CHr™

This parameter provides a snapshot of iron status in red cells by looking at the hemoglobin content in reticulocytes. It can, therefore, provide an immediate indication of the patient’s response to EPO therapy.

Recent Abstracts:

I. The Role of Iron Status Markers in Predicting Response to Intravenous Iron in Hemodialysis Patients on Maintenance Erythropoietin
Nephrology Dialysis Transplantation (2001) 16:1416-1423 Tessitore et al.

This is the first study to simultaneously compare the diagnostic power of all the available laboratory markers of iron status by looking at 125 hemodialysis patients on EPO. Diagnosis of iron deficiency was based on hemoglobin response to i.v. iron over an 8-week period (See Table 1).

Conclusions:
Topping the list with an efficiency of 90.4%, sensitivity of 86.3%, and specificity of 93.2% was the combination of % hypochromasia and CHr parameters as measured by the ADVIA 120 Hematology System. The other markers trailed behind these two parameters significantly, with ferritin demonstrating an efficiency of only 64%.

II. Optimizing Erythropoietin Therapy in Hemodialysis Patients
American Journal of Kidney Disease (2001) Vol.#38, No.#1:109-117 Richardson et al.

This paper evaluates the use of a computer-aided algorithm to measure the effectiveness of increasing i.v. iron therapy with a subsequent reduction in the use of recombinant human erythropoietin. The algorithm relied upon specific data such as the % hypochromic red cells (HRC) and serum ferritin in order to maintain optimum hemoglobin levels (See Table 2). The European guidelines on management of renal patients suggest maintaining % HRC at less than 10% and serum ferritin above 100 ng/mL in order to maintain optimum quality of life.

Conclusions:

• Optimization and subsequent maintenance of Hb outcome allowed improvements in cost-effectiveness through manipulation of iron therapy.
• The % hypochromic red cells parameter is both sensitive and specific enough to predict accurately which patients will benefit from i.v. iron therapy.
• The EPO cost savings achievable using % hypochromasia were as high as 30% per patient.
• Changes in % hypochromic red cells may be seen up to two months after serum ferritin levels have stabilized. In this instance, the use of the reticulocyte hemoglobin content (CHr™) gives a rapid indication of altered iron status.