Reticulocytic Hemoglobin Content in Patients with Congenital Cyanotic Heart Disease

Abstract

SUMMARY AND CONCLUSION C hildren with cyanotic congenital heart disease (CCHD) have complex alterations in their whole blood composition and coagulation profile due to longstanding hypoxemia. In addition, in anemic patients especially those with microcytic iron deficiency anemia, permeability of microcytic erythrocytes decreases in comparison to normocytic cells, therefore thromboembolic and cardiovascular events are encountered more commonly (Felker et al., 2006). Patients with cyanotic heart disease may have an acceptable quality of life. However, they are invariably prone to several complications. For instance, hyper viscosity, thrombocytopenia (decreased level of platelet production), blood clotting abnormalities(reduced synthesis of clotting factors and/or deranged platelet aggregation), cerebral abscess, cerebral embolism hyperuricemia (mainly due to age-related impairment of uric acid excretion in adults),and endocarditis (Rose et al., 2007). Anemia is highly prevalent in the general population and in the clinical setting. It is associated with diminished quality of life, worsening of clinical outcome, and increased health care costs. Iron deficiency is the predominant cause (Kristine et al., 2015). IDA is associated with impaired neurocognitive function and exercise intolerance, and the association exists even after its successful treatment. Therefore, preventing the progression of iron deficiency is especially important during infancy and early childhood when the rapid growth and development rate, especially of the brain, increases the vulnerability to IDA-induced impairment (Young et al., 2016). In CCHD, defining anemia is difficult, as optimal hemoglobin concentration is dependent on degree of hypoxemia. Relative anemia therefore occurs at much higher hemoglobin levels than in the general population, and often goes unnoticed (Paul et al., 2004). A major cause of relative anemia in CCHD is iron deficiency. More than a third of CCHD patients are iron deficient. Typical indices of iron deficiency including hypochromia and microcytosis are often absent; exclusion of iron deficiency therefore requires a complete iron metabolism workup, such as serum iron, ferritin, and ransferring saturation. However, these parameters are subject to biological variability, for example, diurnal variation, fluctuation with dietary intake and in infection/ inflammatory states (acute-phase reactants) (Weimann et al., 2016). In the last years, there has been much interest in the potential use of new reticulocyte parameters in the diagnosis of anemia and the monitoring of the erythropoiesis activity of bone marrow; these reticulocyte parameters provide information that could allow the differential diagnosis of anemia, the early (latent) detection of iron deficiency, and the real-time monitoring of bone marrow erythropoietic activity. Besides aiding the diagnosis of iron-deficiency anemia, reticulocyte parameters could potentially be helpful in monitoring the response of erythropoiesis to iron supplementation (Buttarello et al., 2016).