Is there any value in a Reticulocyte blood test to evaluate B12 and Irons if taking B12 and B Complex supplements?

[Gillybean1]

Hello Everyone,

As usual I am a bit out of my depth, or clutching at straws possibly. But wondered on your thoughts about doing this test, and would appreciate any thoughts or experience please.

Kind regards, G

[wedgewood]

I’ve never had a reticulocyte test , but I believe it can be done with a full blood test . They are immature red blood cells which are larger than mature ones . They can be immature because of the lack of B12 . If the percentage is higher than about 2% , it can indicate B12 deficiency .

[Gillybean1 in reply to wedgewood]

Hello Wedgewood,

Lovely to hear from you again, I hope you are doing well now?

Thank you for replying.........do you know if being on B complex and B12 supplement though if that would scupper the test ?

G.

[wedgewood in reply to Gillybean1]

No not “scupper “ the test . If you are absorbing the B12 and B9 that you are taking , and you are not iron deficient , then your reticulocyte reading should be normal . I’m not medically qualified. , but that’s how I would interpret the situation .

[Gillybean1 in reply to wedgewood]

Thank you so much for your reply Wedgewood, I really appreciate it.

Every best wish to you, G

[Gillybean1 in reply to wedgewood]

Hello Wedgewood,

May I please PM you about a B12 supplier Ive been told about.....not that I know how to PM

Kind regards, Gillybean1

[FlipperTD]

Scientist, not medic.

I did very many retic counts in my career. If they're an automated test from a good analyser then they're precise, whereas in the old days of manual counts then precision was considerably lower, but still useful. But in terms of actual retics:

When your bone marrow releases 'newborn' red cells, they 'come out' as reticulocytes. They stay as countable retics for around two days, give or take. A retic is a considerably more biologically active red cell than a mature erythrocyte. Red cells stay in circulation for around 100-115 days, before they go off to 'the scrapyard' [mainly the spleen] to be dismantled and recycled. So, a 'normal' range for retics would be around 2% of the total.

If you're anaemic [say, B12 and/or folate deficient and anaemic] once you get the replacement therapy, your bone marrow goes into overdrive and produces many more red cells to make up the difference and get your Hb back up into the reference range. The initial spike in retics can be seen in under a week. [In iron deficiency, it takes a bit longer, but it's still quick.] If you don't check the retic count promptly, then you can miss the peak, which can be disappointing and maybe misleading too.

Is it worth doing a retic when you're well into replacement therapy and your Hb is in range, then no, it probably isn't, although if you have a haemolytic process going on [destroying red cells early, before their 100 days or so] then this should be reflected with a raised retic count. If you have a haemolytic process going on and you run out of folate, then your Hb can drop alarmingly, and the retic count will be higher, as the retics are more resistant to destruction.

Retics are identified by a special staining technique.

Retics contain active mitochondria, so they're able to generate considerably more energy than mature red cells.

[I could go on, but I've gone on quite long enough for today!]

[Myoldcat in reply to FlipperTD]

No, that was fascinating!

[Cherylclaire Forum Support in reply to Myoldcat]

Yes, wasn't it ?

First time I have seen that explained.

Thanks FlipperTD

[Dance_queen in reply to FlipperTD]

Thank you for that FlipperTD. I wondered if you could help, my retic count was 20.40 10*9L(25.00-105.00) two months ago, and I was also slightly anaemic, but it has now increased to 39.80. I have been taking oral B12 supplements for two and a half months, so I assumed that was why it had increased. But my GP said it’s likely that it was low due to a viral infection at the time and nothing to do with the supplements, even though other symptoms have improved since taking them. Could this be true?

[FlipperTD in reply to Dance_queen]

Full marks to GP! Right first time. Absolutely right, and that's what we pay them for.

Any viral infection can cause suppression of your bone marrow for a few days. Parvo virus is good for that. [And not just in doggies!] Anything putting stress on you can cause further effects. I've seen someone go from coping very well with a Haemolytic Anaemia to 'crashing' spectacularly due to a virus. We didn't know about the Haemolytic Anaemia because he was compensating very well.

The bone marrow can cope with a huge amount of over-production until you run out of, usually, folate. Well done to the GP, and good to hear you're on the mend.

[Dance_queen in reply to FlipperTD]

Thanks FlipperTD

[Gillybean1 in reply to FlipperTD]

Hello Flipper TD,

Thank you very much for taking the time to reply, I really appreciate it. Thank you for explaining so clearly too.

I dont know if im clutching at straws , but i dont believe my MMA, B12 Active ,B12 serum could ever have been accurate because of 25years of B Complex supplements, and I just wonder whether ita a route cause for me. I am MTHFR+ ( one parent ) and I know this relates to Folates not B12 , and I wondered if Reticulocytes would give any more info/picture.

Does that mean for accuracy a Retic blood test would need analysis the same day? I ask as mine would be a home draw and posted to lab for next day. Medichecks offer one but dont state this as an issue but.....

Every best wish , G

[FlipperTD in reply to Gillybean1]

Hi Gillybean.

The MTHFR+ business is far to complicated! There's a huge diversity out there amongst us and I suspect that it's about as relevant as hair colour; it's simply a bit of variation. If it really mattered as far as our metabolism goes, we've have far more problems. Likewise, I suspect [but this is purely guessing, as I'm out of my comfort zone] if you only have one copy of a variant gene, the other copy is generally enough to keep you healthy.

Whatever you do, if your Hb is being maintained in the reference range then your retics are doing their job as they're reflecting the fact that your marrow is keeping up with the demand.

If you see some of my other ramblings, I'm not a great lover of samples requiring analysis via the post, and especially not full blood counts. Quite a few of the values are little better than worthless if the sample is delayed in processing, and ideally they're better processed within a couple of hours. However, your retic count would still be OK, as they don't mature in the blood sample, so it'd still be worth measuring.

Hope this helps!

[Gillybean1]

Hello Flipper TD,

My Haemoglobin is 130 (115-165) and im female. So is it a waste of money to check Reticulocytes then ?

That is alarming if blood test posted could be flawed..... the ones I have done with Medichecks are done early AM and received and processed next day, 24 hours on. Im not sure how im going to get around this being mostly housebound to this disease.

Another company NOT Medichecks told me that they pick up blood test overspill from the NHS sometimes, and that these had been sitting waiting for more than 2 days.....not ideal either.

Thank you for your help and knowledge, every best wish , G.

[FlipperTD in reply to Gillybean1]

Dear Gilly

Your Haemoglobin is absolutely fine. A retic count wouldn't add a great deal of knowledge, to be honest. The more things we measure, the more likely we are to find something outside the range whilst we're still normal for us. [Ranges are 95% limits, so 5% of normals are outside the range whilst still normal.

Blood samples not analysed within two days are a reflection of lack of capacity. They, in general, would be better consigned to the dustbin. Clotted samples for U&E etc should be centrifuged within a couple of hours, but FBC samples can't be stabilised. Stuff goes off very quickly. Just because we can analyse stuff, doesn't mean what we get will be of any value. Things that are certain are that samples for Potassium will yield incorrect results within a few hours unless centrifuged. Samples for FBC and Diff are not much use beyond 4, maybe 6 hours. Some things have already 'gone off' before they arrive at the lab.

[Gillybean1 in reply to FlipperTD]

Thank you for your reply FlipperTD, I wont waste vital money.

Its a bit misleading then to offer 24hr fast track if results can be flawed. They are not exactly cheap to us even if in reality they are pennies to do.......big business.... for small labs

I knew about the centrifuging for Potassium and it being time critical to the lab, but now you may have explained why I have had 3 different Electrolyte test done over a period of a year and all 3 were showing out of range but for different things each time....which ok maybe twice, but 3 times suggest not reliable result.

Thank you for advising me, you have been very kind and very helpful.

Every best wish , G.

[FlipperTD in reply to Gillybean1]

Oh, potassium, potassium! Red cells rich in it, plasma poor. Leaks out of the red cell very easily, and if your sample is transported by van to the lab, then it happens in the van. If it's centrifuged at the point of collection, at least that's stabilised. Most things are worse if kept warmer, but potassium leaks more if the samples are cooler. We could see this when we had samples coming in from GPs via other hospitals, and doing a few statistics on the results showed that samples via hospital A [furthest away] were higher than hospital B's, [nearer] and hospital C [us] had the lowest. That's not saying who is correct either! We can easily fall into the trap of relying on numbers.

[Gillybean1 in reply to FlipperTD]

My potassium are centrifuged, that said one was reported as failed for arriving warm, a second I wrapped in ice and was told that was better , but still a 24hr lapse……. Oh dear seems I’ve wasted money.

Kind regards G

[FlipperTD in reply to Gillybean1]

It's awfully complicated, as we've got stuff that goes off for being too cold, some goes off for being too warm, and some goes off for taking too long to arrive. To make matters worse, some things actually increase in activity on storage. As I said, it's complicated.

I wish I had a better answer for you!

[Gillybean1 in reply to FlipperTD]

It’s a money pit I’m beginning to realise. And I thank you for waking me up to this.

I will have to rethink what to do for the future.

Thank you for your support. G

[FlipperTD in reply to Gillybean1]

There are some organisations there that seem to be there to help us, but they're helping themselves too. Everyone has to eat, but that doesn't mean that we have to feed them! Speaking generally, the NHS can provide [even in these hard times] the analytical tests we need, and to be honest, it's as much about interpreting the results with reference to our clinical situations. If there's a test that isn't available on the NHS, you might ask yourself why that could be. Our GPs are the gatekeepers to these services, and whilst it may seem that they're obstructive, I don't believe that's the case usually.

Good luck.

[Gillybean1 in reply to FlipperTD]

Hello FlipperTD,

I hear you. I dont think its that they are being obstructive ,I think its just that some are not always invested......particularly if they just dont know whats wrong. There is the lack of respect from one Consultant views/opinions/diagnosis etc to the next one you see.

18 months ago I waited 6 months for a telephone F/U to be told I was "a waste of time, a waste of her time, and a waste of an NHS appointment", and was being referred back to my GP. So I go it alone, looking for solutions.

There have been a couple of Consultants over 10 years or more who have stuck their necks out and ordered complex tests, and been honest enough to say there is something amiss, we dont know what, keep reading and researching. But many more that say I will never get well and get use to...........I reject that..........if there was a way in , there must be a way out.

You have been very kind, thank you. Best wishes. G

[FlipperTD in reply to Gillybean1]

Good luck! I hope you don't need it, but it's good to know you're persistent.

[Oneash]

Is your B complex methylated? pmc.ncbi.nlm.nih.gov/articl...

[Gillybean1 in reply to Oneash]

Hello Oneash, Thank you for taking the time to reply.

Yes my B Complex is methylated, and thank you for the link, now filed.

Every best wish to you , G.