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Reticulocyte Count and ESR Analysis

The document discusses reticulocyte count as a measure of erythropoiesis and the bone marrow's response to anemia, detailing methods for calculating relative and absolute reticulocyte counts. It also covers the corrected reticulocyte count and Reticulocyte Production Index (RPI) for assessing bone marrow response, along with conditions that may interfere with hematology analyzers. Additionally, it explains the erythrocyte sedimentation rate (ESR) as a non-specific inflammatory response measurement, including factors affecting it and common errors in testing.

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Bae Allahnie Lengga
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26 views8 pages

Reticulocyte Count and ESR Analysis

The document discusses reticulocyte count as a measure of erythropoiesis and the bone marrow's response to anemia, detailing methods for calculating relative and absolute reticulocyte counts. It also covers the corrected reticulocyte count and Reticulocyte Production Index (RPI) for assessing bone marrow response, along with conditions that may interfere with hematology analyzers. Additionally, it explains the erythrocyte sedimentation rate (ESR) as a non-specific inflammatory response measurement, including factors affecting it and common errors in testing.

Uploaded by

Bae Allahnie Lengga
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

Reticulocyte count

Reticulocyte count
•Provides a measure of erythropoiesis and often used to assess the bone marrow’s response to
anemia.
•Manual methods use supravital stains such as new methylene blue or brilliant cresyl blue.
•Relative reticulocyte count (use miller disk)
Relative retics (%) = # of retics / 1000 RBCs observed X 100
Normal Value = 0.5 to 1.5%
•Absolute reticulocyte count (actual number or reticulocytes / 1L of whole blood)
Absolute retics = retic (%) X RBC count / 100
Normal value = 25-75 x 109/L
Reticulocyte count
• Corrected reticulocyte count – done on specimens with low hematocrit, falsely Increase Retics,
decrease RBC count
Corrected retics = retic (%) X Hct (L/L) / 0.45
Normal Value = Hct = 35% ; Retic ct = 2-3 %
= Hct = <25% ; Retic ct = 3-5%
•Reticulocyte Production Index (RPI) – for shift retics (immature retics)
- Check to the response of Bone marrow
- Retics result on previous day (overlap retics released)
RPI = Corrected retics / Maturation time in days
Reticulocyte count
Hct Retic maturation time (in days)
0.40 – 0.45 1.0
0.35-0.39 1.5
0.25-0.34 2.0
0.15-0.24 2.5
<0.15 3.0

Normal value

>3% = Adequate Bone marrow response


<2% = Inadequate Bone marrow response
CONDITIONS THAT CAUSE INTERFERENCES
ON MOST HEMATOLOGY ANALYZERS
CAUSE EFFECT REMEDY

Cold agglutinins ↓RBC, ↑MCV, ↑ MCHC Warm sample and rerun


Indicator : shift to the right in the
rbc histogram
Lipemia, icterus, chylomicrons ↑ hgb, MCHC, MCH Plasma replacement
(affect spectro reading) Indicator : Hgb x 3 not equal to
Hct
Lysis resistant RBCs w/ abnormal ↑ WBC and hgb -Manual dilution of lysing reagent
Hbs. RBCs with Hb S, C or F may Indicator : Interference on -Allow incubation time for lysis
fail to lyse and be counted as Histogram
WBCs
Platelet clumps (plt satellitism) ↓ Platelet, ↑ WBC -Redraw specimen in sodium
Indicator : Interference on citrate & multiply result by 1.1.
histogram
ERYTHROCYTE SEDIMENTATION
RATE
• Non-specific measurement used to detect and monitor an inflammatory response
•Settling of RBC at the bottom of a tube upon standing undisturbed for 1 hour
•Distance in mL that the RBC fall in 1 hour
Decrease Increase

RBC factors •
•
Microcytes
Anisocytes
•
•
Macrocytes
Anemia
• Poikilocytes • Agglutination
• Polycythemia • Rouleaux
• Sickle Cells

Plasma Factors (single most important • Albumin (Increase viscosity) •


•
Fibrinogen
Globulins
factor in ESR determination)

Technical Factors •
•
Delay in testing
Overanticoagulation
•
•
Tilting of tube
Increased temperature
• Mechanical vibration
• Length & diameter of tube
Stages of Erythrocyte
Sedimentation
1. Lag phase - 10 minute
- Rouleaux phase
- Rouleaux formation occurs and sedimentation rate is slight

2. Decantation phase – 40 minutes


- Rapid settling phase
- Sedimentation occurs at a more rapid and constant rate

3. Slow sedimentation phase – 10 minutes


- Packing phase
- RBCs accumulate at the bottom of the tube
Commonly encountered
Errors
• Overanticoagulation with EDTA – Falsely decrease (shrinkage of cells)
• ESR stands for more than 60 minutes or less than 60 minutes
- > 60mins = Falsely increase
- < 60mins = Falsely decrease
• Temperature – directly proportional
• Tilting of the ESR tube = Falsely increase
• Bubbles in the blood - Invalidate results
• Fibrin Clots present - Invalidate results

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