Chris Kresser: The next one is from Eileen: “Is hemoglobin reticulocyte count different from the reticulocyte count that’s offered in all the labs now? I’ve been using reticulocyte count for many years to determine if the bone marrow is active in cases of anemia. RBC [red blood cell] reticulocyte count is not widely available in the anemia section. I asked Dr. Nett, but she referred me to you. She was not sure. Thanks. Learning so much from the blood chem section from you. Despite learning it and using it conventionally, there is so much more to it and I have been able to use it with testing with great advantage. Thanks so much for what you do and teach.”
You’re welcome, Eileen. I’m glad you’re getting a lot out of that.
The hemoglobin reticulocyte count is different than the reticulocyte count. I don’t use it very often, and in my practice, I generally have not found it to be necessary. Mostly, with anemia, I’m able to track—the majority of the anemia that I’m seeing is nutritional, although occasionally, we’ll get people with bleeding issues in the gut or heavy menstruation. We might sometimes get people who’ve got various red blood cell disorders, but that’s less typical. Sometimes, we’ll get someone with anemia of chronic disease, but again, that’s less typical. In my patient population, it’s almost always nutritional, so that’s been the focus.