To accurately measure reticulocyte counts, automated
counters use a combination of laser excitation, detectors and a
fluorescent dye that marks
RNA and
DNA (such as
titan yellow or
polymethine). Reticulocytes appear slightly bluer than other red cells when looked at with the normal
Romanowsky stain. Reticulocytes are also relatively large, a characteristic that is described by the
mean corpuscular volume. of a smear of human blood from a patient with
hemolytic anemia. The reticulocytes are the cells with the dark blue dots and curved linear structures (reticulum) in the cytoplasm. The normal fraction of reticulocytes in the blood depends on the clinical situation but is usually 0.5% to 2.5% in adults and 2% to 6% in infants. A reticulocyte percentage that is
higher than "normal" can be a sign of
anemia, but this depends on the health of a person's bone marrow. Calculating the
reticulocyte production index is an important step in understanding whether or not the reticulocyte count is appropriate to the situation. This is often a more important question than whether the percentage is in the normal range; for instance, if someone is anemic but has a reticulocyte percentage of only 1%, the bone marrow is likely not producing new blood cells at a rate that will correct the anemia.
Immature reticulocyte fraction (IRF) Reticulocytes at less mature levels can be detected by having higher intensity fluorescence regions. An increased immature reticulocyte fraction (IRF), specifically an IRF more than or equal to 0.23, together with an increased absolute reticulocyte count, generally indicates an adequate erythroid response to anemia. An IRF of more than 0.23 but a subnormal or normal absolute reticulocyte count (with a corresponding reticulocyte production index of less than or equal to 2) is seen in for example acute infection, iron deficiency anemia, human immunodeficiency virus infection, sickle disease with crisis, pregnancy, and myelodysplastic syndrome. An IRF of less than 0.23 is seen in diseases that lead to decreased erythropoietic activity, predominantly chronic renal insufficiency. ==Development==