Anemia 2013 July-4


Transient impairment of reticulocyte hemoglobin content and hepcidin-25 induction in patients with community-acquired pneumonia.

Scand J Clin Lab Invest. 2013 Feb;73(1):54-60.

Schoorl M, Snijders D, Schoorl M, Boersma WG, Bartels PC.




Patients with community-acquired pneumonia (CAP) often exhibit a declining hemoglobin (Hb) concentration. During inflammation pro-inflammatory cytokines and cells of the reticuloendothelial system induce disturbances in iron homeostasis. In this study inflammation markers and hepcidin-25 concentrations were monitored together with short-term alterations in reticulocyte hemoglobinization (RET-He).


A total of 25 patients with CAP participated in the study. The assay for serum hepcidin-25 is based on a combination of weak cation exchange chromatography and time-of-flight mass spectrometry.


At hospital admission serum hepcidin-25 concentrations (14.6 ± 6.9 nMol/L, mean ± SD) were established in the upper level of the reference range (0.5-13.9 nMol/L). Results for C-reactive protein (CRP) and Interleukin-6 (IL-6) were obviously increased compared to the reference ranges. From admission until day 14 hepcidin-25, CRP and IL-6 steadily decreased towards the reference ranges. Hb concentrations declined from admission until day 4 from 8.1 ± 1.0 mMol/L to 7.4 ± 0.9 mMol/L. At admission Ret-He results were within the lower region of the reference range (1900-2300aMol) and results demonstrated a decline during admission from 1931 ± 241 aMol until 1845 ± 199 aMol (NS) at day 4. From a minimum Ret-He value at day 4 results increased towards 2129 ± 136 aMol at day14.


A transient increase of cytokine-stimulated serum hepcidin-25 in combination with a temporary decrease of Hb and Ret-He is demonstrated in patients with CAP. Our results support the hypothesis that hepcidin-25 induces transient impairment of reticulocyte hemoglobin content (Ret-He).



The anemia of inflammation is in part due to a disturbance of systemic iron utilization. In pathological conditions, temporarily decreased hemoglobin synthesis may be due to reduced iron availability to the developing erythron.

Recently new haemocytometric parameters like reticulocyte haemoglobin content (Ret-He),  erythrocyte haemoglobin content (RBC-He) and Ret-He/RBC-He ratio have been introduced.

Ret-He is demonstrated to be a sensitive indicator of monitoring short-term deteriorations in functional iron supply for erythropoiesis. In case of healthy subjects Ret-He results exceed the results of RBC-He amounting to 5-15%. From corresponding shifts in decreased values for Ret-He and Ret-He/RBC-He ratios respectively, a temporarily decreased degree of hemoglobinization is concluded. The RET-He/RBC-He ratio provides accurate and sensitive information of the deviation in hemoglobinization between the (normocytic) RBC population(RBC-He) and the (hypochromic) Reticulocyte population (Ret-He) [Bartels et al 2006].

We hypothesize that transient impairment of hemoglobin synthesis in patients with acute inflammation due to CAP corresponds with increased hepcidin-25 concentrations.

The aim of this study was to elucidate the effects of iron deprivation yielding short term alterations of hemoglobinization by simultaneously monitoring hepcidin-25 and biomarkers regarding activity of infection in patients with CAP.



Margreet Schoorl-2Results (Mean ± SD) for serum hepcidin-25 concentration (nMol/L) which have been established in 25 patients at hospital admission (day 1), at several days during antibiotic treatment (day 2, 3, 4)  and after completion of antibiotic treatment (day 14). The horizontal lines indicate the lower and upper level of the reference range for apparently healthy subjects (0.5–13.9 nMol/L). The horizontal dashed line indicate the median value for apparently healthy subjects (4.2 nMol/L)


Margreet Schoorl-3aResults (Mean ± SD) for reticulocyte hemoglobin content (RET-He, aMol).



1.   Bartels PCM, Schoorl M, Schoorl M. Haemoglobinization and functional availability of iron for erythropoiesis in case of thalassemia and iron deficiency anemia. Clin Lab 2006;52:107-14.

2.   Schoorl M, Snijders D, Schoorl M, Boersma W , Bartels PCM. Temporary impairment of reticulocyte haemoglobin content in subjects with community-acquired pneumonia. Int J Lab Hematol 2012;34:390–395.

Multiselect Ultimate Query Plugin by InoPlugs Web Design Vienna | Webdesign Wien and Juwelier SchönmannMultiselect Ultimate Query Plugin by InoPlugs Web Design Vienna | Webdesign Wien and Juwelier Schönmann