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Clinical AdvisorReticulocyte Hemoglobin Content: Early Marker of Iron-Deficiency Anemia

Article explores the diagnostic applications of CHr, the ease of its measurement, and the benefits it offers in early detection, treatment adaptation, and specific patient population screening.

Iron deficiency is a predominant nutritional deficiency and the leading cause of anemia across the globe. In addition to conventional markers for diagnosing iron-deficiency anemia, the use of reticulocyte hemoglobin content (CHr) emerges as a promising tool that circumvents some of the challenges with traditional methods.

Key Points:

  • Iron deficiency anemia affects both developed and developing countries, with different causative factors such as chronic blood loss and malnutrition.
  • Traditional iron markers, like ferritin and serum iron, are influenced by other body processes such as inflammation, making them less reliable.
  • Reticulocyte hemoglobin content provides a more accurate real-time assessment of red blood cell production and is unaffected by confounding factors such as inflammation or infection.
  • CHr has potential applications in early detection, treatment response assessment, differentiation of hematologic conditions, and special population screening, such as neonates and chronic kidney disease patients.
  • Measurement of CHr is cost-effective and rapid, typically completed in less than 2 minutes with automatic processors.

Additional Points:

  • Conventional markers of iron-deficiency anemia can be affected by diet, physical activity, and acute or chronic inflammation, causing variability in their effectiveness.
  • RET-He, another method to calculate reticulocyte hemoglobin, is performed on a Sysmex automated hematological analyzer and strongly correlated with CHr.
  • Future research and standardization are needed for wide clinical applications of CHr.


  • The adoption of reticulocyte hemoglobin content in clinical practice offers a promising advancement in the screening, diagnosis, and treatment of iron-deficiency anemia. It brings a more direct, efficient, and cost-effective method that may eventually replace or complement existing techniques.

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Did You Know?
Anemia affects approximately one-third of the world’s population, making it the most common blood disorder. In some developing countries, up to half of all women and children may be affected by some form of anemia.

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