Anemia appears in the early stages of CKD and its prevalence increases as kidney function declines. RET-HE can be used to diagnose iron-deficiency anemia in cases of CKD patients undergoing hemodialysis as a parameter to assess iron. Therefore, this parameter to examine the ability of RET-He as an alternative parameter to assess iron deficiency in hemodialysis patients. The number of reticulocytes in the peripheral blood is a fairly accurate reflection of erythropoietic activity, assuming that the reticulocytes are released normally from the bone marrow and that they remain in circulation for the normal time period. These assumptions are not always valid because an increased erythropoietic stimulus leads to premature release into the circulation. The average maturation time of these so-called ‘stress’ or stimulated reticulocytes may be as long as 3 days. In such cases, a higher than normal proportion of immature reticulocytes will be found in circulation. Measuring RET-He is considered a sensitive test to assess iron status but its utility has not been shown in preoperative iron therapy. An invasive procedure like bone marrow aspiration can thus be avoided in IDA. So RET- He is a sensitive marker of bone marrow iron store in IDA.