Name:_______________________________ SGD Grp:______

TESTS ON BLOOD CELL DISORDERS

RETICULOCYTE COUNT

I. Clinical Significance:

As a red cell matures, several days are needed for the hemoglobin containing cell to rid
itself of residual cytoplasmic ribonucleic acid after its nucleus has been expelled. The RNA
containing cell is slightly larger than the mature cell; it contains miscellaneous fragments of
mitochondria and other organelles as well as ribosomal RNA. These young red blood cells,
called “reticulocytes”, can often be distinguished on Wright stained peripheral smears by
their larger size and slightly gray or purple or bluish-pink appearance (polychromasia) due
to residual RNA.

The reticulocyte count is an index of the production of mature red cells by the blood
forming organs, mostly the bone marrow. Increased reticulocyte counts mean an
increased number of RBC is being put out into the peripheral blood in response to a
stimulus. Reticulocytes normally make up 1% of the total RBC count, but may exceed
levels of 4% when compensating for anemia. In exceptionally great reticulocyte responses
(reticulocytosis), there may even be nucleated RBC pushed out into the peripheral blood
due to massive red cell production activity of bone marrow.

* Immature precursor of the red blood cell, in which the remains of the residual RNA are
visible as network of filaments and granules (reticulum).
• very few are seen in normal blood as they are retained in the marrow until mature
• On remission of anaemia, when there is a high rate of production, reticulocytes appear
in the bloodstream (reticulocytosis).
• =On increased erythropoiesis, younger reticulocytes, also called "shift cells" are
released, which require two days to mature.

*Absolute Reticulocyte count

= The absolute reticulocyte count can also distinguish between hypo/hyperproliferative
anemia.
= If the absolute reticulocyte count is 100,000 /mm3 or higher, the anemia is
hyperproliferative type (i.e. hemolytic anemia or anemia of acute blood loss). 
= If it is less than 100,000/ mm3 the anemia is hypoproliferative (iron, B12, or folic
deficiency, anemia of chronic disorder etc.).

II. Procedure:
1. Mount the prepared Blood Smears (stained with New Methylene Blue or Cresyl blue)
2. For counting, choose an area of the film where the cells are undistorted, mostly
one-cell layer, and where the staining is good. The cells should not overlap.
3. Cells are counted using the oil immersion lens.
4. Count a total number of 1000 red cells. As this number is being counted, jot down
the number of cells with granules or filaments seen.

 Report as percent (%) Reticulocytes counted (per 1,000 Red cells).

 Normal adult range: 0.5-1.5%
III. Calculation:

_____Total number of reticulated cells X 100 = % reticulocytes

1,000

Absolute count:
RBC/cumm X percent reticulocyte

 Absolute reticulocyte count:

Actual number of reticulocytes (range 25,000 – 125,000/ul)

IV. Questions:

1. Draw a Reticulocyte.

2. What is the reticulocyte percentage of your blood sample? Show your calculation.

3. What other red cell cytoplasmic inclusion bodies may be confused with reticulocytes.
How could they be differentiated from reticulocytes?

4. If a markedly anemic patient has a very low count or even absence of reticulocytes,
what is it indicative of?