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Within-patient variation of hemoglobin and reticulocytes: implications for evaluating ESA responsiveness in dialysis patients.
MedLine Citation:
PMID:  22672348     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Introduction:  Techniques that assess percent reticulocytes (%retics) or hemoglobin (Hb) to detect erythropoiesis-stimulating agents (ESA) use in athletes may be useful in evaluating ESA responsiveness in dialysis patients. However, within-patient variation, appropriate transformation, or the relationship between the blood draw interval length and analyte variation are untested. Methods:  In a prospective, single-arm trial, we determined Hb and %retics in 30 hemodialysis patients receiving stable ESA doses. Within-patient results were evaluated for variance homogeneity and normality with and without transformation. Results:  Square-root transformation (sqrt) of %retics produced the most constant variance (lowest r-value for correlation between sqrt|normalized residuals| and fitted values: 0.018 highest P-value 0.739) compared with log transformation (r = -0.198, P < 0.001) or no transformation (r = 0.215, P < 0.001) and showed the least departure from normality (highest P-value: 0.002 vs. < 0.001 vs. < 0.001, respectively). Hb results did not improve with transformation. Within-patient variance in both %retics and Hb increased with interval length between lab draws (P < 0.001). Conclusions:  Initial assessment of anti-doping tool use in dialysis patient anemia management indicates square-root transformation of %retics and adjustment for time between lab draw intervals for both %retics and Hb will be required.
Authors:
D B VAN Wyck; I Giles; K Sharpe
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-6
Journal Detail:
Title:  International journal of laboratory hematology     Volume:  -     ISSN:  1751-553X     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101300213     Medline TA:  Int J Lab Hematol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 Blackwell Publishing Ltd.
Affiliation:
DaVita Inc., Denver, CO, USA Sysmex, Mundelein, IL, USA University of Melbourne, Melbourne, Vic., Australia.
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