scholarly journals Effect of oral vitamin C on serum hepcidin level, iron status and inflammation among hemodialysis patients with functional iron deficiency anaemia

2021 ◽  
Vol 7 (1) ◽  
pp. e16-e16
Author(s):  
Maha A. Behairy ◽  
Ahmed Gharib ◽  
Mahmoud Zaki ◽  
Reem El Sharabasy
Keyword(s):  
Iron Deficiency ◽  
Vitamin C ◽  
Iron Status ◽  
Hemoglobin Level ◽  
Control Group ◽  
Oral Vitamin ◽  
Functional Iron Deficiency ◽  
Serum Hepcidin ◽  
Hs Crp ◽  
Erythropoietin Stimulating Agents

Introduction: Hepcidin is a key regulatory peptide in iron homeostasis, the pathogenesis of functional iron deficiency (FID) anemia and erythropoiesis-stimulating agent (ESA) resistance is contributed to the inflammatory mediated increase in the serum hepcidin levels among prevalent hemodialysis (HD) patients. Objectives: To test the reducing therapeutic effect of oral vitamin C supplements on hepcidin levels and iron status among HD patients with FID anemia. Patients and Methods: This study is an interventional prospective cohort study; 48 prevalent HD patients were enrolled. Group one: 31 patients who received the conventional treatment of erythropoietin stimulating agents together with oral supplementation of vitamin C 500 mg every other day dose for 3 months. Group two: 17 patients who received only the conventional therapy of erythropoietin stimulating agents. Patients with hemoglobin level <11 g/dL, ferritin level >200 ng/mL and transferrin saturation (TSAT) >20 % were included. Laboratory parameters: serum hepcidin, high-sensitivity C-reactive protein (hs-CRP) titre, CBC, and iron indices were measured at baseline and after 3 months. Results: On comparing the two groups, oral vitamin C in group 1 resulted in a statistically significant reduction in hepcidin levels [mean 2506.456 ± 1320.53 pg/mL to 1748.396 ± 1432.28 pg/mL (P = 0.03)], and a significant reduction in hs-CRP level [mean 8603.236 ± 2547.77 ng/mL to 5611.296 ± 2829.27 ng/mL] (P = 0.001) after three months of treatment in comparison to control group. A decrease of EPO requirement and elevation of hemoglobin level were observed in a study group with oral vitamin C. Conclusion: Oral vitamin C may be a promising therapy in decreasing serum hepcidin and inflammatory markers among prevalent HD patients with FID anemia.

Effects of Oral Vitamin C on Hepcidin Levels and Erythropoietin Requirements in Functional Iron Deficiency Anemia among Hemodialysis Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mahmoud Mohamed Zaki Ali ◽  
Maha Abd ElMoniem Behairy ◽  
Reem Mohsen El Sharabasy ◽  
Ahmed Hamed Ahmed Gharib
Keyword(s):  
Iron Deficiency ◽  
Vitamin C ◽  
Iron Deficiency Anemia ◽  
Hemodialysis Patients ◽  
Deficiency Anemia ◽  
Study Group ◽  
Oral Vitamin ◽  
Functional Iron Deficiency ◽  
Serum Hepcidin ◽  
Hs Crp

Abstract Background Hepcidin has long been postulated as a key regulatory peptide in iron homeostasis. Its reduced clearance and elevated levels in hemodialysis (HD) patients lead to functional iron deficiency (FID) and ESA resistance. Vitamin C may be used as adjuvant therapy in FID anemia, but there are limited studies investigating the direct relation between vitamin C and hepcidin levels in HD patients. We aimed to test the reducing effect of Oral vitamin C therapy on hepcidin levels among hemodialysis patients with functional iron deficiency anemia. Patients and Methods This study is an open label randomized controlled clinical trial. It was conducted in the hemodialysis units of Ain Shams University hospitals. 48 adult prevalent HD patients were included and were divided into two groups. Group 1 (study group) included 31 patients who received the conventional treatment of erythropoietin stimulating agents (ESAs) together with oral supplementation of vitamin C 500 mg every other day for 3 months in addition to IV iron therapy. Group 2 (control group) included 17 patients who received only the conventional therapy of ESAs according to their hemoglobin (Hb) levels in addition to IV iron therapy. Laboratory parameters including serum hepcidin levels, highly sensitive CRP (hs-CRP) titer, CBC, kidney function tests and iron indices were measured at the baseline of the study and after 3 months. Results Oral vitamin C therapy resulted in a statistically significant reduction in both hepcidin and hs-CRP levels in the study group after 3 months. The study group showed a significant reduction in serum iron and ferritin levels (P &lt; 0.05). A Decrease in EPO requirements and elevation of hemoglobin level were observed in the study group but were not statistically significant as a short term effect of oral vitamin C, in comparison to the control group. A highly significant correlation was observed between serum hepcidin and hs-CRP (R=0.46, P&lt;0.01). Conclusion Oral vitamin C may be a promising therapy in decreasing serum hepcidin and hs-CRP levels in prevalent hemodialysis patients with functional iron deficiency anemia.

P1375ORAL VITAMIN C EFFECT ON HEPCIDIN LEVEL IN HAEMODIALYSIS PATIENTS WITH FUNCTIONAL IRON DEFICIENCY ANAEMIA

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Maha Abdelmoneim Behairy Said ◽  
Reem Elsharabasy ◽  
Ahmed Gharib ◽  
Mahmoud Zaki
Keyword(s):  
Iron Deficiency ◽  
Vitamin C ◽  
Deficiency Anemia ◽  
Control Group ◽  
Study Group ◽  
Oral Vitamin ◽  
Functional Iron Deficiency ◽  
Hepcidin Level ◽  
Serum Hepcidin ◽  
The Mean

Abstract Background and Aims Hepcidin is a key regulatory peptide in iron homeostasis, inhibiting iron absorption by binding to ferroportin. Inflammatory mediated increase in hepcidin levels and reduced clearance in hemodialysis (HD) patients lead to functional iron deficiency ( FID) and Erythropoiesis-stimulating agent (ESA) resistance. Ascorbic acid (Vitamin C) may be used as adjuvant therapy in FID anemia through its anti-inflammatory and anti-oxidant nature, but there was limited studies investigating the direct relation between vitamin C and hepcidin level in HD patients. We Aimed to test the reducing therapeutic effect of oral vitamin C supplement on hepcidin level among hemodialysis patients with functional iron deficiency anaemia. Method This study is an open label randomized controlled clinical trial that was conducted in hemodialysis units of Ain Shams University hospitals, 48 prevalent HD patients with mean age of 46.48 ± 15.57 years were included ,Group 1 (study group) :31 patients [13(41.9%) males & 18(58.1%) females] who received the conventional treatment of erythropoietin stimulating agents together with oral supplementation of vitamin C 500 mg every other day dose for 3 months. Group 2 (control group): included 17 patients [8(47.1%) males and 9 (52.9%) females] who received only the conventional therapy of erythropoietin stimulating agents according to their Hb levels. The patients enrolled in the study were patients on regular conventional HD for more than 6 months with functional iron deficiency anemia, defined as: hemoglobin level &lt;11 gm/dl, ferritin level &gt;200 ng/ml and TSAT &gt;20 %. Patients with history of non-renal causes of anemia including malignancy, end-stage liver disease, or chronic hypoxia, patients with evidence of active or occult bleeding, patients who received blood transfusion within the last 4 months, history of recent hospitalization or infection requiring antibiotics within the last 4 weeks and patients with evidenced iron deficiency anemia were all excluded from the study .Laboratory parameters including serum hepcidin level, highly sensitive CRP (hsCRP) titer, CBC, kidney function tests and iron indices were measured at baseline and after 3 months . Results Oral vitamin C supplementation in Group 1(study group) resulted in statistically significant reduction in Hepcidin levels in the study group [mean 2506.45± 1320.53 pg/ml to 1748.39 ±1432.28 pg/ml ](P=0.03), and highly significant reduction in hsCRP level [mean 8603.23 ±2547.77 ng/ml to 5611.29 ±2829.27 ng/ml](P=0.001) after 3months of treatment. On comparing the two groups regarding changes in Hepcidin levels during follow up, illustrates that vitamin C together with time resulted in significant reduction of hepcidin levels in the study group (P&lt;0.05) by repeated measure ANOVA test (Figure 1). Comparison between the two groups regarding change in hsCRP levels during follow up showed there was a highly significant change in the mean hsCRP over time, and the mean hsCRP differed significantly between the two groups (Figure 2). A significant reduction in serum iron and ferritin levels was observed in study group after treatment vitamin C but the change of the mean of S. ferritin level didn’t differ significantly in comparison to control group . Decreased EPO requirements and elevation of hemoglobin level were observed in the study group but without a statistical significance compared to the control group, this might be attributed to the short period of vit C supplementation. There was a highly significant correlation between serum hepcidin and hsCRP (r=0.46, P&lt;0.01) . Conclusion : Oral Vitamin C may be promising therapy in decreasing serum hepcidin and hsCRP in prevalent hemodialysis patients with functional iron deficiency anemia.

scholarly journals The Association between Hepcidin and Iron Status in Children and Adolescents with Obesity

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Ekkarit Panichsillaphakit ◽  
Orapa Suteerojntrakool ◽  
Chitsanu Pancharoen ◽  
Issarang Nuchprayoon ◽  
Sirinuch Chomtho
Keyword(s):  
Iron Deficiency ◽  
Iron Homeostasis ◽  
Complete Blood Count ◽  
Iron Status ◽  
Standard Deviation Score ◽  
Transferrin Saturation ◽  
Obese Group ◽  
Control Group ◽  
Low Grade ◽  
Serum Hepcidin

Introduction. Iron deficiency (ID) is the most common nutritional deficiency found in pediatric practice. A higher prevalence of ID may be found in children with obesity. Obesity is a chronic low-grade inflammatory condition. It is postulated that inflammation increases hepcidin, a regulator of iron homeostasis. The aim of this study was to investigate the associations between iron status, hepcidin, and BMI-standard deviation score (BMI-SDS) in children with and without obesity. Methods. A cross-sectional study of Thai children with obesity (5 to 15 years old) versus age- and sex-matched, nonobese controls was conducted. A total of 63 children with obesity and 27 controls were enrolled. Complete blood count, serum iron, ferritin, transferrin saturation, and total iron binding capacity were analyzed. Serum hepcidin-25 was assayed using a hepcidin ELISA Kit (Human Hepc25). Results. There were 63 children with obesity, the median age (IQR) being 10 (9–13) years, and 27 controls. The median (IQR) BMI-SDS of the obese group was 2.3 (2.0–2.6) vs. −0.5 ((−1.3)−0.4) of the control group. ID was diagnosed in 27 children in the obese group (42.9%); 4 of the children with obesity and ID had anemia. Serum hepcidin-25 levels of the children with ID vs. without ID in the obese group were not significantly different (median (IQR) 25 (12.9–49.2) and 26.4 (12.6–43.6), respectively) but both of them were significantly higher than controls (19.7 (8.3–25.5) ng/ml, p  = 0.04). BMI-SDS was positively correlated with hepcidin-25 (r = 0.28, p  = 0.001). Conclusion. Prevalence of iron deficiency in Thai children with obesity and serum hepcidin-25 was higher than controls. Further study in a larger population, preferably with interventions such as weight loss program, is warranted to clarify this association.

scholarly journals Recent Versus Conventional Iron Status Parameters for Diagnosis of Anemia in Juvenile Idiopathic Arthritis Patients

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3360-3360
Author(s):  
Hoda MA Hassab ◽  
Wafaa A El-Neanaey ◽  
Ghada M F El-Deriny ◽  
Eman El-Mahy
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Iron Status ◽  
Deficiency Anemia ◽  
Control Group ◽  
P Value ◽  
Different Types ◽  
Serum Hepcidin ◽  
Sensitivity Specificity

Abstract Objective: Juvenile Idiopathic Arthritis (JIA) is commonly associated with different types of anemia. The diagnosis and treatment of IDA is a medical necessity; being a well-recognized cause of both short and long term morbidity plus being strongly related to poor disease outcome. In the presence of concomitant chronic illness or inflammation, the diagnosis of iron deficiency using the conventional laboratory parameters is a major medical challenge. Therefore, the utility of two recent iron status parameters; hepcidin-25 "active form of iron metabolism negative regulator" and reticulocyte hemoglobin content (CHr) "functional anemia indicator" was compared to that of two conventional ones; transferrin saturation (TSAT) and red cell distribution width percentages (RDW%) in diagnosing iron deficiency anemia in patients with JIA. Methods: Blood samples were obtained from 43 JIA patients whose ages ranged from 3 to 16 years and 20 age and sex matched healthy children as control group. Three different types of anemia; iron deficiency anemia (IDA), anemia of chronic disease (ACD) and combined anemia (IDA/ACD) were identified within the studied patients using iron profile, ESR and C-reactive protein. Serum hepcidin-25 was assessed by ELISA technique; CHr, TSAT% and RDW% were all estimated using Siemens ADVIA 2120 analyzer in patients and the control group. Results: Anemia was identified in 22 (51.2%) patients. Serum hepcidin-25 and TSAT% were significantly lower in IDA than ACD & IDA/ACD patients (p= 0.032 and p=0.034 for hepcidin and p= 0.004 and p=0.012 for TSAT%). Significantly lower CHr and higher RDW% were found in IDA/ACD compared to ACD patients (p= 0.032 and p< 0.001, respectively). Serum hepcidin ≤ 3.8ng/mL and TSAT% ≤ 5.8% differentiated IDA from both ACD and IDA/ACD with 80 and 100% sensitivity and 88.24% specificity. CHr ≤24.4pg and RDW % > 16.4% showed 80 and 90% sensitivity and 100% specificity; distinguishing IDA/ACD from ACD. Conclusion: Serum hepcidin and CHr were not superior to TSAT% and RDW%; discriminating among different types of anemia in JIA patients. Table 1. Comparison between anemia subgroups according to CHr and serum hepcidin IDA(n=5) ACD(n=6) Combined anemia(n=7) Control(n=20) p CHr (pg) 23.61 ± 3.80a 27.36 ± 2.30b 23.37 ± 3.18a 30.54 ± 1.99 <0.001* Serum hepcidin (ng/ml) 3.60 (3.0-4.9)bc 5.10 (3.10 - 90.0) 7.15 (3.1-60.0) 5.0 (0.10-10.8) 0.121 Data was expressed as Mean ± SD. for normally distributed data and Median (Min. - Max.) for abnormaly distrbutied data a: Significant with control gorup b: Significant with combined anemia group c: Significant with ACD group Table 2. Comparison among anemia subgroups and control group according to RDW & TSAT% IDA(n=5) ACD(n=7) Combined anemia(n=10) Control(n=20) Test of sig. p RDW% Min. - Max. 17.30 - 19.90 13.10 - 16.40 15.60 - 22.0 12.40 - 15.80 F=45.032* <0.001* Mean ± SD. 18.42 ± 1.04 14.49 ± 1.30 18.46 ± 1.92 13.47 ± 0.86 Median 2.62 13.90 18.20 13.10 Sch p* p1<0.001* ,p2=0.362,p3<0.001* ,p4=1.000,p5<0.001* ,p6<0.001* TSAT % Min. - Max. 4.20 - 5.80 6.0 - 20.50 4.40 - 26.0 11.0 - 40.0 KW χ2 =* <0.001* Mean ± SD. 4.78 ± 0.64 10.73 ±4.82 13.82 ± 8.63 22.71 ± 8.32 Median 4.50 10.0 12.80 20.70 MW p1 0.001* 0.001* 0.016* MW p2 0.012* 0.660 MW p3 0.004* KW c2 : Chi square for Kruskal Wallis test F: F test (ANOVA) p1: p value for comparing between control and IDA p2: p value for comparing between control and ACD p3: p value for comparing between control and combined anemia p4: p value for comparing between combined anemia and IDA p5: p value for comparing between combined anemia and ACD p6: p value for comparing between ACD group and IDA group MW: Mann Whitney test Sch: Post Hoc Test (Scheffe) *: Statistically significant at p ≤ 0.05 Table 3. Agreement (sensitivity, specificity and accuracy) for serum hepcidin and TSAT% with IDA vs. ACD and combined anemia in JIA patients ACD and combined anemia IDA Sensitivity Specificity PPV NPV Accuracy Serum hepcidin (ng/ml) >3.8 15 1 80.0 88.24 66.67 93.75 86.36 <3.8 2 4 TSAT% >5.8 15 0 100.0 88.24 71.43 100.0 90.91 ≤5.8 2 5 Table 4. Agreement (sensitivity, specificity and accuracy) for CHr and RDW% with ACD vs. combined anemia in JIA patients ACD Combined anemia Sensitivity Specificity PPV NPV Accuracy CHr >24.4 7 2 80 100.0 100.0 77.78 88.24 ≤24.4 0 8 RDW % ≤16.4 7 1 90.0 100.0 100.0 87.50 94.12 >16.4 0 9 Disclosures No relevant conflicts of interest to declare.

Perbandingan Efek Suplementasi Tablet Tambah Darah Dengan Dan Tanpa Vitamin C Terhadap Kadar Hemoglobin Pada Ibu Hamil Dengan Usiakehamilan 16-32 Minggu Di Desa Keniten Kecamatan Mojo Kabupaten Kediri

2017 ◽  
Vol 3 (1) ◽  
pp. 76
Author(s):  
Siti Asiyah ◽  
Dwi Estuning Rahayu ◽  
Wiranti Dwi Novita Isnaeni
Keyword(s):  
Treatment Group ◽  
Vitamin C ◽  
Gestational Age ◽  
Group Treatment ◽  
Sampling Technique ◽  
Hemoglobin Level ◽  
The Body ◽  
Control Group ◽  
Fetal Organ ◽  
And Control

The needed of Iron Tablet in pregnancy was increase than mother who not pregnant.  That  cause of  high metabolism at the pregnancy for formed of  fetal organ and energy. One of effort for prevent anemia in mother pregnant with giving the Iron tablet and vitamin c. The reason of  this research in 4 June – 11 July 2014 is for compare the effect of  iron tablet suplementation with and without vitamin C toward Hemoglobin level in mother pregnant With Gestational Age Of 16-32 Weeks In Desa Keniten Kecamatan Mojo Kabupaten Kediri. This research method using comparative analytical.  Research design type of Quasy Eksperiment that have treatment group and control group. Treatment group will giving by Iron tablet and 100 mg vitamin C, and control group just giving by iron tablet during 21 days. Population in this research are all of mother pregnant with Gestational Age Of 16-32 Weeks with Sampling technique is  cluster random sampling is 29 mother pregnant. Comparison analysis of  iron tablet suplementation effect with and without vitamin C toward Hemoglobin level in mother pregnant With Gestational Age Of 16-32 Weeks, data analysis using Mann Whitney U-test and the calculated U value (44,5) less than U-table (51). So there was difference of iron tablet suplementation effect with and without vitamin C toward Hemoglobin level in mother pregnant With Gestational Age Of 16-32 Weeks Therefore, the addition of vitamin C on iron intake is needed to increase the uptake of iron tablets. When the amount of iron uptake increases, the reserves of iron in the body will also increase, so as to prevent anemia in pregnant women; Keywords : Iron Tablet (Fe), Vitamin C, Hemoglobin level, Mother Pregnant

scholarly journals Consumption of a Double-Fortified Salt Affects Perceptual, Attentional, and Mnemonic Functioning in Women in a Randomized Controlled Trial in India

2017 ◽  
Vol 147 (12) ◽  
pp. 2297-2308 ◽  
Author(s):  
Michael J Wenger ◽  
Laura E Murray-Kolb ◽  
Julie EH Nevins ◽  
Sudha Venkatramanan ◽  
Gregory A Reinhart ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Iron Status ◽  
Controlled Trial ◽  
Reproductive Age ◽  
Deficiency Anemia ◽  
Control Group ◽  
Attention And Memory ◽  
Double Blind ◽  
Iron Deficient ◽  
Mnemonic Function

Abstract Background: Iron deficiency and iron deficiency anemia have been shown to have negative effects on aspects of perception, attention, and memory. Objective: The purpose of this investigation was to assess the extent to which increases in dietary iron consumption are related to improvements in behavioral measures of perceptual, attentional, and mnemonic function. Methods: Women were selected from a randomized, double-blind, controlled food-fortification trial involving ad libitum consumption of either a double-fortified salt (DFS) containing 47 mg potassium iodate/kg and 3.3 mg microencapsulated ferrous fumarate/g (1.1 mg elemental Fe/g) or a control iodized salt. Participants' blood iron status (primary outcomes) and cognitive functioning (secondary outcomes) were assessed at baseline and after 10 mo at endline. The study was performed on a tea plantation in the Darjeeling district of India. Participants (n = 126; 66% iron deficient and 49% anemic at baseline) were otherwise healthy women of reproductive age, 18–55 y. Results: Significant improvements were documented for iron status and for perceptual, attentional, and mnemonic function in the DFS group (percentage of variance accounted for: 16.5%) compared with the control group. In addition, the amount of change in perceptual and cognitive performance was significantly (P < 0.05) related to the amount of change in blood iron markers (mean percentage of variance accounted for: 16.0%) and baseline concentrations of blood iron markers (mean percentage of variance accounted for: 25.0%). Overall, there was evidence that the strongest effects of change in iron status were obtained for perceptual and low-level attentional function. Conclusion: DFS produced measurable and significant improvements in the perceptual, attentional, and mnemonic performance of Indian female tea pickers of reproductive age. This trial was registered at clinicaltrials.gov as NCT01032005.

Iron status of adolescent girls from two boarding schools in southern Benin

2008 ◽  
Vol 11 (7) ◽  
pp. 737-746 ◽  
Author(s):  
Halimatou Alaofè ◽  
John Zee ◽  
Romain Dossa ◽  
Huguette Turgeon O’Brien
Keyword(s):  
Iron Deficiency ◽  
Vitamin C ◽  
Adolescent Girls ◽  
Binding Capacity ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Meat Consumption ◽  
Boarding Schools ◽  
Important Health ◽  
Iron Binding Capacity

AbstractIron deficiency (ID) is the most prevalent micronutrient deficiency in the world, particularly in developing countries. Blood samples and a qualitative FFQ on Fe- and vitamin C-rich foods were obtained in 180 adolescent girls aged 12 to 17 years living in two boarding schools from south Benin. ID, defined as serum ferritin either <20μg/l or 20–50μg/l, plus two of the following parameters: serum Fe<11μmol/l, total iron-binding capacity>73μmol/l or transferrin saturation<20%, was found in 32% of subjects. Anaemia (Hb<120g/l) was found in 51% of adolescents, while 24% suffered from iron-deficiency anaemia (IDA) (ID and Hb<20g/l). After adjusting for confounding factors (age, mother's and father's occupation, household size) in a logistic regression equation, subjects having a low meat consumption (beef, mutton, pork) (<4 times/week) were more than twice as likely to suffer from ID (OR=2·43; 95% CI 1·72, 3·35;P=0·04). Adolescents consuming less fruits (<4 times/week) also had a higher likelihood of suffering from ID (OR=1·53; 95% CI 1·31, 2·80;P=0·03). Finally, subjects whose meat consumption was low were twice as likely to suffer from IDA (OR=2·24; 95% CI 1·01, 4·96;P=0·04). The prevalence of ID represents an important health problem in these Beninese adolescent girls. A higher consumption of Fe-rich foods and of promoters of Fe absorption (meat factor and vitamin C) is recommended to prevent ID deficiency in these subjects.

Reticulocyte hemoglobin measurement – comparison of two methods in the diagnosis of iron-restricted erythropoiesis

2005 ◽  
Vol 43 (11) ◽  
Author(s):  
Lothar Thomas ◽  
Susanne Franck ◽  
Maren Messinger ◽  
Jo Linssen ◽  
Marcus Thomé ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Iron Deficiency ◽  
Biochemical Markers ◽  
Iron Status ◽  
Anemia Of Chronic Disease ◽  
Forward Scatter ◽  
Functional Iron Deficiency ◽  
Hematology Analyzer ◽  
Advia 120 ◽  
Hemoglobin Measurement

AbstractThe aims of this study were to diagnose iron-restricted erythropoiesis (functional iron deficiency) in patients with classic iron deficiency (ID), anemia of chronic disease (ACD) and the combined state of ID/ACD with the use of two hematological methods for the measurement of reticulocyte hemoglobinization. In comparison, the biochemical markers of iron status were determined. We studied 474 anemic patients admitted to hospital with a broad spectrum of diseases. We measured indicators of reticulocyte hemoglobinization. CHr was determined on an Advia 120 hematology analyzer. A Sysmex XE-2100 hematology analyzer was used to determine RET-Y, the forward scatter of fluorescence-labeled reticulocytes, which can also be expressed as the reticulocyte hemoglobin equivalent (RET-H

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