Background: The appearance of nucleated red blood cells (NRBCs) in peripheral blood is associated with a variety of severe diseases. When NRBCs are detected in blood, this is generally associated with increased mortality.
Methods: In a prospective study, NRBCs and other laboratory parameters were measured daily in the peripheral blood of surgical intensive care patients. The appearance of NRBCs was analyzed in relation to laboratory indicators of organ injury.
Results: A total of 284 surgical intensive care patients were included in this study. The mortality of NRBC-positive patients was 44.0% (40/91). This was significantly higher (p<0.001) than the mortality of NRBC-negative patients (4.2%, 8/193). Mortality increased with the NRBC concentration and the length of the NRBC-positive period. Multiple logistic regression analysis of several other clinical and laboratory risk indicators revealed a significant association between NRBCs and increased mortality, with an odds ratio of 1.95 (95% CI 1.35–2.82; p<0.001) for each increment in NRBC category (0, 1–40, 41–80, 81–240 and >240NRBC/μL). After the initial detection of NRBCs in blood, there were no significant increases in creatinine concentrations or alanine aminotransferase activity. However, the appearance of NRBCs coincided with increasing C-reactive protein and thrombocyte concentrations.
Conclusions: The detection of NRBCs in blood of surgical intensive care patients is of prognostic power with regard to patient mortality. This prognostic significance of NRBCs was independent of some clinical and other laboratory risk parameters. The appearance of NRBCs in blood was not associated with kidney failure or lesion of the liver.
Clin Chem Lab Med 2006;44:955–61.
1. Budmiger H, Graf C, Streuli RA. The leukoerythroblastic blood picture. Incidence and clinical significance. Schweiz Rundsch Med Prax 1984; 73:1489–93.Search in Google Scholar
2. Mettier SR. Hematologic aspects of space consuming lesions of the bone marrow (myelophtisic anemia). Ann Intern Med 1940; 14:436–48.10.7326/0003-4819-14-3-436Search in Google Scholar
3. Schwartz SO, Stansbury F. Significance of nucleated red blood cells in peripheral blood. J Am Med Assoc 1954; 154:1339–40.10.1001/jama.1954.02940500019007Search in Google Scholar
4. Delsol G, Guiu-Godfrin B, Guiu M, Pris J, Corberand J, Fabre J. Leukoerythroblastosis and cancer frequency, prognosis, and physiopathologic significance. Cancer 1979; 44:1009–13.10.1002/1097-0142(197909)44:3<1009::AID-CNCR2820440331>3.0.CO;2-JSearch in Google Scholar
5. Weick JK, Hagedorn AB, Linman JW. Leukoerythroblastosis. Mayo Clin Proc 1974; 49:110–3.Search in Google Scholar
6. Tavassoli M. Erythroblastemia. West J Med 1975; 122:194–8.Search in Google Scholar
7. Andres WA. Normoblastemia after thermal injury. Am J Surg 1976; 131:725–6.10.1016/0002-9610(76)90188-4Search in Google Scholar
8. Böning A, Stachon A, Krismann M, Weisser H, Laczkovics A, Skipka G, et al. Postoperative cholesterol and erythroblasts as a parameter of perioperative mortality after cardiothoracic surgery. Z Herz Thorax Gefäßchir 2001; 15:242–8.Search in Google Scholar
9. Stachon A, Böning A, Krismann M, Weisser H, Laczkovics A, Skipka G, et al. Prognostic significance of erythroblasts in blood after cardiothoracic surgery. Clin Chem Lab Med 2001; 39:239–43.10.1515/CCLM.2001.038Search in Google Scholar
10. Briggs C, Harrison P, Grant D, Staves J, Maciag T. New quantitative parameters on recently introduced automated blood cell counter – the XE 2100™. Clin Lab Haematol 2000; 22:345–50.10.1046/j.1365-2257.2000.00330.xSearch in Google Scholar
11. Walters J, Garrity P. Performance evaluation of the Sysmex XE-2100 hematology analyzer. Lab Hematol 2000; 6:83–92.Search in Google Scholar
12. Stachon A, Sondermann N, Krieg M. Incidence of nucleated red blood cells in the blood of hospitalised patients. Infusion Ther Transfus Med 2001; 28:263–6.10.1159/000050251Search in Google Scholar
13. Stachon A, Sondermann N, Imöhl M, Krieg M. Nucleated red blood cells indicate high risk for in-hospital mortality. J Lab Clin Med 2002; 140:407–12.10.1067/mlc.2002.129337Search in Google Scholar
14. Stachon A, Kempf R, Holland-Letz T, Friese J, Becker A, Krieg M. Daily monitoring of nucleated red blood cells in the blood of surgical intensive care patients. Clin Chim Acta 2006; 366:329–35.10.1016/j.cca.2005.11.022Search in Google Scholar
15. Stachon A, Eisenblätter K, Köller M, Holland-Letz T, Krieg M. Cytokines and erythropoietin in the blood of patients with erythroblastemia. Acta Haematol 2003; 110:204–6.10.1159/000074228Search in Google Scholar
16. Stachon A, Bolulu O, Holland-Letz T, Krieg M. Association between nucleated red blood cells in blood and the levels of erythropoietin, interleukin-3, interleukin-6, and interleukin-12p70. Shock 2005; 24:34–9.10.1097/01.shk.0000164693.11649.91Search in Google Scholar
17. Ruzicka K, Veitl M, Thalhammer-Scherrer R, Schwarzinger I. The new hematology analyzer Sysmex XE-2100: performance evaluation of a novel white blood cell differential technology. Arch Pathol Lab Med 2001; 125:391–6.10.5858/2001-125-0391-TNHASXSearch in Google Scholar
18. Lehnhardt M, Katzy Y, Langer S, Druecke D, Homann HH, Steinstraesser L, et al. Prognostic significance of erythroblasts in burns. Plast Reconstr Surg 2005; 115:120–7.10.1097/01.PRS.0000138809.15740.8CSearch in Google Scholar
19. West CD, Ley AB, Pearson OH. Myelophthisic anemia in cancer of the breast. Am J Med 1955; 18:923–31.10.1016/0002-9343(55)90173-XSearch in Google Scholar
20. Otsubo H, Kaito K, Asai O, Usui N, Kobayashi M, Hoshi Y. Persistent nucleated red blood cells in peripheral blood is a poor prognostic factor in patients undergoing stem cell transplantation. Clin Lab Haematol 2005; 27:242–6.10.1111/j.1365-2257.2005.00687.xSearch in Google Scholar
21. Clifford GO. The clinical significance of leukoerythroblastic anemia. Med Clin North Am 1966; 50:779–90.10.1016/S0025-7125(16)33177-7Search in Google Scholar
22. Stachon A, Holland-Letz T, Krieg M. High in-hospital mortality of intensive care patients with nucleated red blood cells in blood. Clin Chem Lab Med 2004; 42:933–8.10.1515/CCLM.2004.151Search in Google Scholar PubMed
23. Stachon A, Lehnhardt M, Katzy Y, Holland-Letz T, Steinau HU, Krieg M. Making the case for adapting the abbreviated burn severity index to include erythroblast count. J Wound Care 2005; 14:97–100.10.12968/jowc.2005.14.3.26749Search in Google Scholar PubMed
24. Beguin Y. Erythropoietin and platelet production. Haematologica 1999; 84:541–7.Search in Google Scholar
25. Ertenli I, Kiraz S, Oztutk MA, Haznedaroglu I, Celik I, Caguneri M. Pathologic thrombopoiesis of rheumatoid arthritis. Rheumatol Int 2003; 23:49–60.10.1007/s00296-003-0289-0Search in Google Scholar PubMed
26. Bruno E, Miller ME, Hoffman R. Interacting cytokines regulate in vitro human megakaryocytopoiesis. Blood 1989; 73:671–7.10.1182/blood.V73.3.671.671Search in Google Scholar
27. Briddell RA, Hoffman R. Cytokine regulation of the human burst-forming unit-megakaryocyte. Blood 1990; 76:516–22.10.1182/blood.V76.3.516.516Search in Google Scholar
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