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SEED HAEMATOLOGY
History
n
1865
blood cells.
n 1932
n
1960
a further three days and for one day in the peripheral blood-
n
1983
cytometry.
Morphological description
Stage 0
Nucleus
Stage I
<0.1
Stage II
7.0
Stage III
32.0
Stage IV
61.0
in granulopoiesis).
Reticulocyte count
peripheral bloodstream.
bloodstream.
Manual count
(Materials: supravital stains, such as brilliant cresyl blue
a microscope).
stain.
Forward scatter
Fluorescence
Fig. 2 Scattergram of the reticulocyte channel (RBC: mature red blood
cells; RET: reticulocytes; PLT: fluorescence-optical platelets)
Reticulocyte count
in blood (%)
39,600
19,600
7,600
10
3,600
20
1,600
50
400
locyte count in severe anaemia does not indicate a sufficiently strong regeneration of erythropoiesis, but merely
indicates a shortened life span of the red blood cells. It is
preferable to report the absolute reticulocyte concentration
as reticulocytes/L, as this provides a direct measurement
of erythropoietic performance.
Automated counting
To accurately measure reticulocyte counts, automated counters
some information about the life span of the red blood cells,
RBC, and reach its peak in 610 days [11]. If that does not
following:
Relative reticulocytes:
Reticulocyte count:
called a shift). This leads to a pronounced increase in circulating reticulocytes, but does not represent proof of erythropoietic performance. The maturation time of reticulocytes
in bone marrow is proportional to the haematocrit, i.e. it
only after having validated them. Since there are also differ-
Reticulocyte-associated parameters
Reticulocyte index (RI)
The relative portion ( and %) of reticulocytes may
increase, if either the reticulocytes are in fact increased or
the red blood cells are decreased. Corrective measures can
be carried out via the patients haematocrit by reference
to a normal haematocrit of 0.45 [L/L]. This type of correction
3645%
1 day
2635%
1.5 days
1625%
2 days
2.5 days
RPI =
Example:
Patient values: HCT= 0.25 L/L, reticulocytes = 20
RET [%]
HCT [L/L] (patient)
x
RET maturation time
0.45 (standard HCT)
in blood in days
RPI =
20 [%]
x
2
0.25
0.45
= 5.5
Reticulocyte maturation
days. If the IRF value does not increase during the treatment
intensity. The higher the RNA content, the less mature the
reticulocytes are.
in 80% of the cases the IRF value reaches its 5% mark earlier
granulocytes/L [13].
n HFR
semi-mature reticulocytes
ent pathologies are represented with different levels of
(high-fluorescence reticulocytes)
immature reticulocytes
blood cells but not the ones of the white blood cell line.
maturation index.
Immature
reticulocytes
Acute
leukaemia
Haemolysis
High
Dyserythropoiesis
Normal
Low
Polycyth.
vera
Normal
Aplasia
Low
Normal
High
Reticulocytes
MFR
HFR
Low-Fluorescence Reticulocytes
Medium-Fluorescence Reticulocytes
High-Fluorescence Reticulocytes
Mature reticulocytes
Semi-mature reticulocytes
Immature reticulocytes
Indication
n
anaemias
to erythropoiesis.
RET-He represents the HGB content of young RBC, the reticulocytes, and thus offers real-time information on iron supply
means you can look at the current iron supply to erythropoiesis and judge the quality of the newly produced cells.
This lets you detect changes in iron status far earlier than
ment of the iron actually used for the biosynthesis of haemoglobin can indicate even in these cases whether there is
Thomas-Plot index
are under treatment and see how they move from one quad-
rant to another.
Conclusions
red blood cells, but the quantity aspect is not the only one
References
[1]
Koepke et al. (1986): Reticulocytes. Clin Lab Haematol 8, 169179.
[7]
Peebles DA et al. (1981): Paediatric Haematology. Churchill
Livingstone.
[2] T
he Expert Panel on Cytometry of the International Council of
Standardization in Haematology. (1992): ICSH Guidelines for
Reticulocyte Counting by Microscopy of Supravitally Stained Preparations. World Health Organization, Geneva.
[8]
Savage RA et al. (1985): Analytical Inaccuracy and Imprecision of
Reticulocyte Counting: A Preliminary Report from the College of
American Pathologists Reticulocyte Project. Blood Cells 11:97.
[3]
Means RT et al. (2009): Anemia: Wintrobes Clinical Hematology,
12th ed. Philadelphia, PA: Lippincott Williams and Wilkins. Vol. 1:
Chapter 26.
[4]
Lilleyman JJ et al. (1992): Paediatric Haematology. Churchill
Livingstone.
[5]
Piva E et al. (2010): Automated reticulocyte counting: state of the
art and clinical applications in the evaluation of erythropoiesis.
Clin Chem Lab Med 48(10):1369 1380.
[6]
Cavill et al. (1996): In vitro stability of the reticulocyte count. Clin
Lab Haem 18 Suppl:911.
[11]
Hoffbrand AV & Moss PAH. (2011): Essential Haemotology,
6th Ed. Wiley and Blackwell; West Sussex, UK.
[12]
Adamson JW & Longo DL. Anemia and polycythemia. In:
Braunwald E et al. (2001): Harrison's Principles of Internal
Medicine (15th Edition). McGraw Hill (New York).
[15]
Thomas C et al. (2006): The diagnostic plot: A concept for
identifying different states of iron deficiency and monitoring the
response to epoetin therapy. Medical Oncology Volume 23, Issue 1,
pp. 2336.
[16] Thomas L & Thomas C. (2004): Biochemical markers and
haematologic indices in the diagnosis of iron-restricted erythropoiesis and monitoring of r-HuEPO therapy. Jugoslov Med Biohem
23(3):235238.
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[13]
dOnofrio G et al. (1996): Indicators of haematopoietic recovery
after bone marrow transplantation: the role of reticulocyte
measurements. Clin Lab Haem 18(Suppl.1):4553.