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Reticulocyte counts in newborns.

Q When doing a reticulocyte count on a newborn, if the hematocrit is greater than 0.45 but the polychromasia is moderate or marked, should a reticulocyte index still be performed? Everything I read links the reticulocyte index to the lower hematocrits and does not address this problem, which can be found in healthy newborns.

A The methods to express reticulocyte counts have been studied for many years. Before the advent of accurate and precise red cell counts, the reticulocyte index was a popular method to report this information by putting it in context with the presence or absence of anemia.

Current recommendations for reporting reticulocytes are that reticulocytes be reported in absolute terms.[1] The reason for this recommendation is that it avoids questions such as the one you asked. With the availability of accurate and precise red cell counts coupled with a reasonably precise manual/visual reticulocyte percentage, the reticulocyte count can be technically very good.[2] The automated reticulocyte counters, which are now quite popular, report the reticulocyte counts in absolute as well as proportional terms.

It may require a certain amount of staff education to modify your reporting procedures; but in the long run, less ambiguous results should improve patient care.

John A. Koepke, MD Professor Emeritus of Pathology Duke University Medical Center Durham, NC


(1.) NCCLS. Methods for Reticulocyte Counting (Flaw Cytometry and Supravital Stains): Approved Guideline. H44-A. Wayne, PA: NCCLS; 1997: p. 17.

(2.) Koepke JA. Update on reticulocyte counting. Lab Med. 1999;30:339-343.
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Author:Koepke, John A.
Publication:Medical Laboratory Observer
Article Type:Brief Article
Geographic Code:1USA
Date:Apr 1, 2000
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