Low Reticulocyte Count without Anemia

[alevoy18]

Long story short:

I have been having mild anemia off and on for the last 4-5 months. My lowest tests came back as:

Test#1
RBC- 3.6
HB- 115
HCT- .355
WBC- 5.3
ABS LYM- 0.6
ABS NEU- 4.5
PLAT- 164

After this, I was sent for a retic count, but this time my anemia went from mild to now only borderline low in all categories. I wasn't anemic, but my retic was still low. I was tested again a month later and the same story:

Test#1
RBC- 4.57
HB- 140
HCT- .410
WBC- 5.1
ABS LYM- 1.2 (LOW)
ABS NEU- 3.3
PLAT- 177
ABS RETIC- 15 (LOW, should be 25-100)

Test#2
RBC- 4.53
HB- 141
HCT- .411
WBC- 4.8 (low..barely)
ABS LYM- 1.2 (low)
ABS NEU- 3.0
PLAT- 188
RETIC- 13 (LOW, should be 25-100)

As you can see, I am borderline low everything, but not anemic. Yet my retic count has stayed low over the tests. My GP referred me to a hematologist back during the 1st test...but is more concerned now that my retic count is staying low, but she is confused.

How can the retic stay low...but I am not anemic, just borderline low???

Thanks in advance.

[triumphe64]

Have they done a BMB?

[alevoy18]

I am waiting to see the Hematologist, my appointment is on December 23rd. My GP wants me to do a BMB, but the hematologist is uncertain to whether she wants to until my numbers get worse. My GP doesn't like the retic count so low, but the hematologist tells her it does no harm until the rest drops more, so waiting is best. I'm hoping for a BMB because even the hematologist has said herself it may be something not fully evolved. No clue what is going on...thanks.

[Lbrown]

I am very interested in your retic count! Good luck with your upcoming appointment and I hope you get some answers. Your last counts that you posted look great.

I am wondering if some retics are better than others. My retic count right now is only 2.3 but my HGB is behaving exactly like when my retic count was 48. It makes no sense unless some retics are strong and some die before maturing into RBCs. I'm wondering if maybe the count doesn't tell the full story.

Just a thought - maybe you can ask your hematologist if they can tell if you have better retics, thus not affecting your counts much? I would ask mine but I don't see her again until Feb.

[evansmom]

A retic count of 2.3 sounds like a percentage of the total number of red cells, which is good, while a retic count of 13 is the absolute number, which is low. A low red cell count may show up in a few months as red cells live for 90-120 days.
In other words, a low retic count trend in recent lab tests could foreshadow a low hemoglobin in a few months, so it's a good thing to keep an eye on.

[Lbrown]

Hi Nicole,

The retic range was 25 - 100 so I am certain it is the absolute count.

[Lindsayt]

Just wondered if there was any answer or dx to this as my 7 yr old has been going through these very same symtoms for the last 3yrs. He never had a retic done until this past Sept tho. He had two low retic counts with in 3 week both very low. The first test hbg was normal @ 125 with retic @23 with a slighlty hi rdw. The 2ND test only 3weeks later upon our regular drs return was
Hb 116 lo (120-160)
Hematocrit .35 lo (0.360-0.480)
Rbc 4.28 lo (4.50-5.50)
Rdw 15.0 hi (11.5-14.5)
Retic 29 lo ( 40-80)
We were then refered to a hematologist with our pedi saying he may need a bmb and to start him back on iron. When we saw the hematologist his numbers were perfect that day which I attribute to being back on an iron suppliment as is always the case and possibly being on prednisone for poison ivy but I have no idea if that would have affected it.. The hematologist had reviewed all of our prior b/w but had not seen the first b/w with low retic in Sept because it was done by a different dr. When I showed it to him he felt that maybe my son was just sick at the time and thats why the retic was lo... explaining that your always gonna have some numbers out in b/w ....but I don't recall him being sick with anything viral ect .anyway hematologist was unconcerned as numbers were good that day. Told us to go off iron he didnt need to see us again and do cbc in six months. so we just had that done and results are hbg good @130, rdw is hi , and retic is 19. I haven't heard from the pedi so I assume that he's fine with that but I'm not sure if I should contact the hematologist again or if it is just beating a dead horse after they said he's fine.... I just don't like the low retic and he gets low energy and nosebleeds but over the last 3 yrs . hb has never been below 100 and Platelets are always normal any advice please!!!

[Hopeful]

Hi Lindsayt,

Let me preface by saying I am not a doctor. I just have opinions and experiences that I am happy to share as another data point.

First, the nosebleeds... Some kids always get nosebleeds, and they are nothing to worry about, although they usually occur at the most inopportune times and can be pretty alarming! What has worked for my daughter is to use a saline spray (like Ocean Mist) in the morning and evening, depending on when your son gets them.

If your son's hematologist said to stop the iron, I would stop the iron. Iron can be toxic in large does. Many foods are fortified with iron like cereal, bread, etc. So unless you had iron testing done or you had a bone marrow biopsy done that showed low/absent iron stores, I would not blindly supplement with iron! Iron overload can cause a host of other problems. So don't supplement with iron without a diagnosis. Again, this is just my opinion.

Since your son's hematologist is not concerned at this point and is ordering a follow-up blood test at 6 months (vs 1 week or 1 month), I would take this as a good sign that he doesn't think something is seriously wrong. At the time of his next blood test, if your son is sick or was sick in the last week or two, I would delay the blood test. Otherwise you may see results that will causes you unnecessary panic! If you stop the iron supplementation and your son becomes symptomatic or his HGB is low next blood test, consult with the hematologist to root cause the source of his anemia.

Wishing you and your son well!

[Lindsayt]

Thanks You so much for your response and insight I really appreciate it . He has been taking iron for the last 2 yrs on and off up until the hematologist saw him in dec as he was unable to maintain a decent hb without it but that was under the direction and supervision of the pediatrician. The hematologist at the time felt that low retic was related to a virus at the time.
I am sorry my original post is hard to follow but what i meant was he has just had the CBC completed that the hematologist had recomended 6 months after our visit and the results were
Retic 19 (40-80)
Hb 130 great for him
Rdw hi

So he had the two low counts within three weeks of each other and his hb dropped from 125 to 116 was put back on iron had good results and then taken off iron and now 6 months later has that low retic and hi rdw. We don't see the hematologist again and I haven't heard from the pediatrician about these recent results I'm just wondering is I should be concerned about it

[Hopeful]

Hi Lindsayt,

If it were my child, I would stop the iron and see what happens. If your son's energy goes down or he shows other symptoms, I would get his CBC done right away, and if his HGB is low again, bring him to the hematologist. The doctors need to root cause the source of his anemia, but won't be inclined to do this if his HGB is normal because of the iron supplementation.

Have they checked his MCV, ferritin, serum iron, total iron binding capability, folate, B12, or lead levels? Does he eat a well-balanced diet? A hematologist can also look at a blood smear for unusual shapes that may be clues to what is going on.

I think you are wise to stay on top of this, as you know your child best. I would be concerned about a child requiring iron supplements without knowing why.

[Lindsayt]

Thanks hopeful. He has been off iron completely for last 6 months and this cbc showed a great hb for him 130, but retic still lo at 19...... all the other things you asked about have been tested and have been good other than rdw which has always been slightly hi

[Hopeful]

If it were me, I'd have a CBC done again in 3 months (or sooner if he becomes symptomatic).

If his HGB is still good, you have piece of mind

If something else is going on, it may start to show itself again.

Hopefully, it was nothing but a nasty virus, but it seems like you need another data point based on his history.

[Lindsayt]

Thanks hopeful, that maybe exactly what I will do.