**10. Reticulocyte mean cell Hemoglobin content (CHr)**

As understood the early reticulocytes continue to synthesize hemoglobin, with approximately one fourth of the total hemoglobin of the RBC. Hence, CHr is the measurement of the Hb content of reticulocytes expressed in pg./cell. CHr is the product of the cellular volume and the cellular Hb concentration. The measurement of CHr can directly reflect the functional availability of iron in that time frame of life span of reticulocyte (up to 4 days) and is helpful in real-time assessment of the functional state of erythropoiesis. It can be of help in identifying iron deficiency before the development of IDA and also its serum level can guide for the route of administration of iron supplementation. Critically low value of CHr warrants for intravenous iron therapy, because oral iron is ineffective in preventing iron-deficient erythropoiesis. The prediction of the absence of bone marrow iron stores can better be diagnosed by CHr less than 28 pg., over than MCV, serum ferritin or transferrin saturation. Adequate iron levels must be ensured to optimize Hb production in a balance with erythropoietic stimulation by Epo in cases of chronic renal disease and it can be assessed by CHr.
