At one time a number of conditions could result in pseudo-reticulocytosis. Newer analyzers have ways of detecting and handling this interference. How these are handled can be part of the evaluation of a new instrument.
Conditions that could interfere with automatic reticulocyte counts:
(1) malaria parasites
(2) cold agglutinins (with clumping of red blood cells)
(3) giant platelets
(4) nucleated red blood cells
(5) red blood cell autofluorescence
(6) high leucocyte count
(7) high platelet count
Conditions that may or may not interfere with automatic reticulocyte counts:
(1) Howell-Jolly bodies
(2) Pappenheimer bodies
(3) basophilic stippling
Situations in which a problem is detected:
(1) very high reticulocyte count
(2) normal reticulocyte count in a patient with hypoplastic marrow
(3) very low reticulocyte count (can occur with nucleated RBCs)
An automated analyzer may handle the situation by:
(1) regating
(2) giving an alert (flagging) to the operator
Occasionally the peripheral blood smear may need to be reviewed to confirm or identify the cause.
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