Chorionic Villus Sampling

The diagnostic procedure of taking out a sample tissue (Choroinic Villi) from the placenta to detect congenital abnormalities in a fetus is known as Chorionic Villus Sampling (CVS). With the guidance of ultrasound, the position of placenta is first determined. There are two methods - trans-cervical and trans-abdominal to perform this test. The position of the placenta helps the physician choose a suitable method. For trans-cervical CVS, parameters like the position of the uterus, the size of the gestational sac and the position of the placenta inside the uterus are first determined using abdominal ultrasound. Using a good antiseptic, the vulva, vagina and the cervix are cleansed. The abdomen is also cleansed for trans-abdominal procedure.

Trans cervical procedure: A thin plastic tube is inserted through the vagina and cervix for the trans-cervical procedure to reach the placenta. A tiny sample of chorionic villus tissue is taken out after locating the exact position of the placenta.

Trans-abdominal procedure: This procedure is similar to the earlier one, but a needle is inserted through the abdomen in this test to reach the uterus and then to the placenta. The chorionic villus sample tissue is drawn into the syringe, while the needle is guided by ultrasound.

This sample is then taken to the laboratory for evaluation. This procedure can be conducted even earlier than amniocentesis to detect any congenital defects present in the fetus. It is done at around 10 to 12 weeks after the last menstruation. Study of the DNA, chromosomes and enzymes of the fetus can be conducted using the sample taken out during the test. Results are available within a week or two. If there are any abnormalities found in the fetus, it is easy to conduct a therapeutic abortion, in case it is necessary. Pregnant women over the age of 35 who are at risk for giving birth to a baby with Downs Syndrome or those who have had birth defects in an earlier pregnancy are advised this test. For detecting neural tube defects and the Rh-incompatibility, amniocentesis is a better option. Hemoglobinopathies and Tay-Sachs disease can be detected through Chorionic Villus Sampling.

The risk involved in using CVS is slightly higher when compared to amniocentesis. Some complications like rupture of the amniotic membrane, miscarriage, infection, bleeding, Rh-incompatibility in the mother if she is Rh-negative and contamination of the sample with maternal cells can occur. When CVS is performed after 10 weeks of gestational period, there is a risk for limb defects in the fetus. If the mother's blood is Rh-negative, she has to receive Rho GAM to avoid Rh incompatibility. After the CVS, it is advised to have an ultrasound done after about two or four days to ensure the fetus is fine.

Amniocentesis

During the early days of pregnancy, amniocentesis is carried out on pregnant woman to find out if the developing fetus is free from certain abnormalities. This procedure involves certain invasive methods like inserting a hollow needle into the uterus of the woman through her abdominal wall to withdraw a sample of amniotic fluid that surrounds the fetus. Using ultrasound, the location of the fetus floating in the amniotic fluid is determined. The abdominal skin surrounding the area is cleaned. The procedure may be conducted either by injecting a local anesthetic in that area, or by just applying a tropical anesthetic around the area through which the needle is to be inserted. About 1 cc per week of gestation of the fetus is taken out from the amniotic fluid.

This procedure is used as a tool which can detect chromosomal disorders like Downs Syndrome and many rare metabolic disorders which are normally inherited. Some structural defects like spina bifida and anencephaly can be detected using this test. This procedure is normally carried out for women over the age of thirty five. It is recommended for women who had undergone a triple screen blood test during pregnancy and for those who have a family history of birth defects or some inherited metabolic disorders. This procedure may be conducted even in later stages of pregnancy to detect suspected problems like Rh incompatibility or infection. This test is also used to determine lung maturity of the infant in the last trimester.

A cell culture is done with the fetal cells taken out during the procedure and the analysis of the DNA is conducted to detect chromosomal abnormalities. It may take up to a month for the results to arrive. This is rated as a highly accurate procedure.

After the withdrawal of the amniotic fluid which takes only a few minutes, the pregnant woman is advised to be in bed for several hours, though the entire procedure will last for about 45 minutes. Doctors check the heart beat of fetus to ensure that it is normal. It is wise to call the health care provider, if the woman experiences fever, bleeding or leakage of amniotic fluid for a long time. Though the chances of infection or injury to the fetus are not ruled out, they are quite rare. There is also a slight chance of miscarriage, but the percentage is negligible. During later stages of pregnancy, a Doppler ultrasound is safer than amniocentesis because it is non-invasive. Anemia in the fetus can easily be detected using ultrasound by measuring the velocity of the blood flow in the middle cerebral artery.

Reticulocyte Count Test

Blood is a precious fluid. Plasma, white blood corpuscles and red blood corpuscles are the three kinds of cells in the blood. The blood cells are normally made in the bone marrow. To know the level of red blood cells in the blood, reticulocyte count test is done.

Reticulocyte Count Test

Reticulocyte are immature red blood cells made by the bone marrow. Reticulocytes are in the blood for two days before developing into mature cells. Reticulocyte count test is done to determine if red blood cells are being made in the bone marrow at an appropriate rate. The count indicates how quickly reticulocytes are being produced and released by the bone marrow.

Need for Reticulocyte count test

Paleness, tiredness, weakness, shortness of breath, and/or blood in the stool are symptoms when doctors recommend Reticulocyte count test to:

• Assess the functioning of bone marrow i.e. if enough red blood cells are made by the bone marrow.
  
• Diagnose and distinguish the different kinds of anemia and the reasons for anemia, if it is due to fewer red bloods or due to great loss of red blood cells.
  
• Evaluate reasons for chronic bleeding and or/blood in the stool.
  
• Monitor progress after chemotherapy, bone marrow transplant, treatment for iron deficiency etc.
  
• Determine the degree and rate of increased number of RBCs and elevated hemoglobin (rare occurrence) and hematocrit.

Reticulocyte count test - Preparation

There isn't any specific preparation required before Reticulocyte count test. However, it is recommended to check with health care provider if any specific pre test preparation is needed. Those who have had a recent blood transfusion should inform the doctor. This can affect test results. Important information to be shared with the doctor is about medicines being taken. Women who are pregnant and mothers who are breastfeeding infants should talk to doctor before opting for the test.

Reticulocyte count test Method

The test result is available few hours after collecting blood or the next day. An elastic band is wrapped around the upper arm to stop the flow of blood. Sample of blood from the vein of the arm is taken. A drop of blood is placed on a slide, smeared, stained and is examined under a microscope. This is the manual method. Automated methods that allow for greater number of cells to be counted are most likely to replace the manual method.

Reticulocyte count test result Interpretation

The number of reticulocytes is compared to the total number of red blood corpuscles (RBC) and is reported as a percentage of reticulocytes.

Reticulocyte (%) = [Number of Reticulocytes / Number of total Red Blood Cells] X 100

In a healthy adult person, the normal range is 0.5% to 1.5%. In kids, the normal range is 3% to 6%. This is a stable percentage. The normal range may slightly vary.

High reticulocyte count suggests more red blood cells are being made by the bone marrow. This could be due to acute bleeding, chronic blood loss, hemolytic anemia, kidney disease and potentially a fatal blood disorder in the fetus or new born - erythroblastosis fetalis (Erythroblastosis Fetalis refers to a serious blood disorder in infants - Rh incompatibility disease and ABO incompatibility disease) or hemolytic disease. Also, the count increases post treatment for certain anemia like iron deficiency anemia, pernicious anemia, or folic acid deficiency anemia.

Erythroblastosis Fetalis refers to a serious blood disorder in infants - Rh incompatibility disease and ABO incompatibility disease. Low reticulocyte count suggests fewer red blood cells are being made by the bone marrow. This can be due to aplastic anemia or iron deficiency anemia. Other instances such as exposure to radiation, a chronic infection or due to intake of certain medicines (drug toxicity) can lead to low count.

The reticulocyte count increases temporarily during pregnancy. The count is high in newborns but within few weeks the count drops to adult levels. In case the result is abnormal more tests may be administered for further analysis.