Reference intervals for reticulocyte indices, immature reticulocyte fraction, and the percentage of hypochromic red blood cells in adult large breed dogs using the ADVIA 2120 hematology analyzer.

Reticulocyte indices are used to characterize anemia, including the identification of regeneration. In people, the immature reticulocyte fraction (IRF), percentage of hypochromic red blood cells (%HYPO-RBC), and other reticulocyte indices have been used as earlier indicators of erythropoiesis and as valuable monitoring tools in the assessment of various therapies. The reference intervals (RI) of the IRF and %HYPO-RBC have not been reported in dogs. The objective of this study was to establish RIs for novel variables (IRF, %HYPO-RBC, and CH-delta) and assess RIs for more commonly reported reticulocyte indices in healthy dogs. RIs were calculated from blood results retrospectively collected from 106 client-owned healthy dogs at the time of induction into a blood donor program using the ADVIA 2120 hematology analyzer (Siemens Healthcare Diagnostics). For the calculation of RIs, appropriate tests were applied for outlier detection and normality assessment. For variables normally distributed, RIs and their respective 90% confidence intervals (CIs) were calculated using parametric methods, while for variables not normally distributed, robust methods were used and bootstrapping for calculating the 90% CIs. The following RIs were established: reticulocyte hemoglobin content (CHr) 24.5-28 pg, mean reticulocyte volume (MCVr) 85.9-99.3 fL, mean corpuscular hemoglobin concentration of reticulocytes (CHCMr) 271.0-306.3 g/L, IRF 10.4%-43.5%, CH-delta 0.5-4.3 pg, and percentage of hypochromic red blood cells (%HYPO-RBC) 0.10%-0.80%. The results of this study provide RIs for novel reticulocyte variables. Further studies are required to determine the clinical utility of IRF, %HYPO-RBC, and CH delta as early indicators of erythropoietic activity in canine patients.

Mean reticolocyte hemoglobin content index plays a key role to identify children who are carriers of ß-thalassemia.

Reticulocyte (r) and red blood cell (RBC) indices provide reliable parameters for screening and monitoring iron deficiency anemia (IDA) patients and ß-thalassemia trait (BTT) carriers. The aim of this study is to identify a simple method for use to distinguish ß-thalassemia trait carriers from IDA and to evaluate the correlation between BTT genetic mutation and MCV values and new discrimination index for the detection of ß-thalassemia trait (DI-BTT). We analyzed CHr, MCHCr, MCVr, RBC, mean cellular hemoglobin concentration (MCHC) and mean cellular volume (MCV) indices among a pediatric population of IDA patients (n=90), ß-thalassemia trait carriers (n=72) and normal controls (NC) (n=131). Furthermore, to distinguish IDA patients from ß-thalassemia trait carriers we evaluated clinical utility of new DI for the detection BTTcarriers, using the following polynomial: (RBC × MCHC × 50/MCV)/CHr. We found that CHr, MCVr and DI-BTT mean values were significantly different between ß-thalassemia trait carriers and IDA patients. CHr, MCVr and DI-BTT plotting curves showed exclusive distribution in ß-thalassemia trait carriers. Moreover, DI-BTT was very accurate in differentiating ß-thalassemia trait carriers from IDA patients. All BTT patients showed a heterozygous mutation of the ß-globin gene including CD39, IVS1.110, IVS1.6 and IVS2.745, IVS2.1 and IVS1.1. The highest MCV values were displayed by those carrying the IVS1.6 mutation. CONCLUSIONS: The simultaneous measurement and plotting of CHr and MCVr indices, as well as the DI-BTT allow to distinguish ß-thalassemia carriers from IDA patients.

Mean reticolocyte hemoglobin content index plays a key role to identify children who are carriers of ß-thalassemia.

Reticulocyte (r) and red blood cell (RBC) indices provide reliable parameters for screening and monitoring iron deficiency anemia (IDA) patients and ß-thalassemia trait (BTT) carriers. The aim of this study is to identify a simple method for use to distinguish ß-thalassemia trait carriers from IDA and to evaluate the correlation between BTT genetic mutation and MCV values and new discrimination index for the detection of ß-thalassemia trait (DI-BTT). We analyzed CHr, MCHCr, MCVr, RBC, mean cellular hemoglobin concentration (MCHC) and mean cellular volume (MCV) indices among a pediatric population of IDA patients (n=90), ß-thalassemia trait carriers (n=72) and normal controls (NC) (n=131). Furthermore, to distinguish IDA patients from ß-thalassemia trait carriers we evaluated clinical utility of new DI for the detection BTTcarriers, using the following polynomial: (RBC × MCHC × 50/MCV)/CHr. We found that CHr, MCVr and DI-BTT mean values were significantly different between ß-thalassemia trait carriers and IDA patients. CHr, MCVr and DI-BTT plotting curves showed exclusive distribution in ß-thalassemia trait carriers. Moreover, DI-BTT was very accurate in differentiating ß-thalassemia trait carriers from IDA patients. All BTT patients showed a heterozygous mutation of the ß-globin gene including CD39, IVS1.110, IVS1.6 and IVS2.745, IVS2.1 and IVS1.1. The highest MCV values were displayed by those carrying the IVS1.6 mutation. CONCLUSIONS: The simultaneous measurement and plotting of CHr and MCVr indices, as well as the DI-BTT allow to distinguish ß-thalassemia carriers from IDA patients.

Reticulocyte Hemoglobin Content During the First Month of Life in Critically Ill Very Low Birth Weight Neonates Differs From Term Infants, Children, and Adults.

BACKGROUND: Reticulocyte hemoglobin content (RET-He)-an established indicator of iron status in children and adults-was determined in very low birth weight (VLBW) infants. METHODS: Longitudinal retrospective RET-He data in 26 VLBW neonates during the first month of age were compared with: (a) concurrent complete blood counts (CBCs), including hemoglobin (Hb) concentration, reticulocyte count, and immature reticulocyte fraction (IRF), and erythropoietin (EPO) levels; (b) clinical variables; and (c) RET-He data from the literature for term infants, children, and adults. RESULTS: RET-He within 24 hr following birth was 31.8 ± 1.1 pg (mean ± SEM). This was followed by an abrupt, significant decline to 28.3 ± 1.1 pg at 2-4 days, and to steady state levels of 28.4 ± 0.5 pg thereafter. The changes in RET-He were mirrored by changes in plasma EPO, reticulocyte count, and IRF, but not Hb. Steady state RET-He values after 4 days were significantly lower than RET-He values for term infants, children, and adults (31.6 ± 0.11, 32.0 ± 0.12, and 33.0 ± 0.13 pg, respectively). CONCLUSION: Although RET-He values in VLBW infant were lower than term infants, children, and adults, the significance and mechanism(s) responsible are unknown. The present VLBW infant data are relevant to investigations assessing hemoglobinization following treatment with recombinant human EPO (r-HuEPO) and/or iron.

Discrimination of various thalassemia syndromes and iron deficiency and utilization of reticulocyte measurements in monitoring response to iron therapy.

Decreased hemoglobinization of red cells resulting in hypochromia and microcytosis are the main features of thalassemia syndromes, and also of iron deficiency anemia (IDA). A simple and reliable method is required to distinguish the two conditions in the routine laboratories. In this study we analyzed the red cell and reticulocyte parameters from 414 samples of various types of thalassemias and IDA and discovered a variety of discriminating criteria including a discrimination index (DI) which should be useful for differential diagnosis. Slightly decreased MCV and CH are suggestive of α-thalassemia 2, Hb CS, and Hb E heterozygotes whereas the increased Rbc counts are obvious in α-thalassemia 1 and ß-thalassemia. In Hb E, the number of microcytic red cells was greater than the number of hypochromic red cells resulting in an increased M/H ratio. Hb H diseases are characterized by a higher number of hypochromic red cells and decreased CHCM, while broadening of hemoglobin concentration histogram results in increased HDW in ß-thalassemia diseases. Iron deficiency anemia results in hypochromic-microcytic red cells and increased RDW. The number of reticulocyte with %High Retic and CHr value were increased in the first month of iron supplementation indicating the response to iron therapy.

Reticulocyte Indices for the Differential Diagnosis of Anemia of Chronic Disease and Iron Deficiency Anemia in Adult Women with Microcytic Hypochromic Anemia

BACKGROUND: Iron deficiency anemia (IDA) is the most common anemia followed by anemia of chronic disease (ACD). Reticulocyte indices have been shown to be helpful indicators for detecting IDA. We investigated whether RBC and reticulocyte indices can be used to differentiate ACD from IDA. METHODS: A total of 85 women showing microcytic hypochromic anemia (38 IDA and 47 ACD cases) were enrolled. IDA was defined as those with ferritin level of 450 microg/dL. ACD was defined as ferritin level of > or =6 microg/dL, TIBC of or =24.6 pg could be used to differentiate ACD from IDA with 85.1% sensitivity and 81.6% specificity. CONCLUSIONS: The reticulocyte indices, especially CHr, are useful for the differential diagnosis of microcytic hypochromic anemias, ACD and IDA.

O hemograma: importância para a interpretação da biópsia / Blood cell analysis: the importance for biopsy interpretation

Os dados fornecidos pelo hemograma são essenciais dentro da investigação das doenças hematológicas. Os contadores automatizados constantemente têm incorporado novas tecnologias que permitem uma análise mais detalhada das células. Informações referentes tanto a aspectos quantitativos como morfológicos das células sanguíneas podem ser úteis na análise da medula óssea. Nessa minirrevisão alguns desses novos parâmetros são apresentados, como o RDW (distribuição da população de hemácias de acordo com o volume) e índices relacionados ao tamanho, grau de maturidade e conteúdo de hemoglobina dos reticulócitos. A interpretação dos histogramas de hemácias, leucócitos e plaquetas podem fornecer informações adicionais aos resultados numéricos. Outros parâmetros e índices plaquetários, como o volume plaquetário médio (VPM) e a fração de imaturidade das plaquetas (IPF) são introduzidos, embora não estejam ainda padronizados e devam ser usados com cautela. São ainda discutidas a quantificação das várias populações de leucócitos presentes na circulação sanguínea obtidas pelos sistemas automatizados, suas vantagens e limitações. Embora o desenvolvimento de sofisticados analisadores hematológicos tenha reduzido o número de revisões de lâminas de esfregaço sanguíneo, essa prática deve ser encorajada, uma vez que a observação microscópica das células é uma ferramenta importante na identificação de diversas patologias.

Examination of blood cells is an essential part of the hematological investigation. The introduction of new physical principles for cell analysis incorporated into automated cell counters has provided new information about blood cells. Data related to both quantification and cell morphology features observed in peripheral blood examinations may be helpful during bone marrow analysis. In this brief review some of these new parameters are presented, such as the red blood cell distribution width (RDW) and indices related to volume, immaturity and hemoglobin content of reticulocytes. The interpretation of graphic displays (histograms of red cells, white cells and platelets) can provide further information that is not available from the assessment of numeric data. Other parameters and platelet indices, such as the mean platelet volume (MPV) and immature platelet fraction (IPF) are introduced, although they are still not standardized and must be used with caution. The quantification of various white blood cell populations present in peripheral blood and the advantages and limitations of automated counts are considered. Although the development of sophisticated automated blood cell analyzers has reduced the number of blood smear examinations, this type of procedure should be encouraged as the smear is an important tool in the diagnosis of several pathologic conditions.

Reference Intervals of Reticulocyte Parameters using ADVIA 120 / 대한진단검사의학회지

BACKGROUND: Reticulocytes are circulating immature erythrocytes at the stage just before maturity of the erythrocyte. The maturation time for reticulocyte is 3.5 to 4 days including one day of circulation; therefore, circulating reticulocytes represent marrow erythropoietic activity that is faster than any other hematologic item. To take advantage of reticulocyte parameters, we should first identify the reference ranges and understand the basic information of the parameters. METHODS: We selected healthy subjects with normal Hb, WBC and platelet count in an annual health surveillance of employees of Boramae Hospital. In total, 285 subjects (74 males and 211 females) were analyzed using ADVIA 120. The analyzed parameters were reticulocyte count, reticulocyte indices and reticulocyte maturity indices. The reference intervals were obtained with the central 95% of the distribution. RESULTS: The reference intervals: reticulocyte count 41.8-121.3 (106/ L), 0.9-2.5 (%); MFR (middle fluorescence reticulocyte) 1.3-9.8 (%); HFR (high fluorescence reticulocyte) 0-1.5%; MCVr (MCV for reticulocyte) 100.6-112.7 (fL); CHCMr (cellular hemoglobin concentration mean for reticulocyte) 29.5-33 (g/dL); RDWr 8-10.5 (%); CHr (cellular hemoglobin content for reticulocyte) 30.8-35.5 (pg). According to the maturation of reticulocytes, the volume decreased 20%, CHCM increased 11%, and CH decreased 6%. CONCLUSIONS: The reticulocyte parameters are available for realtime assessment of marrow erythropoietic activity and clinically they will help in the diagnosis and treatment of various anemias.