# Laboratory Markers of Impaired Erythropoiesis in Early Diagnosis of Perioperative Anemias

## TL;DR

This study shows that reticulocyte hemoglobin and delta-hemoglobin levels can help detect early signs of anemia risk in patients with normal total hemoglobin levels before surgery.

## Contribution

The study introduces the use of Ret-He and Delta-He as early markers for impaired erythropoiesis in patients with normal hemoglobin.

## Key findings

- 26% of patients with normal hemoglobin showed Ret-He and Delta-He deviations linked to anemia risk.
- Changes in Ret-He and Delta-He predicted the need for ECC transfusion therapy post-surgery.
- Deviations in these markers align with diagnostic signs of various anemias and early erythropoiesis impairment.

## Abstract

The aim of the study was to assess the diagnostic value of laboratory indicators of hemoglobin content in reticulocytes for the early detection of predisposition for perioperative anemia in patients with total hemoglobin within the reference range.

Observational retrospective single-center continuous cross-sectional study has been carried out to determine the need for transfusion of erythrocyte-containing components (ECC) depending on the values of reticulocyte hemoglobin (Ret-He) and delta-hemoglobin (Delta-He) in patients with unchanged (within the reference range) values of the total hemoglobin. The groups of comparison were formed using the diagnostic Hema-Plot algorithm, under which Ret-He and Delta-He values deviate from the reference range towards greater or smaller magnitudes in various types of anemia.

Deviations from the reference intervals of Ret-He and Delta-He values were observed in 26% of patients not formally meeting the WHO criteria for anemia on admission. Indications for ECC transfusion therapy were more likely to occur in patients who had changes in Ret-He and Delta-He corresponding to the signs of anemias of different genesis according to the Hema-Plot algorithm.

The Ret-He and Delta-He values in patients with unchanged hemoglobin allow for making a decision on the need for ECC transfusion therapy in the postoperative period.

The differences between the groups formed on the basis of Ret-He and Delta-He deviations from the reference values are in line with the diagnostic signs of anemias of various origins. They also allow one to discuss the variants of impaired erythropoiesis at the very early stages of the disorder and the risk of anemia development in patients with formally unchanged total hemoglobin levels.