Test Catalog

Test Id : RETB

Reticulocyte Profile, Blood

Useful For
Suggests clinical disorders or settings where the test may be helpful

Assessing erythropoietic bone marrow activity in anemia and other hematologic conditions

Assessment of acute iron deficiency

Monitoring early response to iron therapy or erythropoiesis-stimulating agents

Early monitoring of therapy for nutritional anemias (eg, megaloblastic, iron deficiency) where immature reticulocyte fraction precedes reticulocyte count increase by several days

Monitoring therapeutic efficacy of erythropoietin treatment

Monitoring early engraftment after bone marrow transplantation

Method Name
A short description of the method used to perform the test

Flow Cytometry

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Reticulocyte Profile, B

Aliases
Lists additional common names for a test, as an aid in searching

Immature red blood cells

Reticulocyte hemoglobin content

RET-He

Reticulocyte Hemoglobin equivalent

CHr

Specimen Type
Describes the specimen type validated for testing

Whole Blood EDTA

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Container/Tube: Lavender top (EDTA)

Specimen Volume: 3 mL

Collection Instructions: Send whole blood specimen in original tube. Do not aliquot.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

0.5 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis Reject
Clotted Reject

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Whole Blood EDTA Refrigerated (preferred) 48 hours
Ambient 24 hours

Useful For
Suggests clinical disorders or settings where the test may be helpful

Assessing erythropoietic bone marrow activity in anemia and other hematologic conditions

Assessment of acute iron deficiency

Monitoring early response to iron therapy or erythropoiesis-stimulating agents

Early monitoring of therapy for nutritional anemias (eg, megaloblastic, iron deficiency) where immature reticulocyte fraction precedes reticulocyte count increase by several days

Monitoring therapeutic efficacy of erythropoietin treatment

Monitoring early engraftment after bone marrow transplantation

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Reticulocytes are immature erythrocytes (RBC) that have been released into the peripheral blood from the bone marrow after extrusion of their nucleus. The reticulocyte contains residual polyribosomes used in the formation of hemoglobin in the developing erythrocyte.

 

Iron deficiency suppresses hemoglobin synthesis.(1) Iron indices that rely on measurement of mature RBC may not accurately reflect acute iron status due to their long (approximately 120 days) lifespan.

 

Reticulocytes are differentiated from erythroblasts (RBC containing a nucleus made in the bone marrow) after hemoglobin synthesis is complete and enucleation (extrusion of the nucleus). The reticulocyte is released from the bone marrow into peripheral circulation to complete maturation through loss of its reticulum (RNA and protein visible with staining) over the course of 1 to2 days becoming mature RBC. Ultimately, hemoglobin content in reticulocytes is more reflective of real time hemoglobin synthesis, provided there is not an underlying hematopoietic disorder preventing the production of reticulocytes.

 

Reticulocyte Hemoglobin:

Reticulocyte hemoglobin may be particularly useful to evaluate iron deficiency in chronic kidney disease patients on hemodialysis receiving erythropoietin or other erythropoiesis-stimulating agents as they are prone to chronic inflammatory states that complicate traditional iron evaluations. Studies report reticulocyte hemoglobin concentrations below 29 to 32 pg in this population have areas under the receiver-operating curve (ROC area) of 0.74-0.95 for diagnosing iron deficiency compared to low serum ferritin (ROC area range: 0.53 to 0.63) or transferrin saturation (ROC area range: 0.56 to 0.76).(2)

 

Iron deficiency in childhood is common yet critical to recognize early and treat. Guidelines recommend using hemoglobin in combination with either ferritin and C-reactive protein or reticulocyte hemoglobin. The advantage of using reticulocyte hemoglobin is its lower cost and does not require additional blood volume to be collected when combined with complete blood count testing.

 

Reticulocyte hemoglobin is also used to evaluate response to treatment for iron deficiency, which is one of the earliest markers of response to oral iron treatment (48 hour) in children with severe iron deficiency anemia. Measurement within 7 days from the start of oral iron is predictive of reaching reference value of hemoglobin at day 30 (3) and has been used to improve iron sufficiency rates in neonatal ICU populations.(4)

 

Other patient populations that may benefit from reticulocyte hemoglobin measurement include those with anemia of chronic disease, postpartum, and blood donors.(2)

 

Immature Reticulocyte Fraction:

The reticulocyte is released from the bone marrow into peripheral circulation to complete maturation through loss of its reticulum (RNA and protein measured via fluorescence) over the course of 1 to 2 days becoming mature RBC. The immature reticulocyte fraction measures reticulocyte maturity through quantitation of fluorescence intensity. The most intense signal corresponds to the most immature reticulocytes containing the greatest amount of reticulin. When present in highest proportion of total reticulocytes can be the earliest indicator of beginning erythropoiesis.

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

% RETICULOCYTES

1-3 days: 3.47-5.40%

4 days-4 weeks: 1.06-2.37%

5 weeks-7 weeks: 2.12-3.47%

8 weeks-5 months: 1.55-2.70%

6 months-23 months: 0.99-1.82%

24 months-5 years: 0.82-1.45%

6-11 years: 0.98-1.94%

12-17 years: 0.90-1.49%

Adults: 0.60-2.71%

 

ABSOLUTE RETICULOCYTES

1-3 days: 147.5-216.4 x 10(9)/L

4 days-4 weeks: 51.3-110.4 x 10(9)/L

5 weeks-7 weeks: 51.8-77.9 x 10(9)/L

8 weeks-5 months: 48.2-88.2 x 10(9)/L

6 months-23 months: 43.5-111.1 x 10(9)/L

24 months-5 years: 36.4-68.0 x 10(9)/L

6-11 years: 42.4-70.2 x 10(9)/L

12-17 years: 41.6-65.1 x 10(9)/L

Adults: 30.4-110.9 x 10(9)/L

 

IMMATURE RETICULOCYTE FRACTION (IRF)

1-3 days: 30.5-35.1%

4 days-1 month: 14.5-24.6%

1-2 months: 19.1-28.9%

3-5 months: 13.4-23.3%

6 months-<2 years: 11.4-25.8%

2-<6 years: 8.4-21.7%

6-<12 years: 8.9-24.1%

12-<18 years: 9.0-18.7%

Female-> or = 18 years: 3.0-15.9%

Male- > or = 18 years: 2.3-13.4%

 

RETICULOCYTE HEMOGLOBIN

Males:

1 day-5 months: 27.6-38.7 pg

6 months-<2 years: 28.7-35.7 pg

2-<6 years: 27.7-37.8 pg

6-<12 years: 32.4-37.6 pg

12-<18 years: 30.0-37.6 pg

Adults: 30.0-37.6 pg

 

Females:

1 day-5 months: 29.2-37.5 pg

6 months-<2 years: 30.1-35.7 pg

2-<6 years: 29.3-37.3 pg

6-<12 years: 30.4-39.7 pg

12-<18 years: 30.0-37.6 pg

Adults: 30.0-37.6 pg

 

RED BLOOD CELL COUNT (RBC)

Males:

0-14 days: 4.10-5.55 x 10(12)/L

15 days-4 weeks: 3.16-4.63 x 10(12)/L

5 weeks-7 weeks: 3.02-4.22 x 10(12)/L

8 weeks-5 months: 3.43-4.80 x 10(12)/L

6 months-23 months: 4.03-5.07 x 10(12)/L

24 months-35 months: 3.89-4.97 x 10(12)/L

3-5 years: 4.00-5.10 x 10(12)/L

6-10 years: 4.10-5.20 x 10(12)/L

11-14 years: 4.20-5.30 x 10(12)/L

15-17 years: 4.30-5.70 x 10(12)/L

Adults: 4.35-5.65 x 10(12)/L

 

Females:

0-14 days: 4.12-5.74 x 10(12)/L

15 days-4 weeks: 3.32-4.80 x 10(12)/L

5 weeks-7 weeks: 2.93-3.87 x 10(12)/L

8 weeks-5 months: 3.45-4.75 x 10(12)/L

6 months-23 months: 3.97-5.01 x 10(12)/L

24 months-35 months: 3.84-4.92 x 10(12)/L

3-5 years: 4.00-5.10 x 10(12)/L

6-10 years: 4.10-5.20 x 10(12)/L

11-14 years: 4.10-5.10 x 10(12)/L

15-17 years: 3.80-5.00 x 10(12)/L

Adults: 3.92-5.13 x 10(12)/L

 

Interpretation
Provides information to assist in interpretation of the test results

Reticulocyte Quantitation:

The reticulocyte count is a measure of the number of red blood cells delivered by the bone marrow. It is elevated with active erythropoiesis such as regeneration and is decreased in hypoplastic or deficiency conditions such as vitamin B12 deficiency.

 

Reticulocyte Hemoglobin:

Decreased values are suggestive of acute iron deficiency

Increasing values following treatment with iron or erythropoiesis-stimulating agents suggest early response to therapy

 

Immature Reticulocyte Fraction:

Immature reticulocyte fraction (IRF) is interpreted in conjunction with the reticulocyte count. It provides similar information as the traditional reticulocyte production index, which was a value calculated from the reticulocyte percentage and hematocrit.

 

An increase in both total reticulocytes and IRF is associated with erythropoiesis in conditions such as acquired hemolytic anemias or the loss of blood.(5)

 

A decrease in both IRF and absolute reticulocyte count is associated with reduced marrow production.(5)

 

An increased IRF associated with reduced or normal reticulocyte count is associated with acute infections, myelodysplastic syndromes, or dyserythropoietic anemias.(5)

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Reticulocyte counts must be carefully correlated with other clinical and laboratory findings.

 

Clotted specimens yield unreliable results and are unacceptable for analysis.

 

Reticulocyte hemoglobin concentration is decreased in thalassemia syndromes and other microcytic anemias resulting from congenital hemoglobin diseases.

 

A pronounced decrease in reticulocyte hemoglobin greater than 25 pg has a high degree of accuracy for detecting alpha or beta thalassemia.(6)

 

Reticulocyte hemoglobin values should be interpreted in the context of the patient’s overall erythrocyte physiology, including knowledge of recent blood transfusions, iron therapy, vitamin B12 or folate deficiency, chemotherapy, and the results of hemoglobin analysis.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Chabot-Richards DS, Zhang QY, George TI: Automated hematology. In: Rifai N, Horvath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics; 6th ed. 2018:1734-1734

2. Ogawa C, Tsuchiya K, Maeda Kl :Reticulocyte hemoglobin content. Clinica Chimica Acta. 2020 May;504:138-145

3. Parodi E, Romano F, Ramenghi U:How we use reticulocyte parameters in workup and management of pediatric hematologic diseases. Front Pediatr.2020 Dec 4;8:588617

4. Morton SU, Yuen JC, Feldman HA, et al: Screening with Retic Hb increased iron sufficiency among NICU patients. Pediatr Qual Saf. 2020 Feb 13;5(2):e258.doi: 10.1097/pq9

5. Buttarello M. Laboratory diagnosis of anemia: are the old and new red cell parameters useful in classification and treatment, how? Int Jn  Lab Hematol. 2016 May;38 Suppl 1:123-132

6. Saboor M. Discrimination of iron deficiency, alpha and beta thalassemia on the basis of red cell distribution width and reticulocyte indices. Clin Lab. 2021 Jun 1;67(6):1365-1370.

7. Morkis IV, Farias M, Scotti L. Determination of reference ranges for immature platelet and reticulocyte fractions and reticulocyte hemoglobin equivalent. Rev Bras Hematol Hemoter. 2016 Jul;3 8(4):310–313

8. Soldin J, Brugnara C, Wong EC: Pediatric Reference Intervals. 5th ed. AACC Press; 2005

Method Description
Describes how the test is performed and provides a method-specific reference

The Sysmex XN reticulocyte analysis is based on flow cytometry method using a semiconductor laser. A two-dimensional scattergram is plotted, with the X-axis representing the intensity of the side fluorescent light, and the Y-axis representing the intensity of the forward scattered light. This scattergram displays groups of reticulocytes, mature red blood cells and platelets.

 

The scattergram is divided into three reticulocyte (RET) zones based on the intensity of the fluorescent light, and the ratio of the reticulocytes in each zone to the total number of reticulocytes is calculated.

 

The immature reticulocyte fraction (IRF) is obtained as a ratio of reticulocytes count in the area with strong fluorescent light intensity in the RET scattergram (IRF zone), to the total reticulocytes count.

 

RET-He (reticulocyte hemoglobin equivalent) is a unique parameter developed by Sysmex that is derived using the reticulocyte scattered light signals and a proprietary Sysmex calculation equation.(Instruction manual: Automated Hematology Analyzer XN series [XN-9000], North American edition, Code No. CJ410539.Sysmex; 11/2015)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Sunday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

1 to 3 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

3 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

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  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

85046

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
RETB Reticulocyte Profile, B 50262-5
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
RBC Erythrocytes 789-8
PRTIC Reticulocytes, B 17849-1
ARTIC Absolute Reticulocyte 60474-4
IRF1 Immature Retic Fraction 33516-6
RETHB Reticulocyte Hemoglobin 71694-4

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports