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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter

IMPACT FACTOR 2017: 3.556

CiteScore 2017: 2.34

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Volume 54, Issue 12


Evaluation of the hypochromic erythrocyte and reticulocyte hemoglobin content provided by the Sysmex XE-5000 analyzer in diagnosis of iron deficiency erythropoiesis

Mauro Buttarello
  • Corresponding author
  • Clinical Pathology Laboratory, Hospital of Adria, Piazza degli Etruschi, 45011, Adria (RO), Italy
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Rachele Pajola / Enrica Novello / Giacomo Mezzapelle / Mario PlebaniORCID iD: http://orcid.org/0000-0002-0270-1711
Published Online: 2016-09-22 | DOI: https://doi.org/10.1515/cclm-2016-0041



Iron deficiency represents the most frequent cause of anemia. To diagnose iron deficiency some biochemical tests such as serum ferritin and the transferring saturation percent (TSAT%) are usually used. Recently, some hematological parameters such as mean reticulocyte hemoglobin content (CHr or Ret-He) and percentage of hypochromic RBCs (Hypo% or %Hypo-He) were proposed as alternative to biochemical tests. In this study, the analytic performance and the diagnostic efficiency of these two parameters provided by Sysmex XE5000 analyzer on iron deficiency patients with or without anemia (IDA and ID, respectively) were evaluated.


One hundred and sixty-four healthy adults, 58 with IDA, 21 with iron depleted stores (ID), 23 with β-thalassemia trait, and 24 with non iron deficiency anemia were selected. The gold standard used to define iron deficiency was the coexistence of serum ferritin below 15 μg/L (12 in women) and TSAT <16%.


For %Hypo-He, the best cut-off value for both IDA and ID is 0.9% while for Ret-He is 30.6 pg. For both parameters the performance was better to diagnose IDA (AUC, 0.96 and 0.98) than ID (AUC, 0.93 and 0.95). The Ret-He behavior was always slightly better than that of %Hypo-He.


The use of these two parameters is useful to detect iron deficiency conditions if the hemoglobin synthesis has already been compromised.

Keywords: hypochromic erythrocytes; iron deficiency; reticulocyte hemoglobin content; Sysmex XE-5000


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About the article

Corresponding author: Mauro Buttarello, MD, Clinical Pathology Laboratory, Hospital of Adria, Piazza degli Etruschi, 45011, Adria (RO), Italy

Received: 2016-01-17

Accepted: 2016-04-25

Published Online: 2016-09-22

Published in Print: 2016-12-01

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 54, Issue 12, Pages 1939–1945, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2016-0041.

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