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.