Usefulness of measuring reticulocyte hemoglobin equivalent in the management of haemodialysis patients with iron deficiency.

The evaluation of iron status in dialysis patients provides information essential to the planning of adequate recombinant human erythropoietin treatment. The cellular iron status of the patients can be determined from the recently available measurement of reticulocyte hemoglobin equivalent (RET-He). RET-He is measured on the basis of automated fluorescent flow cytometry which in the reticulocyte channel, using a polymethine dye, also measures the mean value of the forward light scatter intensity of mature red blood cells and reticulocytes. These values equate with reticulocyte hemoglobin content. In this study, to clarify the accuracy of RET-He in diagnosing iron deficiency in dialysis patients, we initially compared RET-He with such iron parameters as serum ferritin levels, transferrin saturation and content of reticulocyte hemoglobin (CHr) which has been established as indicators of functional iron deficiency. Secondly, we investigated the changes in RET-He during iron supplementation for iron-deficient patients to determine whether this marker is a prospective and reliable indicator of iron sufficiency. The participants in this study were 217 haemodialysis patients. Iron deficiency was defined as havsing a transferrin saturation (TSAT) < 20% or serum ferritin < 100 ng/ml. Conventional parameters of red blood cells and RET-He were measured by on a XE-2100 automated blood cell counter (Sysmex). CHr was measured on an ADVIA120 autoanalyser (Siemens). RET-He mean value was 32.4 pg and good correlation (r = 0.858) between RET-He and CHr is obtained in dialysis patients. Receiver operating characteristic curve analysis revealed, values of the area was 0.776 and at a cutoff value of 33.0 pg, a sensitivity of 74.3% and a specificity of 64.9%, were achieved. Iron supplements given to the patients with low TSAT or ferritin, RET-He responded within 2 weeks, and this seemed to be a potential advantage of using RET-He in the estimation of iron status. RET-He is a new parameter, equivalent value to CHr, and is easily measurable on the widely spread and popular blood cell counter and is a sensitive and specific marker of iron status in dialysis patients.

Fluoride concentrations and distribution in premolars of children from low and optimal fluoride areas.

We have compared the fluoride (F) concentrations from the enamel surface to the dentino-enamel junction (DEJ), and through dentine to the dentino-pulpal junction (DPJ) in premolars extracted from school children in Chemnitz (former Karl-Marx-Stadt), Germany (F: 1.0 ppm in the water supply), Erfurt, Germany (F: 0.2 ppm in the water supply) and Nagoya, Japan (F: 0.1 ppm in the water supply). In teeth from children in Cheminitz, Erfurt and Nagoya, the profiles of F distribution using an abrasive microsampling technique revealed high F concentrations in the enamel surface, with a substantial decrease towards a plateau in the interior. In dentine the F concentrations were higher than in enamel, and also decreased to a plateau from the DEJ, thereafter increasing considerably towards the DPJ. F concentrations at any depth in the enamel and dentine of teeth from Chemnitz were 2-3 times higher than those in Erfurt and Nagoya. There was no significant difference in F concentrations or distributions between Erfurt and Nagoya. Close to the DEJ in both enamel and dentine as well as the enamel surface and the DPJ side of dentine, higher F concentrations were observed in Chemnitz compared with Erfurt and Nagoya.