Reticulocyte Count

Also known as: Retic Count; Reticulocyte Index; Corrected Reticulocyte Formal name: Reticulocyte Count Related tests: Red blood cell count; Hemoglobin; Hematocrit; CBC; Blood smear; Erythropoietin

The Test
How is it used? When is it ordered? What does the test result mean? Is there anything else I should know?

How is it used?
The reticulocyte count is used to help determine if the bone marrow is responding adequately to the bodys need for red blood cells (RBCs) and to help determine the cause of and classify different types of anemia. The number of reticulocytes must be compared to the number of RBCs to calculate a percentage of reticulocytes; so the test is ordered along with a RBC count. A hemoglobin and/or hematocrit are usually ordered in order to evaluate the severity of anemia. The RBC, hemoglobin, and hematocrit are frequently ordered as part of a complete blood count (CBC). The CBC usually includes an evaluation of RBC characteristics, such as cell size, volume, and shape. Based on these results, a reticulocyte count may be ordered to further examine the RBCs. Reticulocytes can be distinguished from mature RBCs because they still contain remnant genetic material (RNA), a characteristic not found in mature RBCs. Circulating reticulocytes generally lose their RNA within one to two days, thus becoming mature RBCs.

When is it ordered?
A reticulocyte count may be ordered when you have a decreased RBC count and/or a decreased hemoglobin and hematocrit and your doctor wants to evaluate bone marrow function. If you have no apparent symptoms, these findings may be found during routine blood work. Testing may also be ordered when you have symptoms such as paleness, fatigue, weakness, shortness of breath, and/or blood in the stool. When you have a known iron or vitamin B12 or folate deficiency, known kidney disease, known bone marrow suppression such as that due to chemotherapy or bone marrow transplant - and/or are receiving erythropoietin, the reticulocyte count may be ordered along with a RBC count, hematocrit, and hemoglobin at intervals recommended by your doctor to monitor marrow function and response to treatment. When you have an increased number of RBCs and elevated hemoglobin and hematocrit, the reticulocyte count may be ordered to help determine the degree and rate of overproduction of RBCs.

What does the test result mean?

What your doctor is looking for is an appropriate response from the bone marrow, to confirm that your bone marrow is reacting as it should to an increased demand for RBC production. In a healthy patient, the reticulocyte percentage is essentially stable. When the number of RBCs and hematocrit decreases, the percentage of reticulocytes may appear increased compared to the overall number of RBCs. In order to get a more accurate assessment of bone marrow function, the calculated reticulocyte percentage (%) is often corrected with a calculation called a corrected reticulocyte count or a reticulocyte index (RI). This calculation compares the patients hematocrit with a normal hematocrit value. An additional calculation called the reticulocyte production index (RPI) is sometimes calculated to correct for the degree of reticulocyte immaturity reflecting how quickly the reticulocytes were released from the bone marrow and how long it will take them to mature in the bloodstream. The RPI and maturation time vary with the hematocrit. Reticulocyte (%) = [Number of Reticulocytes / Number of Red Blood Cells] X 100 Reticulocyte Index = Reticulocyte count (%) X [Measured hematocrit / Normal hematocrit] Reticulocyte Production Index = (Reticulocyte Index) X (1/maturation time) Some automated reticulocyte counts may have an immature reticulocyte fraction (IRF) and a mean reticulocyte volume (MRV) reported. They are primarily research parameters at this time. The reticulocyte count is a reflection of recent bone marrow activity If your bone marrow is responding appropriately to the demand for increased numbers of RBCs, then the bone marrow will allow for the early release of more immature RBCs, increasing the number of reticulocytes in the blood. An increased reticulocyte percentage may indicate conditions such as: Bleeding: If you bleed (hemorrhage), then the number of reticulocytes will rise a few days later in an attempt to compensate for the red cell loss. If you have chronic blood loss, then the number of reticulocytes will stay at an increased level as the marrow tries to keep up with the demand for new RBCs. Hemolytic anemia Hemolytic disease of the newborn If your marrow is unable to keep up or is not functioning normally, then the number of reticulocytes may be normal or only slightly elevated despite demand but will eventually decrease due to lack of adequate production. If the number of reticulocytes is not elevated when you are anemic, then it is likely that there is some degree of bone marrow dysfunction or failure and/or a deficiency of erythropoietin. Decreased reticulocyte percentages may be seen, for example, with: Iron deficiency anemia Pernicious anemia or folic acid deficiency Aplastic anemia Radiation therapy

Bone marrow failure caused by infection or cancer The reticulocyte count gives an indication of what may be happening but is not directly diagnostic of any one particular disease. I is a sign that further investigation may be necessary and a tool that can be used to monitor the effectiveness of therapy. If reticulocyte numbers rise following chemotherapy, a bone marrow transplant, or treatment of an iron or vitamin B12 or folate deficiency, then bone marrow RBC production is beginning to recover. In conditions causing RBC overproduction, the number of reticulocytes and RBCs, the concentration of hemoglobin, and percentage of hematocrit will all be increased.

Is there anything else I should know?

Patients who move to higher altitudes may have increased reticulocyte counts as their body adapts to the lower oxygen content of their new location. Smokers also may demonstrate an increased number of RBCs and reticulocytes. Reticulocyte counts may be increased during pregnancy. Newborns have a higher percentage of reticulocytes, but the number drops to near adult levels within a few weeks. Traditionally, reticulocyte counts have been done manually by looking at a specially stained slide under the microscope and counting the number of reticulocytes in a number of fields of view. This method is still in use, but it is in the process of being replaced by automated methods that allow for a greater number of cells to be counted, thus enhancing the accuracy of reticulocyte counts.

This article w as last review ed on February 20, 2009. | This article w as last modified on March 31, 2011.

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