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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter / Tate, Jillian R.

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Nucleated red blood cells and soluble transferrin receptor in thalassemia syndromes: relationship with global and ineffective erythropoiesis

Paolo Danise1 / Giovanni Amendola2 / Rosanna Di Concilio2 / Enrico Cillari3 / Maria Gioia3 / Anna Di Palma1 / Daniela Avino1 / Paolo Rigano4 / Aurelio Maggio4

1Department of Laboratory of Hematology, “Umberto 1°” Hospital, Nocera Inferiore, Salerno, Italy

2Department of Pediatrics and Neonatal Intensive Care Unit – Pediatric Hematology and Oncology Section, “Umberto 1°” Hospital, Nocera Inferiore, Salerno, Italy

3Department of Clinical Pathology, “V. Cervello” Hospital, Palermo, Italy

4Second Hematology Unit, “V. Cervello” Hospital, Palermo, Italy

Corresponding author: Paolo Danise, MD, Department of Laboratory of Hematology, “Umberto 1°” Hospital, Via S. Francesco 1, Nocera Inferiore (Sa), 84014, Italy Phone: +390819213470, Fax: +390819213370,

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 47, Issue 12, Pages 1539–1542, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.2009.340, October 2009

Publication History

Published Online:


Background: The technology to recognize nucleated red blood cells (NRBC) automatically has only recently been developed. Modern hematology analyzers allow for rapid and accurate NRBC counts. The goal of our study was to evaluate NRBC counts and the concentrations of serum transferrin receptor (sTfR) in patients affected by different thalassemia syndromes and hereditary spherocytosis. We wished to gain a better understanding of the meaning of the presence of NRBC in peripheral blood and the relationship of the two parameters with effective and ineffective erythropoiesis in the different thalassemia syndromes.

Methods: NRBC counts in peripheral blood were evaluated in a large group of patients with thalassemia (36 thalassemia major, 55 thalassemia intermedia and 61 Sβ-thalassemia patients) and compared with data from 29 patients with hereditary spherocytosis; in all the patients the concentration of sTfR was evaluated as an index of global erythropoiesis.

Results: The NRBC count showed a good relationship with ineffective erythropoiesis: highest counts were observed in the thalassemia syndromes characterized by almost completely ineffective erythropoiesis. NRBCs were absent in patients affected by hereditary spherocitosis, a disease characterized by effective erythropoiesis.

Conclusions: The NRBC count can be useful for better defining ineffective erythropoiesis in patients with thalassemia, and can help optimize transfusion therapy in severe thalassemia syndromes.

Clin Chem Lab Med 2009;47:1539–42.

Keywords: erythropoiesis; hereditary spherocytosis; nucleated red blood cells; serum transferrin receptor; thalassemia syndromes

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