Perennial Parameter for Intravenous Iron Therapy in Heart Failure: Reticulocyte Crisis


Kumral Z., UYSAL H., YILMAZ M. B.

ANATOLIAN JOURNAL OF CARDIOLOGY, cilt.30, sa.2, ss.109-115, 2026 (SCI-Expanded, Scopus, TRDizin) identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 30 Sayı: 2
  • Basım Tarihi: 2026
  • Doi Numarası: 10.14744/anatoljcardiol.2025.5520
  • Dergi Adı: ANATOLIAN JOURNAL OF CARDIOLOGY
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE, Directory of Open Access Journals, TR DİZİN (ULAKBİM)
  • Sayfa Sayıları: ss.109-115
  • Anahtar Kelimeler: Ferritin, heart failure, inflammation, iron deficiency, reticulocyte crisis
  • Dokuz Eylül Üniversitesi Adresli: Evet

Özet

Background: Managing comorbidities alongside guideline-directed medical therapy is essential in heart failure (HF) treatment. Intravenous (IV) iron therapy is recommended for HF patients with left ventricular ejection fraction (LVEF) <50% to correct iron deficiency. Traditional markers such asferritin and transferrin saturation (TSAT) are affected by inflammation and have delayed responses, limiting their clinical utility. This study aimed to evaluate early response to IV iron therapy by monitoring reticulocyte counts, a parameter unaffected by inflammation. Methods: Hospitalized HF patients with LVEF <50% meeting CONFIRM-HF criteria for IV iron therapy were included. Reticulocyte counts were measured at admission and 72-120 hours post treatment. Associations with hemoglobin (Hb) increase at 1 month, hospital stay duration, emergency department (ED) readmissions, and mortality were assessed. Results: Patients with >= 1 g/dL Hb increase at 1 month had higher reticulocyte levels at admission (2.0% vs. 1.5%, P = .04) and 72-120 hours posttreatment (2.2% vs. 1.3%, P = .004). A >= 9% reticulocyte increase at 72-120 hours predicted Hb rise >= 1 g/dL with 90% specificity (area underthe curve: 0.79, P = .002). Those with higher reticulocyte increases had shorter hospital stays (7 vs. 10 days, P = .023) and fewer ED readmissions (24% vs. 66%, P = .004). Higher reticulocyte and Hb levels correlated with reduced mortality over 2 years. Conclusion: Reticulocyte increase within 72-120 hours after IV iron therapy offers an early, inflammation-independent marker of treatment response in HF patients, outperforming ferritin and TSAT. Elevated baseline reticulocytes may indicate active bone marrow and predicttherapeutic benefit.