Immature Reticulocyte Count as an Indicator of Erythropoiesis in CRF

Lee, Jae Gyoon; Cho, Jong Tae; Yun, Sung Chul

Abstract

Transfusion requirement or hemoglobin level has been a major indicator of the erythropoiesis of CRF patients. However, the more objective and earlier detectable parameters to monitor the erythropoiesis has been required. We investigated the significance of immature reticulocyte count(IRC) with flowcytometry in CRF patients as a convenient index of erythropoietin(EPO) therapy. We evaluated CRF patients undergoing hemodialysis(n=35) and normal control group(n=14). The 26 patients of CRF have been under EPO therapy, the others(n=9) have not been under therapy. 1) The response of IRC to EPO therapy : IRC increased daily 4.95% in average upto 3rd day and decreased daily 3.7% in average since then. 2) The similar IRC was maintained in similar hemoglobin state : IRC, total reticulocyte count(TRC) and hemoglobin were compared between CRF patients with low dose EPO therapy and those who weren't needed EPO administration from the beginning. 3) The increase of IRC depends on the dose of EPO : 4) Correlation between IRC and other hematologic parameters : IRC was significantly correlated with TRC and serum iron level(R value : 0.736, 0.522 respectively). Taken together, these results suggest that maintenance of IRC level, 8-10%, was necessary at a minimum to obtain 8g/dL of hemoglobin level. However, IRC level could be readjusted more than 20% with higher EPO therapy to maintain 8g/dL of hemoglobin in severe case. In conclusion, the measurement of IRC in CRF is clinically more objective, useful, earlier indicator for estimating erythropoiesis than hemoglobin and TRC.