Better monitoring of Erythropoietin supported renal failure patients
Research type
Research Study
Full title
Using Reticulocyte Haemoglobin and Delta Haemoglobin parameters in Erythropoietin Supported Renal Failure monitoring
IRAS ID
160755
Contact name
david e mcgowan
Contact email
Sponsor organisation
Sheffield Teaching Hospitals NHS Foundation Trust
Duration of Study in the UK
0 years, 3 months, 31 days
Research summary
Renal failure is a chronic condition in patients which also develops chronic anaemia. This is partly associated with decline in the production of Erythropoietin, and also the dialysis used as treatment is causative in the destruction of red cells, as well as chronic conditions are usually associated with a chronic anaemia). Erythropoietin is a hormone that is produced mainly in the kidneys; this is one of the main stimulating hormones in red cell production). Part of the treatment regime for the loss of this hormone is to give the patient replacement Erythropoietins as a therapeutic agent, these are produced by recombinant DNA technology in cell culture, and include epoetin zeta (Retacrit, Silapo) and biosimilar epoetin alfa (Binocrit, Hexal, Abseamed.
These patients, because of the increased turnover in red cell production also use up their Iron stores faster and tend to become Iron deficient. To counter this they are given Iron therapy given orally or intravenously, the clinician can either choose to treat an Iron deficiency when it arises or give treatment continuously and risk over dosage. The current testing for the condition for monitoring treatment uses the tests haemoglobin and transferrin receptors. They are used as indicators so when the haemoglobin is low it is appropriate to treat with erythropoietin and when the transferrin receptors are low they give iron. Although satisfactory they are crude tools haemoglobin can be low for other reasons unrelated to the condition this treatment is used for f transferrin receptors although not as reactive as ferritin in inflammatory conditions it also can be elevated in inflammatory responses and chronic disease.
The test Reticulocyte haemoglobin (Ret-He) measures the haemoglobin in the reticulocytes; these are immature red cells produced by the bone marrow in response to stimulation by hormones such as erythropoietin when the body needs to produce more red cells. They are not commonly found in the blood stream as they tend to mature in the bone marrow and are released into the blood stream as mature red blood cells. They are seen when the need for red cells is so acute that the bone marrow releases them to mature in the blood stream. Delta haemoglobin (Delta-He) is a parameter which is basically the difference between the amount of haemoglobin in mature red cells and the amount of haemoglobin in reticulocytes
Current prices:
Haemoglobin measurement as part of a Full blood count = £6.64
Full blood count with Reticulocyte = £10.72 per test
Transferrin Receptors included with Iron profile = £14.67 per test
Erythropoietin injection = £ 385 per injection
Iron treatment oral administration = £3 per month
Intravenous administration £200 per month
I wish to prove the testing of Reticulocyte haemoglobin (Ret-He) and Delta haemoglobin (Delta-He) for monitoring Iron status and the body’s response to Erythropoietin, respectively are more accurate and faster methods, they also have the advantage of being tested from the same sample and so requires less blood from the patient and if proven this could be sampled at the patient's own GP prior to clinic attendance and so would possibly reduce patient time in hospital or waiting at clinic.REC name
South East Scotland REC 01
REC reference
15/SS/0062
Date of REC Opinion
1 Apr 2015
REC opinion
Unfavourable Opinion