Is Reticulocyte Count Part of a Standard CBC?
No, reticulocyte count is NOT automatically included in a standard Complete Blood Count (CBC) and must be ordered separately as an additional test. 1, 2
What is Included in a Standard CBC
A standard CBC includes only these parameters:
- Hemoglobin
- Hematocrit
- Red blood cell (RBC) count
- White blood cell (WBC) count
- Platelet count
- Red cell indices (MCV, MCH, MCHC)
- Red cell distribution width (RDW)
- White blood cell differential (when ordered) 3, 4
Reticulocyte Count as a Separate Test
The reticulocyte count is a distinct laboratory test that must be specifically ordered alongside the CBC when evaluating anemia. 1, 2
- The European Crohn's and Colitis Organisation explicitly states that the minimum anemia workup includes "complete blood count with red cell indices, reticulocyte count, serum ferritin, transferrin saturation, and CRP" - listing these as separate components 1
- Multiple guidelines consistently refer to reticulocyte count as an additional parameter to be "incorporated into the workup along with a complete blood count" 1
- The American Society of Clinical Oncology recommends obtaining "CBC with differential, peripheral smear and reticulocyte counts" as distinct tests 1
When to Order Reticulocyte Count
You should order a reticulocyte count immediately when hemoglobin falls below normal range (men <13.0 g/dL, non-pregnant women <12.0 g/dL, pregnant women <11.0 g/dL) to classify the anemia based on bone marrow production capacity. 2
The reticulocyte count is essential because it:
- Distinguishes decreased RBC production from increased destruction/loss 2
- Identifies bone marrow failure requiring urgent hematology consultation when low in severe anemia 5
- Excludes nutritional deficiencies when elevated 2
Common Clinical Pitfall
Many clinicians fail to order reticulocyte counts routinely despite their critical diagnostic value. Research shows that reticulocyte parameters are underutilized by the majority of clinicians in patient management, even though they are essential for proper anemia evaluation. 6, 3