Median Nucleated Red Blood Cell Research Articles

Emergence role of nucleated red blood cells in molecular response evaluation for chronic myeloid leukemia.

PurposeTo investigate and evaluate the role of nucleated red blood cells (NRBCs) and other markers in predicting remission failure in chronic myeloid leukemia (CML) patients treated with imatinib.MethodsSeventy-one CML patients with BCR-ABL(+) in bone marrow cells were selected for this study. Molecular response evaluations were done every three months according to the recommendations of European LeukemiaNet (ELN). Patients were defined as remission failure if BCR-ABL transcripts >10% after 6 months (T6), >1% after 12 months (T12), and >0.1% after 18 (T18) months of treatment. The logistic regression was used to determine the optimal cut-off point of each marker and test the association of marker level with remission failure.ResultsThe median NRBC, white blood cells, blast cells, basophils, and platelets were declined parallel with the decreases of BCR-ABL transcripts in bone marrow cells after 6 months of treatment (P<0.001). In addition, NRBC was almost not found in the blood of patients who archived good response at T6, T12, and T18 time-points. Interestingly, patients with a high level of NRBC (cut-off: 0.003×109/L) have higher BCR-ABL transcripts compared to others. The elevated NRBC at T6 (OR=6.49, P=0.042), T12 (OR=6.73, P=0.007), and T18 (OR=5.96, P=0.009) time-points was identified as an independent factor for the remission failure.ConclusionThe results of this study showed that a high number of NRBC in peripheral blood of CML patients is associated with higher BCR-ABL transcripts in bone marrow cells. The elevated NRBC might serve as an independent marker for molecular remission failure in CML.

Nucleated Red Blood Cells in Children with Sickle Cell Disease Hospitalized for Acute Vaso-Occlusive Pain

Background: Acute vaso-occlusive crises (VOC) represent the most common reason for hospitalization among children with sickle cell disease (SCD). Acute chest syndrome (ACS) and severe hemolysis, both of which may require transfusion, are common complications during hospitalizations for VOC. Despite the high morbidity associated with these complications, there are currently no reliable clinical predictors of ACS and transfusion requirement in this setting. Nucleated red blood cells (NRBC), reported as the number of NRBC/100 white blood cells (WBC) on a complete blood count (CBC), may reflect marrow necrosis or increased erythropoetic drive, yet their relationship to VOC and its complications have not been studied. We aimed to evaluate the relationship between admission NRBC and development of ACS or transfusion requirement in children with SCD hospitalized for VOC. We hypothesized that higher admission NRBC is associated with greater risk of ACS/transfusion in this population. Methods: We performed a single-institution, retrospective review of all hospitalizations from 2011 through 2015 for uncomplicated VOC in children with SCD. Hospitalization encounters were identified by ICD-9 codes for SCD and use of parenteral opioids for at least 24 hours in the electronic medical record. Data extracted from encounters meeting inclusion/exclusion criteria included all CBCs and clinical outcomes. Between-group comparisons were performed by Mann-Whitney U test and Pearson's chi-square test for continuous and categorical variables, respectively, as well as by Spearman's rank order correlation (SPSS V24). The relationship of admission and change in NRBC (∆NRBC) to complications was evaluated by binary logistic regression and adjusted for significant co-variates on bivariate analysis. For ∆NRBC, we used the final CBC obtained prior to a complication or prior to discharge for encounters not resulting in a complication. Results: We reviewed 271 encounters for uncomplicated VOC in 96 patients (mean age 13.1 years, 47% male, and 76% Hb SS or S/β0 thalassemia). Overall, 48/271 (18%) encounters for VOC resulted in ACS/transfusion, or both. Median NRBC on admission was 2 /100 WBC (range 0 to 137 /100 WBC) for all encounters. Admission NRBC was significantly correlated with age (r = 0.15, p = 0.02), % reticulocytes (r = 0.18, p &lt; 0.01) and hemoglobin (r = 0.39, p &lt; 0.001). Median admission NRBC was higher among patients on hydroxyurea (3 vs. 1.8 /100 WBC, p &lt; 0.01) but did not differ by sex or genotype. In general, median admission NRBC did not differ between hospitalizations that did or did not result in ACS/transfusion (2 vs 2.5 /100 WBC, p = 0.91). In our logistic regression model that included NRBC, % reticulocytes, WBC, hemoglobin, platelets and genotype as co-variates, only lower hemoglobin (p = 0.02) and higher WBC (p &lt; 0.001) on admission were independently associated with ACS/transfusion. A second CBC was obtained in 110/271 (41%) encounters reviewed. Median ∆NRBC was 0 /100 WBC (range -37 to 116 /100 WBC) in these encounters. ∆NRBC was significantly correlated with age (r = 0.2, p = 0.04) but not with change in other lab values. Median ∆NRBC was higher among patients with a history of hypertension (0 vs. 13 /100 WBC, p &lt; 0.01) but did not differ by hydroxyurea status, sex or genotype. Importantly, we found that median ∆NRBC was significantly higher in hospitalizations that resulted in ACS/transfusion compared to those that did not (0 vs 2 /100 WBC, p &lt; 0.01). By logistic regression, greater ∆NRBC (p &lt; 0.01) and lesser ∆platelets (p = 0.04) were independently associated with higher risk of ACS/transfusion after adjustment for ∆hemoglobin and genotype. A receiver operating characteristic curve constructed from a logistic regression model that included only ∆NRBC, admission WBC, admission hemoglobin and ∆platelets resulted in an area under the curve of 0.82. Conclusions: We found no relationship between admission NRBC and complications during hospitalization for VOC in children with SCD. Greater ∆NRBC, however, was independently associated with development of ACS/transfusion requirement during hospitalization for VOC, suggesting ∆NRBC may represent a useful biomarker for predicting complications in children with SCD hospitalized for VOC. Clinical decision rules that incorporate the careful monitoring of ∆NRBC in this setting should be prospectively studied. Disclosures No relevant conflicts of interest to declare.

Nonreassuring fetal heart rate patterns and nucleated red blood cells in term neonates

The aim of this study was to evaluate the association between nonreassuring fetal heart rate patterns during labor and umbilical cord nucleated red blood cell counts. Nucleated red blood cell data was collected prospectively from 41 singleton term neonates presented with nonreassuring fetal heart rate patterns and/or meconium stained amniotic fluid during labor (study group) and from 45 term neonates without any evidence of nonreassuring fetal status (controls). Umbilical artery pH, blood gases and base excess were also determined to investigate the correlation between independent variables. The median nucleated red blood cells per 100 white blood cells were 13 (range 0-37) in the study group and 8 (range 0-21) in the control group. Stepwise regression analysis have identified meconium stained amniotic fluid (R(2) = 0.15, p < 0.0001) and umbilical artery PO(2) (R(2) = 0.1, p = 0.002) as independent variables associated with elevated NRBC counts in patients with nonreassuring fetal heart rate patterns. Nucleated red blood cells in the cord blood of newborns were found to be elevated in patients with nonreassuring FHR patterns during labor. However, the wide range and the poor correlation of NRBC count with umbilical artery pH and blood gas values limit its clinical utility as a marker for fetal hypoxia.

Nucleated Red Blood Cells in Uncomplicated Prolonged Pregnancy

Elevated counts of nucleated red blood cells (NRBCs), as well as prolongation of pregnancy, have been suggested as predictors of adverse perinatal outcome. However, the association between these 2 variables has received only minimal attention. We sought to evaluate fetal NRBCs in prolonged pregnancies. Umbilical cord blood was prospectively collected at delivery from 75 prolonged (at or beyond 287 days) pregnancies. One hundred and fifty term deliveries (260-286 days) served as controls. All pregnancies were accurately dated with the use of first-trimester sonography. Fetal biophysical profile testing was initiated at 40 weeks of gestation. Patients were delivered if they were in spontaneous labor or the biophysical profile was nonreassuring or by 42 weeks of gestation. Nucleated red blood cell counts were expressed per 100 white blood cells (WBC). Umbilical artery pH studies, as well as other demographic and clinical variables, were obtained. Prolonged pregnancy was associated with a significantly increased incidence of induction of labor and a greater birth weight. There were no other differences between the study group and controls. The median NRBCs per 100 WBCs in prolonged pregnancy was not significantly elevated over the term values (median 3, range 0-35 versus median 3, range 0-34, respectively; P =.25). Neonatal outcome was also comparable between groups. The univariate regression analysis demonstrated a significant association between elevated NRBC counts and low arterial cord blood pH (P <.008, R = 0.175), elevated base excess (P =.02, R = 0.149), low platelet counts (P =.046, R = 0.134), and male gender (P =.028). Stepwise regression analysis revealed that low arterial cord blood pH and male gender were the only independent variables predicting elevated NRBC counts at birth. The findings of this study suggest that elevated NRBC counts are associated with specific pregnancy complications rather than uncomplicated prolonged pregnancies in general.

Fine-needle aspiration in the evaluation of nucleated red blood cells in the human placenta

Objective: The purpose of this study was to evaluate the correlation between placental and umbilical cord nucleated red blood cell counts. Study Design: Eighty placentas and their matched umbilical cord blood samples were collected prospectively immediately after delivery. In vitro fine-needle aspiration biopsy specimens were used to obtain placental tissue samples. Nucleated red blood cells were counted by both manual microscopy and flow cytometry. Statistical analysis included Wilcoxon signed rank test and Spearman correlation. Results: The median nucleated red blood cell counts/100 white blood cell counts for manual microscopy in umbilical cord blood; placental samples were 7.5 and 3.0, respectively (P <.0001). The median nucleated red blood cell counts for flow cytometric determination in umbilical cord blood and placental samples were 11.3 and 8.6, respectively (P <.0001). The Spearman correlation between manually counted umbilical cord blood samples and the placental tissue specimens was 0.66 (P <.0001). The Spearman correlation between flow cytometrically counted umbilical cord blood nucleated red blood cell and nucleated red blood cell counts that were obtained from the placenta was statistically significant (r = 0.74, P <.0001). The Spearman correlation between manual microscopy and flow cytometry for umbilical cord samples and their matched placental tissue specimens were 0.80 and 0.58, respectively, with all probability values at <.0001. Conclusion: Previous studies have reported an association between acute and chronic hypoxia and elevated nucleated red blood cells. Our results indicate that in vitro placental nucleated red blood cell counts correlate with umbilical cord nucleated red blood cell counts and suggest that antenatal evaluation of fetal nucleated red blood cells could be achieved by placental fine-needle aspiration biopsy. (Am J Obstet Gynecol 2003;189:155-8.)

The association of fetal heart rate patterns with nucleated red blood cell counts at birth

Objective: The purpose of this study was to evaluate the relationship between fetal heart rate patterns and fetal nucleated red blood cell counts. Study Design: Data were collected prospectively from March through September 2000. Umbilical cord blood was used for nucleated red blood cell analysis. The fetal heart rate pattern was analyzed for reactivity; presence, duration, and type of decelerations; and time interval between the last acceleration and delivery. Results: Two hundred seventy-nine singleton term pregnancies formed the study population, 67% of which were delivered vaginally. The median nucleated red blood cells per 100 white blood cells was 7 (range, 0-158). The univariate analysis indicated that nucleated red blood cells are correlated significantly with abnormal fetal heart rate patterns, time interval between the last acceleration and delivery, fetal growth restriction, the presence of meconium, and a 1-minute Apgar score of ≤7. However, the stepwise regression analysis identified the time interval between the last acceleration and delivery as the only variable that independently predicted elevated nucleated red blood cell count at birth (P <.0001, R2 = 0.26). Conclusion: Earlier studies have demonstrated an association between adverse perinatal outcome and elevated nucleated red blood cell count. In view of the high false-positive rate that is associated with the prediction of adverse perinatal outcome by fetal heart rate abnormalities, our results support previous studies that indicate that the presence of fetal heart rate accelerations is a reliable predictor of the nonhypoxic fetus. (Am J Obstet Gynecol 2003;188:1228-30.)