Reticulocyte count

Definition

A reticulocyte count is a blood test performed to assess the body's production of immature red blood cells (reticulocytes). A reticulocyte count is usually performed when patients are evaluated for anemia and response to its treatment. It is sometimes called a retic count.

Purpose

Diagnosis

A reticulocyte count provides information about the rate at which the bone marrow is producing red cells. A normal count means that the production is adequate; a decreased count means it is not. This information helps determine whether a lack of red cells in an anemic person is caused by a bone marrow problem, by excessive bleeding, or by red cell destruction.

Monitoring

The test is also used to monitor the response of bone marrow response to treatment for anemia. The reticulocyte count rises within days if the treatment is successful. It is also used following bone marrow transplant to evaluate the new marrow's cell production.

Description

Reticulocytes were first described as transitional forms of red blood cells by Wilhelm H. Erb in 1865. A red cell begins in the bone marrow as a large bluish cell filled with ribonucleic acid (RNA). As the cell matures, it shrinks. Its color gradually changes from blue to pink as its load of oxygen-carrying protein (hemoglobin) increases and the RNA decreases. The center of the cell (nucleus) becomes clumped. It is expelled three days before the cell leaves the bone marrow. The cell is now a reticulocyte. On its fourth and final day of maturation, the reticulocyte enters the bloodstream. One day later, it is a mature red blood cell.

The first step in a retic count is drawing the patient's blood sample. About 17 oz (5 ml) of blood is withdrawn from a vein into a vacuum tube. The procedure, which is called a venipuncture, takes about five minutes.

After the sample is collected, the blood is mixed with a dye (methylene blue) in a test tube. The RNA remaining in the reticulocytes picks up a deep blue stain. Drops of the mixture are smeared on slides and examined under a microscope. Reticulocytes appear as cells containing dark blue granules or a blue network. The laboratory technologist counts 1,000 red cells, keeping track of the number of reticulocytes. The number of reticulocytes is reported as a percentage of the total red cells. When the red cell count is low, the percentage of reticulocytes is inaccurately high, suggesting that more reticulocytes are present than there are in reality. The percentage is mathematically corrected for greater accuracy. This figure is called the corrected reticulocyte count or reticulocyte index.

Reticulocyte counts can also be done on automated instruments, such as flow cytometers, using fluorescent stains. These instruments are able to detect small changes in the reticulocyte count because they count a larger number of cells (10,000-50,000).

Preparation

The doctor should make a note of any prescription medications that the patient is taking. Some drugs lower the red blood cell count.

Aftercare

Aftercare consists of routine care of the area around the puncture mark. Pressure is applied for a few seconds and the wound is covered with a bandage.

Risks

The primary risk is mild dizziness and the possibility of a bruise or swelling in the area where the blood was drawn. The patient can apply moist warm compresses.

Normal results

Adults have reticulocyte counts of 0.5-2.5%. Women and children usually have higher reticulocyte counts than men.

Abnormal results

A low reticulocyte count indicates that the bone marrow is not producing a normal number of red blood cells. Low production may be caused by a lack of vitamin B₁₂, folic acid, or iron in the diet; or by an illness affecting the bone marrow (for example, cancer). Further tests are needed to diagnose the specific cause.

The reticulocyte count rises when the bone marrow makes more red cells in response to blood loss or treatment of anemia.

Key Terms

Anemia

A condition marked by a decrease in the number or size of red blood cells

Methylene blue

A dye that is used to stain the blood cells for the reticulocyte count.

Reticulocyte

An immature red blood cell.

For Your Information

Periodicals

• Rowan, R. M., et al. "The Reticulocyte Count: Progress Towards the Resurrection of a Useful Clinical Test." Clinical and Laboratory Haematology 18, no. 1 (1996): 3-8.

Source: Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group

The Essay Author is Nancy J. Nordenson.

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