Is manual reticulocyte count a reliable option for under resourced countries?

OBJECTIVES: To establish the credibility of manual reticulocyte counts without compromising the quality of care, and to evaluate the degree of acceptability of manual reticulocyte counts in terms of accuracy and cost effectiveness in comparison with two automated haematology analyzers. METHODS: Visual reticulocyte enumeration was evaluated for comparability, within-batch precision and costing with respect to Coulter STKS and Gen S haematology analyzers. RESULTS: The results of reticulocyte estimation for 80 samples as obtained by 3 modes were correlated using Pearson's correlation coefficient (r) which were computed as 0.884, 0.875, and 0.793 for manual-Gen.S, Gen.SSTKS and manual-STKS respectively thus showing positive association of these results. STKS had the CV of 10.4% and was more precise compared to Coulter Gen.S (CV = 11.6%) while manual counts showed the least precision with a CV of 19.8%. The cost per test was calculated to be $0.11 for manual technique in contrast to $0.45 for Gen S and $1.09 for STKS. CONCLUSION: Visual counting of reticulocytes can be used as a reliable tool for estimating reticulocytes in resource strained countries as it is not only cost effective but can also efficiently discriminate between high and low reticulocyte ranges which are required for sound clinical judgment.

Automated reticulocyte counting and measurement of reticulocyte cellular indices. Evaluation of the Miles H*3 blood analyzer.

This study evaluated reticulocyte counting and measurement of reticulocyte cellular indices with the Miles H*3 blood analyzer, a new instrument that combines the Technicon/Miles technology for blood cells counting with a staining technique allowing counting of reticulocytes, quantification of staining intensity and measurement of reticulocyte cellular indices. Reticulocyte counts obtained with the Miles H*3 analyzer were compared with those obtained by manual counting, flow cytometry (thiazole orange method) and by the Sysmex R-3000 (Baxter Diagnostics) reticulocyte analyzer. Reticulocyte counting with the Miles H*3 showed excellent precision, and linearity in the range tested (1.1-49% and 1-72% reticulocytes, respectively, with two different protocols) with no significant carryover. Reticulocyte counts were stable after storing blood samples for 72 hours at 4 degrees C. Comparison of the four different methods, showed an acceptable intraclass correlation between Miles H*3 and Sysmex R-3000 (intraclass correlation coefficient, [ri] = .952), Miles H*3 and flow cytometry (ri = .922), and Sysmex R-3000 and flow cytometry (ri = .938). There was no satisfactory correlation between any of the three automated methods and the values obtained with manual counting of reticulocytes (ri = .538-.755), consistent with the well known imprecision of the manual technique. For a group of normal pediatric subjects, age 1-10, we obtained the following values (+/- SD) of reticulocyte indices: mean corpuscular volume 97.6 +/- 4.7 fL; cell hemoglobin concentration mean 28.2 +/- 1.4 g/dL; cell hemoglobin content 26.7 +/- 1.6 pg. We determined the direct cost, including depreciation, of the manual and instrumental methods. Cost/test varied from $1.61 for manual method to $6.03 for the Sysmex R-3000. Cost/test for flow cytometry and Miles H*3 were $3.34 and $3.49, respectively.

[Validity of reticulocyte count testing in reimbursement practice: a cost-effectiveness analysis].

Recently reticulocyte count testing has markedly decreased in Japan. We studied the current status of the reduction of reimbursement for reticulocyte count testing and the cost-effectiveness of the test in an academic hospital. The orders of complete blood counts(CBC) accompanied by reticulocyte count testing in Tokai University Hospital declined from 58.9 to 13.3% during the last decade. Among a total of 15,538 test orders for reticulocyte count in outpatients, full reimbursement was refused in 123(0.79%) during a one year period from April 1999 to March 2000. The cost-effectiveness of reticulocyte count testing was evaluated in 719 new outpatients who visited Tokai University Hospital during this period. A useful result(UR) of testing was defined as that which contributed to a change in a physician's diagnosis- or decision-making, relating to a "tentative initial diagnosis" obtained from patient history and physical examination alone. Cost-effectiveness for either CBC alone or in combination with reticulocyte count testing was evaluated by calculating clinical effectiveness(the number of URs yielded by a test per patient), economic efficiency(cost required for a test per UR generated), and the cost-effectiveness values(cost required for additional test(s) per additional UR generated). There was a wide disparity in the clinical effectiveness of reticulocyte count twisting among the hospital departments, ranging from 0.53 UR/patient(Gastroenterology-2) to 0(Oral Surgery, Neurology, Urology). Poor clinical effectiveness shown in particular hospital departments endorsed the increasing percentages in reimbursement rejection by the payer of health insurance. The test should be ordered more carefully in consideration of reimbursement and in regard to its cost-effectiveness among different patients groups.

A cost-effectiveness evaluation of reticulocyte measurement in new outpatients with or without hematologic disorders.

BACKGROUND: Although reticulocyte counts provide very useful information, few studies have analyzed the cost-effectiveness of this testing. METHODS: The yield and cost of reticulocyte count testing were analyzed in 719 new outpatients who visited the comprehensive medicine clinics and received both reticulocyte and complete blood count (CBC) testing. A "useful result" (UR) of the testing was defined as a finding that contributed to a change in a physician's diagnosis or decision-making between the pre- and post-test diagnosis. Patients' medical records were thoroughly reviewed for the assignment of URs. A simulation study was performed, blinding the reticulocyte data to the examiners, for the determination of URs generated by CBC alone. RESULTS: CBC and reticulocyte testing generated a total of 838 URs in 719 patients, while the simulation study demonstrated 612 URs with CBC testing alone. When patients were grouped into 11 major disease categories according to a pre-test diagnosis, clinical effectiveness (UR/patient) varied from 1.69 (hematologic) to 0.13 (metabolic/endocrine patients), with a cost disparity from 206yen to 2784yen/UR. The cost-effectiveness (Deltacost/DeltaUR) of reticulocyte addition against CBC alone was 515yen per additional UR as a whole. Reticulocyte testing showed favorable cost-effectiveness in gastrointestinal ( 234yen) and hematologic patients ( 338yen/additional UR), while the test added few URs in metabolic/endocrine and neurologic patients, resulting in possibly unacceptable cost-effectiveness ( 3240yen and 2916yen/additional UR, respectively). CONCLUSIONS: Wide disparity in its cost-effectiveness among patients apparently indicated that reticulocyte count testing should be performed for selected patient groups on the basis of its cost-effectiveness.

Comparison of the reticulocyte mode of the Abx Pentra 120 Retic, Coulter General-S, Sysmex SE 9500, Abbott CD 4000 and Bayer Advia 120 haematology analysers in a simultaneous evaluation.

The Abx Pentra 120 Retic, Coulter General-S, Sysmex SE 9500, Abbott Cell Dyn 4000 and Bayer Advia 120 were evaluated simultaneously in a general hospital laboratory. Linearity, precision, sample stability, carry-over and comparability of the reticulocyte mode were determined following International Council for Standardization in Haematology guidelines for the evaluation of blood cell analysers. All analysers showed good results for dilution, stability and carry-over testing. The between-batch coefficient of variation of the General-S was high compared to the other analysers evaluated. Multiple correlation studies showed good agreement for all analysers in the normal and high reticulocyte range, with correlation coefficients above 0.7. Multiple correlation studies for reticulocytopenic samples (< 15.109/l) were less satisfactory, with a wider range of correlation coefficients (r-values 0.0-0.9). Overall, the General-S, SE 9500 and Advia 120 gave lower reticulocyte counts than the Pentra 120 Retic and CD 4000. Reagent costs were also evaluated. Reagent consumption was close to the manufacturers' specifications for the SE 9500 (Search reagent), CD 4000 (CD Retic) and Advia 120 (Retics) but was higher than stated for the Pentra 120 Retic (Retix), General-S (Retic kit) and SE 9500 (Sheath reagent). Our results show that these new generation haematology analysers will meet the needs of hospital laboratories for reliable and cost-effective reticulocyte counting.

Comparison of cost effectiveness between measuring the serum erythropoietin level and reticulocyte count for monitoring thalassemic patients: a note in Thai beta thalassemia/Hb E subjects.

Iron deficiency anaemia and the thalassemia syndromes, a group of disorders resulting from inherited abnormality of globin chain production, are common causes of anaemia in Thailand, and in the Far East in general. Monitoring erythropoiesis in these patient is very important in evaluating the disease and the response to treatment. Recently, our group has just reported the feasibility in using serum erythropoietin (EPO) for monitoring purposes in thalassemia and demonstrated that the determination of serum EPO can be an alternative choice in the follow up of these conditions. This study reports a cost effectiveness analysis comparing the recently reported radioimmunoassay (RIA) for serum EPO determination and the previously used tool, the reticulocyte count. The study reports a higher detection rate for ineffective erythropoiesis when using serum EPO determination, however, the increased sensitivity is at balanced by a higher unit cost. In this analysis, the cost effectiveness for serum EPO and reticulocyte are 208.33 and 50 baht/detection, respectively. () Therefore, the reticulocyte count is more cost effective and is recommended for routine usage in our current medico-economic setting.