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      Hemoglobina de reticulocito y su importancia en el diagnóstico temprano de anemia ferropénica Translated title: Reticulocyte hemoglobin and its importance in early diagnosis of iron deficiency anemia

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          Abstract

          Resumen Introducción: El contenido de hemoglobina de reticulocitos (CHr), es un parámetro en la biometría hematológica automatizada que proporciona información sobre el contenido de hierro, por ello se ha utilizado como un marcador de la biodisponibilidad del hierro en la eritropoyesis, permite su detección en una etapa temprana de la anemia ferropénica y otras patologías como inflamación crónica, enfermedad renal crónica; además realizar monitoreo de terapias con eritropoyetina y hierro. Objetivo: Exponer la aplicabilidad de la CHr como un parámetro en el diagnóstico precoz de la anemia por deficiencia de hierro, así como su medición e interpretación. Materiales y métodos: Se realizó la revisión de artículos científicos en inglés y español en las bases de datos PubMed, ScienceDirect, LILACS y Medline, usando descriptores validados en Medical Subject Headings (MeSH), considerando periodo de publicabilidad del 80% inferior a 5 años. Resultados: Se describe la importancia, aplicabilidad, determinación e interpretación de este parámetro como biomarcador específico hemático temprano en el diagnóstico de deficiencia de hierro antes de presentarse cambios morfológicos eritroides. Conclusiones: La CHr es un parámetro de gran utilidad en el diagnóstico temprano de anemia ferropénica y otras patologías como deficiencia funcional de hierro, estados de inflamación crónica y enfermedad renal crónica.

          Translated abstract

          Abstract Introduction: The reticulocyte hemoglobin content (CHr) is a parameter in automated hematological biometrics, which can provide information on the iron content. So it has been used as a marker of the bioavailability of iron in the erythropoiesis, it allows its detection at an early stage of iron deficiency anemia and other pathologies such as chronic inflammation, chronic kidney disease; in addition to monitoring therapy with erythropoietin and iron. Objective: To expose the applicability of CHr as a parameter in the early diagnosis of iron deficiency anemia, as well as its measurement and interpretation. Materials and methods: The review of scientific articles in English and Spanish was carried out in the PubMed, ScienceDirect, LILACS and Medline databases, using descriptors validated in Medical Subject Headings (MeSH), considering the publication period of 80% less than 5 years. Results: The importance, applicability, determination and interpretation of this parameter is described as an early specific biomarker in the blood in the diagnosis of iron deficiency before presenting morphological changes occurring during terminal erythroid differentiation. Conclusions: CHr is a very useful parameter in the early diagnosis of iron deficiency anemia and other pathologies such as functional deficiency, chronic inflammation states and chronic renal disease.

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          Most cited references65

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          From Erythroblasts to Mature Red Blood Cells: Organelle Clearance in Mammals

          Erythropoiesis occurs mostly in bone marrow and ends in blood stream. Mature red blood cells are generated from multipotent hematopoietic stem cells, through a complex maturation process involving several morphological changes to produce a highly functional specialized cells. In mammals, terminal steps involved expulsion of the nucleus from erythroblasts that leads to the formation of reticulocytes. In order to produce mature biconcave red blood cells, organelles and ribosomes are selectively eliminated from reticulocytes as well as the plasma membrane undergoes remodeling. The mechanisms involved in these last maturation steps are still under investigation. Enucleation involves dramatic chromatin condensation and establishment of the nuclear polarity, which is driven by a rearrangement of actin cytoskeleton and the clathrin-dependent generation of vacuoles at the nuclear-cytoplasmic junction. This process is favored by interaction between the erythroblasts and macrophages at the erythroblastic island. Mitochondria are eliminated by mitophagy. This is a macroautophagy pathway consisting in the engulfment of mitochondria into a double-membrane structure called autophagosome before degradation. Several mice knock-out models were developed to identify mitophagy-involved proteins during erythropoiesis, but whole mechanisms are not completely determined. Less is known concerning the clearance of other organelles, such as smooth and rough ER, Golgi apparatus and ribosomes. Understanding the modulators of organelles clearance in erythropoiesis may elucidate the pathogenesis of different dyserythropoietic diseases such as myelodysplastic syndrome, leukemia and anemia.
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            Ferroportin-mediated iron transport: expression and regulation.

            The distinguishing feature between iron homeostasis in single versus multicellular organisms is the need for multicellular organisms to transfer iron from sites of absorption to sites of utilization and storage. Ferroportin is the only known iron exporter and ferroportin plays an essential role in the export of iron from cells to blood. Ferroportin can be regulated at many different levels including transcriptionally, post-transcriptionally, through mRNA stability and post-translationally, through protein turnover. Additionally, ferroportin may be regulated in both cell-dependent and cell-autonomous fashions. Regulation of ferroportin is critical for iron homeostasis as alterations in ferroportin may result in either iron deficiency or iron overload. This article is part of a Special Issue entitled: Cell Biology of Metals. Copyright © 2012 Elsevier B.V. All rights reserved.
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              Renal association clinical practice guideline on Anaemia of Chronic Kidney Disease

              Anaemia is a commonly diagnosed complication among patients suffering with chronic kidney disease. If left untreated, it may affect patient quality of life. There are several causes for anaemia in this patient population. As the kidney function deteriorates, together with medications and dietary restrictions, patients may develop iron deficiency, resulting in reduction of iron supply to the bone marrow (which is the body organ responsible for the production of different blood elements). Chronic kidney disease patients may not be able to utilise their own body’s iron stores effectively and hence, many patients, particularly those receiving haemodialysis, may require additional iron treatment, usually provided by infusion. With further weakening of kidney function, patients with chronic kidney disease may need additional treatment with a substance called erythropoietin which drives the bone marrow to produce its own blood. This substance, which is naturally produced by the kidneys, becomes relatively deficient in patients with chronic kidney disease. Any patients will eventually require treatment with erythropoietin or similar products that are given by injection. Over the last few years, several iron and erythropoietin products have been licensed for treating anaemia in chronic kidney disease patients. In addition, several publications discussed the benefits of each treatment and possible risks associated with long term treatment. The current guidelines provide advice to health care professionals on how to screen chronic kidney disease patients for anaemia, which patients to investigate for other causes of anaemia, when and how to treat patients with different medications, how to ensure safe prescribing of treatment and how to diagnose and manage complications associated with anaemia and the drugs used for its treatment.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                reus
                Universidad y Salud
                Univ. Salud
                Universidad de Nariño (Pasto, Nariño, Colombia )
                0124-7107
                2389-7066
                December 2018
                : 20
                : 3
                : 292-303
                Affiliations
                [1] Boyacá Boyacá orgnameUniversidad de Boyacá orgdiv1Grupo de Investigación Bacteriología y Laboratorio Clínico (GRIBAC) Colombia
                Article
                S0124-71072018000300292
                10.22267/rus.182003.133
                4bb9b3ee-8861-4c99-8237-8111d2889747

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 14 August 2018
                : 08 March 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 75, Pages: 12
                Product

                SciELO Colombia


                reticulocytes,iron deficiency,Anemia,biomarkers,deficiencia de hierro,iron,reticulocitos,biomarcadores,hierro

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