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Brunner‐Ziegler S, Jilma B, Grimm G, Jilma‐Stohlawetz P. Comparison Evaluation of Automated Nucleated Red Blood Cell Enumeration by Sysmex XN 1000 in Comparison With Microscopic Reference in Children Under 1 Year. J Clin Lab Anal 2024; 38:e25037. [PMID: 38619294 PMCID: PMC11073812 DOI: 10.1002/jcla.25037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/12/2024] [Accepted: 03/26/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND In newborns, elevated nucleated red blood cell (NRBC) levels can be associated with enhanced erythropoietic stress and might be predictive for adverse outcome. Also, the presence of NRBC in peripheral blood might lead to erroneous enumeration results of white blood cells in automated hematology analyzers. We aimed to assess the comparability of the Sysmex XN 1000 to manual slide reviews and correlation of NRBC with inflammation markers. METHODS Specimens of 3397 children under 1 year were compared by automated and microscopic NRBC enumeration. Additionally, potential correlations between NRBC and age and inflammation markers were examined. RESULTS Overall, there was good correlation (r = 0.97) between automated (range: 0%-3883%) and microscopic enumeration (range: 0%-3694%) of NRBC with high comparability up to a NRBC value of 200% and an increase in the variation between the two methods with increasing NRBC numbers. When 94 samples with ≤ 200% NRBC and ≥ 30% divergence between methods were separately reanalyzed with respect to overlapping cell populations in their scattergrams, Sysmex would have generated unrecognized incorrect automated results in 47 samples, corresponding to 1.4% of total study samples. NRBC counts were negatively correlated to age, but not to inflammation markers. CONCLUSION Sysmex XN 1000 is highly precise in the enumeration of NRBC in children under 1 year up to counts of 200% and might replace time-intense manual counting in routine diagnostics. In the setting of neonatal and intensive care diagnostics, microscopic control and supervision of scattergrams are highly recommended for any automated NRBC enumeration processes.
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Affiliation(s)
- Sophie Brunner‐Ziegler
- Division of Angiology, Department of Internal Medicine IIMedical University of ViennaViennaAustria
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - Bernd Jilma
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - Gabriele Grimm
- Department of Laboratory MedicineMedical University of ViennaViennaAustria
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Li H, Tu Q, Feng K, Cheng J, Zou Z, Li S, Tan L. Nucleated red blood cells as a novel biomarker in the diagnosis and prediction of sepsis severity in children. Front Cell Infect Microbiol 2023; 13:1264607. [PMID: 38029254 PMCID: PMC10646244 DOI: 10.3389/fcimb.2023.1264607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/20/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Sepsis is a vitally serious disease leading to high mortality. Nucleated red blood cells (NRBCs) are present in some noninfectious diseases, but the relationship between NRBCs and sepsis in children remains unknown. The purpose of this study was to compare the clinical characteristics and outcomes of sepsis with positive NRBCs and negative NRBCs in children, and to further explore whether the count of NRBCs has a relationship with the severity of sepsis. Methods We enrolled children with sepsis who were admitted to the Children's Hospital of Chongqing Medical University between January 2020 and December 2022. The children's clinical data, laboratory data and outcomes were recorded and analyzed. Results One hundred and fifteen children met the inclusion criteria in our study. Compared to negative NRBCs patients, the C-reactive protein, alanine transaminase, urea nitrogen values, mortality rate and length of hospitalization were found to be significantly increased, while platelet counts, and hemoglobin were significantly decreased in sepsis patients with positive NRBC (P < 0.05). Receiver operating characteristic (ROC) curves analysis showed that the optimal cutoff value of the NRBC count in the diagnosis of severe sepsis was 3, with a sensitivity of 87.5% and specificity of 94.9%. The area under the ROC curve was 0.877 (95% CI: 0.798-0.957). Discussion These findings demonstrated that NRBC count has the potential to be a biomarker for the diagnosis of sepsis in children, especially an NRBC count greater than 3, which may predict the severity and poor prognosis in children suffering from sepsis.
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Affiliation(s)
- Hongdong Li
- Department of Emergency, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Qianqian Tu
- Department of Clinical Laboratory, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Kun Feng
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Cheng
- Department of Emergency, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Zhiping Zou
- Department of Emergency, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Shaojun Li
- Department of Emergency, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Liping Tan
- Department of Emergency, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
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Hashmi SA, Khowaja R, Ali M, Mangi AR, Khowaja A, Riaz G, Hashmi SMM, Haider AR, Hussain SDA, Agha S. Prognostic Significance of Nucleated RBCs in Predicting Mortality Among ST-Elevation Myocardial Infarction Patients Admitted to the ICU. Cureus 2023; 15:e45445. [PMID: 37859905 PMCID: PMC10583491 DOI: 10.7759/cureus.45445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Background The nucleated red blood cells (NRBCs) are a readily available hematological parameter with potential for risk stratification for mortality. Therefore, our objective was to assess the predictive significance of NRBCs for ICU mortality among ST-elevation myocardial infarction (STEMI) patients admitted to an ICU. Additionally, we aimed to compare the predictive capacity of NRBCs with that of the acute physiology and chronic health evaluation (APACHE) II score and the sequential organ failure assessment (SOFA) score. Methodology This descriptive cross-sectional study was conducted in the ICU of the National Institute of Cardiovascular Diseases (NICVD) in Karachi, Pakistan, from the 1st of February to the 30th of June, 2023. We included adult patients (≥18 years) diagnosed with STEMI who were subsequently admitted to the ICU. NRBCs were assessed in all patients over up to five days at 24-hour intervals, and the highest NRBC levels were used for the final analysis. Furthermore, the APACHE II score and the SOFA score were also documented. Patients were monitored throughout their ICU stay, and any adverse events or complications, such as re-intubation, bleeding necessitating transfusion, requirement for renal replacement therapy, arrhythmias, re-infarction, and mortality, were recorded. Results This study included 151 patients, of whom 97 (64.2%) were male, with an average age of 61.1 ± 10.7 years. Patients with positive NRBCs had higher mean SOFA scores (7.4 ± 2.9 vs. 5.4 ± 2.6; p < 0.001) and APACHE II scores (14.6 ± 6.3 vs. 12.6 ± 5.5; p = 0.037) compared to those with negative NRBCs. The culprit vessel showed greater mean stenosis (%) in patients with positive NRBCs (98.8 ± 3.0% vs. 96.8 ± 5.7%; p = 0.004). Post-procedure thrombolysis in myocardial infarction (TIMI) flow grade III was lower in patients with positive NRBCs (77.8% vs. 91.8% for positive vs. negative NRBCs, respectively). Moreover, patients with positive NRBCs experienced significantly higher mortality rates (63% vs. 8.2%; p < 0.001), a higher occurrence of arrhythmias (35.2% vs. 19.6%; p = 0.034), and an increased requirement for vasopressors/inotropic support (96.3% vs. 71.1%; p < 0.001) compared to those with negative NRBCs. NRBCs demonstrated superior discriminatory ability compared to the SOFA and APACHE II scores, with an area under the curve of 0.818 (95% CI: 0.738-0.899) for NRBCs, 0.774 (95% CI: 0.692-0.857) for SOFA, and 0.707 (95% CI: 0.613-0.801) for APACHE II. Positive NRBCs exhibited a sensitivity of 81.0% and a specificity of 81.7% in predicting ICU mortality. Conclusion In conclusion, positive NRBCs emerge as a robust and reliable prognostic indicator, strongly associated with an elevated risk of ICU mortality in STEMI patients. Moreover, the predictive power of positive NRBCs surpasses that of both SOFA and APACHE II scoring systems.
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Affiliation(s)
- Syeda Akefah Hashmi
- Critical Care Medicine, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Raheela Khowaja
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Maria Ali
- Transfusion Medicine, Regional Blood Centre Karachi, Karachi, PAK
| | - Ali R Mangi
- Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Aamir Khowaja
- Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Gohar Riaz
- Adult Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | | | - Ali Raza Haider
- Adult Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | | | - Sidrah Agha
- Adult Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
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Pikora K, Krętowska-Grunwald A, Krawczuk-Rybak M, Sawicka-Żukowska M. Diagnostic Value and Prognostic Significance of Nucleated Red Blood Cells (NRBCs) in Selected Medical Conditions. Cells 2023; 12:1817. [PMID: 37508482 PMCID: PMC10378384 DOI: 10.3390/cells12141817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Nucleated red blood cells (NRBCs) are premature erythrocyte precursors that reside in the bone marrow of humans of all ages as an element of erythropoiesis. They rarely present in healthy adults' circulatory systems but can be found circulating in fetuses and neonates. An NRBC count is a cost-effective laboratory test that is currently rarely used in everyday clinical practice; it is mostly used in the diagnosis of hematological diseases/disorders relating to erythropoiesis, anemia, or hemolysis. However, according to several studies, it may be used as a biomarker in the diagnosis and clinical outcome prognosis of preterm infants or severely ill adult patients. This would allow for a quick diagnosis of life-threatening conditions and the prediction of a possible change in a patient's condition, especially in relation to patients in the intensive care unit. In this review, we sought to summarize the possible use of NRBCs as a prognostic marker in various disease entities. Research into the evaluation of the NRBCs in the pediatric population most often concerns neonatal hypoxia, the occurrence and consequences of asphyxia, and overall neonatal mortality. Among adults, NRBCs can be used to predict changes in clinical condition and mortality in critically ill patients, including those with sepsis, trauma, ARDS, acute pancreatitis, or severe cardiovascular disease.
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Affiliation(s)
- Katarzyna Pikora
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Jerzego Waszyngtona 17, 15-274 Bialystok, Poland
| | - Anna Krętowska-Grunwald
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Jerzego Waszyngtona 17, 15-274 Bialystok, Poland
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Jerzego Waszyngtona 17, 15-274 Bialystok, Poland
| | - Małgorzata Sawicka-Żukowska
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Jerzego Waszyngtona 17, 15-274 Bialystok, Poland
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Noor T, Imran A, Raza H, Sarwar M, Umer S, Fatima M. Frequency of Nucleated Red Blood Cells in the Peripheral Blood of ICU-Admitted Patients. Cureus 2023; 15:e33827. [PMID: 36819402 PMCID: PMC9930871 DOI: 10.7759/cureus.33827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 01/18/2023] Open
Abstract
Background Nucleated red blood cells (NRBCs) are not normally found in the peripheral blood of normal healthy individuals. The presence of NRBCs on an adult peripheral blood smear indicates that there is an extremely high demand for the bone marrow to manufacture RBCs and that immature red blood cells are being released into the bloodstream. Anemia, myelofibrosis, thalassemia, miliary tuberculosis, malignancies of the bone marrow (myelomas, leukemias, lymphomas), and prolonged hypoxemia are a few possible pathogenic reasons. Critically ill patients who have NRBCs have a high mortality rate and a worse prognosis. OBJECTIVE To evaluate the clinical significance of NRBCs in the peripheral blood of critically ill patients admitted to the ICU to find a cut-off to predict mortality. MATERIALS AND METHODS A cross-sectional study was carried out over a period of six months September 1, 2020, to March 31, 2021, in Lahore, Pakistan. A total of 800 critically ill patients of both sexes in the age group of 18-70 years were included. Patients younger than 18 years and patients who underwent surgery were excluded. A quantity of 3 ml of whole blood sample in an ethylenediamine tetraacetic acid (EDTA) vial from each patient was run on SYSMEX XN-9000 (Sysmex Corporation, Kobe, Hyogo, Japan) and the results were reviewed on peripheral smears. RESULTS The incidence of NRBCs in ICU-admitted patients was 62.5% (500/800). The total number of NRBC-positive patients recovering after the treatment was 364 (72.8%). The overall mortality of NRBC-positive patients was 30% (150/500). It was significantly higher (p<0.001) than that of NRBC-negative patients (14%; 44/300). During treatment, the highest mortality rate was seen in patients due to malignancy (100%), followed by sepsis (58.8%). It was observed that the disease pattern and number of NRBCs were significantly different (p<0.001) among all disease groups. However, there was no statistically significant difference in NRBCs on the basis of gender (p >0.05). In our study, a cutoff of NRBCs of 2.50 showed a high risk of mortality with a sensitivity of 91%. CONCLUSION The presence of NRBCs may predict mortality in critically ill ICU-admitted patients. Their presence in the blood may be regarded as a marker of severity suggesting a high risk of ICU death.
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Peripheral Nucleated Red Blood Cells and Mortality in Critically Ill Children. J Pediatr Hematol Oncol 2022; 44:79-83. [PMID: 34486569 DOI: 10.1097/mph.0000000000002294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
The present retrospective cohort study examines whether there is an association between circulating nucleated red blood cells (nRBCs) and mortality in critically ill children. nRBCs are erythropoietic progenitor cells not found in peripheral blood of healthy adults and children beyond the neonatal period. The presence of circulating nRBCs is associated with poor prognosis in adults and neonates, though little is known about their significance in children. Admissions to both the general and cardiac pediatric intensive care unit at the Stollery Children's Hospital in Edmonton, Alberta between January 1, 2015 and December 31, 2017 were examined, and logistic regression was performed to ascertain the association between the peak absolute nRBC counts and in-hospital mortality in critically ill children. A total of 2065 admissions were included. The number of admissions with detectable nRBCs was 386 (prevalence: 13.9%), and the number of deaths was 93 (mortality: 4.5%). A statistically significant association was found between the absolute value of nRBC peak and intensive care unit mortality (odds ratio=1.37; 95% confidence interval: 1.13-1.67; P=0.002) as well as hospital mortality (odds ratio=1.38; 95% confidence interval: 1.12-1.70; P=0.003) independent of the Pediatric Index of Mortality 3 score (PIM3). This result warrants more attention to nRBC values and their potential clinical use.
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Prognostic Value of Nucleated RBCs for Patients With Suspected Sepsis in the Emergency Department: A Single-Center Prospective Cohort Study. Crit Care Explor 2021; 3:e0490. [PMID: 34291222 PMCID: PMC8288902 DOI: 10.1097/cce.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Supplemental Digital Content is available in the text. OBJECTIVES: Increase of nucleated RBCs in peripheral blood has been shown to be predictive of mortality in ICU patients. The aim of this study was to explore the prognostic value of nucleated RBCs in the first blood sample taken at admission to the emergency department from patients with suspected sepsis. DESIGN: Single-center prospective cohort study. SETTING: Emergency department. PATIENTS: One-thousand two-hundred thirty-one consecutive adult patients with suspected sepsis were included in a prospective quality register-based cohort study. Inclusion criteria were as follows: patients received in rapid response team with blood cultures taken and immediate antibiotics given in the emergency department. Intervention: Not applicable. MEASUREMENT AND MAIN RESULTS: Nucleated RBCs, Sequential Organ Failure Assessment score, Quick Sequential Organ Failure Assessment, Charlson Comorbidity Index, and commonly used laboratory tests measured in the emergency department were compared with 30-day mortality. Nvaucleated RBC counts were divided into five groups, called “Nucleated RBC score,” according to nucleated RBC count levels and analyzed with logistic regression together with the Sequential Organ Failure Assessment score and Charlson Comorbidity Index. Of the 262 patients with nucleated RBCs equal to or higher than the detection limit (0.01 × 109/L), 26% died within 30 days, compared with 12% of the 969 patients with nucleated RBCs below the detection limit (p < 0.0001). Mortality was significantly higher for each increase in Nucleated RBC score, except from score 2 to 3, and was 62% in the highest group. In multivariate logistic regression, odds ratios for 30-day mortality were as follows: Nucleated RBC score: 1.33 (95% CI, 1.13–1.56), Sequential Organ Failure Assessment score: 1.32 (1.29–1.56), and Charlson Comorbidity Index: 1.17 (1.09–1.25). CONCLUSIONS: Most patients with suspected sepsis in emergency department had undetectable nucleated RBCs at admission to the emergency department. However, increased nucleated RBCs significantly predicted 30-day mortality. Nucleated RBCs may provide additional prognostic information to Sequential Organ Failure Assessment score and other laboratory tests.
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Jenkins PM, Al Daoud F, Mercer L, Scholten D, Wong K, Perinjelil V, Majeski K, Cranford J, Elian G, Nigam T, Carto CA, Sachwani-Daswani GR. The Presence of Nucleated Red Blood Cells as an Indicator for Increased Mortality and Morbidity in Burn Patients. J Burn Care Res 2021; 42:1210-1214. [PMID: 33608722 PMCID: PMC8633085 DOI: 10.1093/jbcr/irab035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Nucleated red blood cells (NRBCs) have been studied in critically ill and injured patients as a predictor of increased in-hospital mortality and poor clinical outcomes. While prior studies have demonstrated the prognostic power of NRBCs in the critical patient, there has been a paucity of literature available describing their value as a prognostic indicator in the severely burned patient. This retrospective observational study was conducted from 2012 to 2017. Inclusion criteria for this study included all burn patients with total body surface area > 10% who were aged ≥ 15 years. Demographic and clinical data were collected from the electronic medical record system. Data analysis consisted of descriptive and comparative analysis using SPSS. Two hundred and nineteen patients (17.5%) met inclusion criteria with 51 (23.3%) patients positive for NRBCs. The presence of NRBCs had an increased mortality rate with an odds ratio of 6.0 (P = .001; 2.5, 14.5); was more likely to appear in older patients (P < .001); and was associated with increased hospital length of stay (P < .001), injury severity scores (P < .001), and complications. The presence of NRBCs even at the low concentrations reported in our study showed a 6-fold increase in the rate of mortality. With the current improvements in burn care leading to higher survival rates, the need to improve upon the numerous models that have been developed to predict mortality in severe burn patients is clear given the significantly increased risk of death that the presence of NRBCs portends.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ghaith Elian
- Michigan State University College of Human Medicine
| | - Tina Nigam
- Michigan State University College of Human Medicine
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Phan TT, Vy HT, Ho TT, Tran VT, Tran TT, Pho SP, Pham TTB, Le TT, Nguyen ST. Emergence role of nucleated red blood cells in molecular response evaluation for chronic myeloid leukemia. Int J Gen Med 2019; 12:333-341. [PMID: 31564956 PMCID: PMC6731972 DOI: 10.2147/ijgm.s219744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/12/2019] [Indexed: 01/26/2023] Open
Abstract
Purpose To 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. Methods Seventy-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. Results The 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. Conclusion The 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.
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Affiliation(s)
- Thang Thanh Phan
- Biomolecular & Genetic Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam.,Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Ha The Vy
- Department of Hematology, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Toan Trong Ho
- Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Vinh Thanh Tran
- Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Tung Thanh Tran
- Department of Hematology, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Suong Phuoc Pho
- Biomolecular & Genetic Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Tuyen Thi Bich Pham
- Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Thao Thi Le
- Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Son Truong Nguyen
- Department of General Director, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam.,Department of the Vice Minister, Ministry of Health, Hanoi City 100000, Vietnam
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Menk M, Giebelhäuser L, Vorderwülbecke G, Gassner M, Graw JA, Weiss B, Zimmermann M, Wernecke KD, Weber-Carstens S. Nucleated red blood cells as predictors of mortality in patients with acute respiratory distress syndrome (ARDS): an observational study. Ann Intensive Care 2018; 8:42. [PMID: 29589209 PMCID: PMC5869325 DOI: 10.1186/s13613-018-0387-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/17/2018] [Indexed: 12/15/2022] Open
Abstract
Background Nucleated red blood cells (NRBCs) in critically ill patients are associated with increased mortality and poor outcome. The aim of the present study was to evaluate the predictive value of NRBCs in patients with acute respiratory distress syndrome (ARDS). Methods This observational study was conducted at an ARDS referral center and included patients from 2007 to 2014. Daily NRBC counts were assessed and the predictive validity of NRBCs on mortality was statistically evaluated. A cutoff for prediction of mortality based on NRBCs was evaluated using ROC analysis and specified according to Youden’s method. Multivariate nonparametric analysis for longitudinal data was applied to prove for differences between groups over the whole time course. Independent predictors of mortality were identified with multiple logistic and Cox’ regression analyses. Kaplan–Meier estimations visualized the survival; the corresponding curves were tested for differences with the log-rank test. Results A total of 404 critically ill ARDS patients were analyzed. NRBCs were found in 75.5% of the patients, which was associated with longer length of ICU stay [22 (11; 39) vs. 14 (7; 26) days; p < 0.05] and higher mortality rates (50.8 vs. 27.3%; p < 0.001). Logistic regression analysis with mortality as response showed NRBC positivity per se to be an independent risk factor for mortality in ARDS with a doubled risk for ICU death (OR 2.03; 95% CI 1.16–3.55; p < 0.05). Also, NRBC value at ICU admission was found to be an independent risk factor for mortality (OR 3.25; 95% CI 1.09–9.73, p = 0.035). A cutoff level of 220 NRBC/µl was associated with a more than tripled risk of ICU death (OR 3.2; 95% CI 1.93–5.35; p < 0.0001). ARDS patients below this threshold level had a significant survival advantage (median survival 85 days vs. 29 days; log rank p < 0.001). Presence of a severe ARDS was identified as independent risk factor for the occurrence of NRBCs > 220/µl (OR 1.81; 95% CI 1.1–2.97; p < 0.05). Conclusions NRBCs may predict mortality in ARDS with high prognostic power. The presence of NRBCs in the blood might be regarded as a marker of disease severity indicating a higher risk of ICU death.
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Affiliation(s)
- Mario Menk
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Lena Giebelhäuser
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Gerald Vorderwülbecke
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Martina Gassner
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Jan A Graw
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Björn Weiss
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Mathias Zimmermann
- Central Institute of Laboratory Medicine, DRK Klinikum Berlin Westend, Spandauer Damm 130, 14050, Berlin, Germany
| | - Klaus-D Wernecke
- Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Sostana GmbH, Wildensteiner Straße 27, 10318, Berlin, Germany
| | - Steffen Weber-Carstens
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
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11
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Da Rin G, Vidali M, Balboni F, Benegiamo A, Borin M, Ciardelli ML, Dima F, Di Fabio A, Fanelli A, Fiorini F, Francione S, Germagnoli L, Gioia M, Lari T, Lorubbio M, Marini A, Papa A, Seghezzi M, Solarino L, Pipitone S, Tilocca E, Buoro S. Performance evaluation of the automated nucleated red blood cell count of five commercial hematological analyzers. Int J Lab Hematol 2017; 39:663-670. [PMID: 28990291 DOI: 10.1111/ijlh.12722] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 06/26/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Recent automated hematology analyzers (HAs) can identify and report nucleated red blood cells (NRBC) count as a separate population out of white blood cells (WBC). The aim of this study was to investigate the analytical performances of NRBC enumeration on five top of the range HAs. METHODS We evaluated the within-run and between-day precision, limit of blank (LoB), limit of detection (LoD), and limit of quantitation (LoQ) of XE-2100 and XN-module (Sysmex), ADVIA 2120i (Siemens), BC-6800 (Mindray), and UniCel DxH 800 (Beckman Coulter). Automated NRBC counts were also compared with optical microscopy (OM). RESULTS The limits of detection for NRBC of the BC-6800, XN-module, XE-2100, UniCel DxH 800, and ADVIA 2120i are 0.035×109 /L, 0.019×109 /L, 0.067×109 /L, 0.038×109 /L, and 0.167×109 /L, respectively. Our data indicated excellent performance in terms of precision. The agreement with OM was excellent for BC-6800, XN-module, and XE-2100 (Bias 0.023, 0.019, and 0.033×109 /L, respectively). ADVIA 2120i displayed a significant constant error and UniCel DxH 800 both proportional and small constant error. CONCLUSION Regards to NRBC counting, the performances shown by BC-6800, XN-module, and XE-2100 are excellent also a low count, ADVIA 2120i and UniCel DxH 800 need to be improved.
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Affiliation(s)
- G Da Rin
- Laboratory Medicine, San Bassiano Hospital, ASL 7 Pedemontana, Bassano del Grappa, Italy
| | - M Vidali
- Immunohematology and Transfusion Medicine Service, Hospital SS. Trinità, Borgomanero, Italy
| | - F Balboni
- Laboratory Medicine, Istituto Fiorentino di Cura e Assistenza (IFCA), Firenze, Italy
| | - A Benegiamo
- Laboratory of Clinical Chemistry and Hematology, Hospital of Parma, Parma, Italy
| | - M Borin
- Clinical Chemistry Laboratory and Microbiology, ASL NO, Borgomanero, Italy
| | - M L Ciardelli
- Clinical Chemistry Laboratory, IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Dima
- Clinical Chemistry Laboratory, AOUI Verona, Verona, Italy
| | - A Di Fabio
- Clinical Chemistry Laboratory, Hospital Civile, Avezzano, Italy
| | - A Fanelli
- General Laboratory, University Hospital Careggi, Firenze, Italy
| | - F Fiorini
- Clinical Pathology Laboratory, USL Nordovest, Toscana, Italy
| | - S Francione
- Clinical Chemistry Laboratory and Microbiology, ASL NO, Borgomanero, Italy
| | | | - M Gioia
- Clinical Chemistry Laboratory, Hospital Abele Ajello, Mazara del Vallo, Italy
| | - T Lari
- Clinical Chemistry Laboratory, Hospital Versilia, Azienda Toscana Nord ovest, Lido di Camaiore, Italy
| | - M Lorubbio
- Laboratory Medicine, Fondazione G. Monasterio CNR Regione Toscana, Pisa, Italy
| | - A Marini
- Clinical Chemistry Laboratory, Hospital Versilia, Azienda Toscana Nord ovest, Lido di Camaiore, Italy
| | - A Papa
- Laboratory Medicine, Fondazione G. Monasterio CNR Regione Toscana, Pisa, Italy
| | - M Seghezzi
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - L Solarino
- Laboratory Medicine I, P.O. V.Emanuele, A.U.O "Policlinico-V.Emanuele", Catania, Italy
| | - S Pipitone
- Laboratory of Clinical Chemistry and Hematology, Hospital of Parma, Parma, Italy
| | - E Tilocca
- Laboratory Medicine I, P.O. V.Emanuele, A.U.O "Policlinico-V.Emanuele", Catania, Italy
| | - S Buoro
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII, Bergamo, Italy
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12
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Tóth J, Debreceni IB, Berhés M, Hajdú E, Deák Á, Pető K, Szabó J, Németh N, Fülesdi B, Kappelmayer J. Red blood cell and platelet parameters are sepsis predictors in an Escherichia coli induced lethal porcine model. Clin Hemorheol Microcirc 2017; 66:249-259. [DOI: 10.3233/ch-170271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Judit Tóth
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ildikó Beke Debreceni
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Mariann Berhés
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Endre Hajdú
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ádám Deák
- Department of Operative Techniques and Surgical Research, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Katalin Pető
- Department of Operative Techniques and Surgical Research, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Szabó
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Norbert Németh
- Department of Operative Techniques and Surgical Research, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Béla Fülesdi
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - János Kappelmayer
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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13
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Purtle SW, Horkan CM, Moromizato T, Gibbons FK, Christopher KB. Nucleated red blood cells, critical illness survivors and postdischarge outcomes: a cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017. [PMID: 28633658 PMCID: PMC5479031 DOI: 10.1186/s13054-017-1724-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Little is known about risk factors associated with out-of-hospital outcomes in survivors of critical illness. We hypothesized that the presence of nucleated red blood cells in patients who survived critical care would be associated with adverse outcomes following hospital discharge. Methods We performed a two-center observational cohort study of patients treated in medical and surgical intensive care units in Boston, Massachusetts. All data were obtained from the Research Patient Data Registry at Partners HealthCare. We studied 2878 patients, age ≥ 18 years, who received critical care between 2011 and 2015 and survived hospitalization. The exposure of interest was nucleated red blood cells occurring from 2 days prior to 7 days after critical care initiation. The primary outcome was mortality in the 90 days following hospital discharge. Secondary outcome was unplanned 30-day hospital readmission. Adjusted odds ratios were estimated by multivariable logistic regression models with inclusion of covariate terms thought to plausibly interact with both nucleated red blood cells and outcome. Adjustment included age, race (white versus nonwhite), gender, Deyo–Charlson Index, patient type (medical versus surgical), sepsis and acute organ failure. Results In patients who received critical care and survived hospitalization, the absolute risk of 90-day postdischarge mortality was 5.9%, 11.7%, 15.8% and 21.9% in patients with 0/μl, 1–100/μl, 101–200/μl and more than 200/μl nucleated red blood cells respectively. Nucleated red blood cells were a robust predictor of postdischarge mortality and remained so following multivariable adjustment. The fully adjusted odds of 90-day postdischarge mortality in patients with 1–100/μl, 101–200/μl and more than 200/μl nucleated red blood cells were 1.77 (95% CI, 1.23–2.54), 2.51 (95% CI, 1.36–4.62) and 3.72 (95% CI, 2.16–6.39) respectively, relative to patients without nucleated red blood cells. Further, the presence of nucleated red blood cells is a significant predictor of the odds of unplanned 30-day hospital readmission. Conclusion In critically ill patients who survive hospitalization, the presence of nucleated red blood cells is a robust predictor of postdischarge mortality and unplanned hospital readmission. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1724-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steven W Purtle
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Boulder, CO, USA
| | - Clare M Horkan
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Takuhiro Moromizato
- Renal and Rheumatology Division, Internal Medicine Department, Okinawa Southern Medical Center and Children's Hospital, Haebaru, Okinawa, Japan
| | - Fiona K Gibbons
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kenneth B Christopher
- The Nathan E. Hellman Memorial Laboratory, Renal Division, Channing Division of Network Medicine, Brigham and Women's Hospital, MRB 418, 75 Francis Street, Boston, MA, 02115, USA.
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14
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Hwang DH, Dorfman DM, Hwang DG, Senna P, Pozdnyakova O. Automated Nucleated RBC Measurement Using the Sysmex XE-5000 Hematology Analyzer: Frequency and Clinical Significance of the Nucleated RBCs. Am J Clin Pathol 2016; 145:379-84. [PMID: 26834126 DOI: 10.1093/ajcp/aqv084] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We validated the automatic nucleated RBC (nRBC) count on a Sysmex XE-5000 hematology analyzer (Sysmex Corporation, Kobe, Japan) and then evaluated the frequency of nRBCs in our patient population. METHODS We correlated automated nRBC enumeration by the Sysmex XE-5000 hematology analyzer on 463 peripheral blood (PB) samples with the manual nRBC count. Results from 360,504 consecutive blood samples were reviewed to determine the frequency of nRBCs in various patient populations in our hospital. RESULTS There was a strong correlation between the automated and manual nRBC count (Pearson's r = 0.97). Frequency of nRBCs varied in different patient populations and was significantly higher in the presence of other morphology flags or abnormal CBC parameters. Low-level nRBCs (0.2%-1.3%) were detected in 0.5% of samples with otherwise normal parameters. CONCLUSIONS The automated method offers many advantages for high-throughput laboratories, including faster turnaround time, labor savings, and high reliability. Automated nRBC measurement allowed us to recognize a group of individuals who have low-level circulating nRBCs with otherwise normal CBC parameters. Nucleated RBC levels below 1.5% as detected by the automated count may be present in patients without increased erythropoiesis or a pathologic bone marrow process.
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Affiliation(s)
- David H Hwang
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - David M Dorfman
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Dick G Hwang
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Patricia Senna
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Olga Pozdnyakova
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
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15
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Monteiro Júnior JGDM, Torres DDOC, da Silva MCFC, Ramos TMDB, Alves ML, Filho WJN, Damasceno EP, Brunet AF, Bittencourt MS, Pedrosa RP, Filho DCS. Nucleated Red Blood Cells as Predictors of All-Cause Mortality in Cardiac Intensive Care Unit Patients: A Prospective Cohort Study. PLoS One 2015; 10:e0144259. [PMID: 26713613 PMCID: PMC4695082 DOI: 10.1371/journal.pone.0144259] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 11/16/2015] [Indexed: 12/21/2022] Open
Abstract
Background The presence of nucleated red blood cells (NRBCs) in the peripheral blood of critically ill patients is associated with a poorer prognosis, though data on cardiovascular critical care patients is lacking. The aim of the present study was to assess the role of NRBCs as a predictor of intensive care unit (ICU) and in hospital all-cause mortality among cardiologic patients. Methods NRBCs were measured daily in consecutive cardiac ICU patients, including individuals with both coronary and non-coronary acute cardiac care. We excluded patients younger than 18 years, with cancer or hematological disease, on glucocorticoid therapy, those that were readmitted after hospital discharge and patients who died in the first 24 hours after admission. We performed a multiple logistic analysis to identify independent predictors of mortality. Results We included 152 patients (60.6 ± 16.8 years, 51.8% female, median ICU stay of 7 [4–11] days). The prevalence of NRBCs was 54.6% (83/152). The presence of NRBC was associated with a higher ICU mortality (49.4% vs 21.7%, P<0.001) as well as in-hospital mortality (61.4% vs 33.3%, p = 0.001). NRBC were equally associated with mortality among coronary disease (64.71% vs 32.5% [OR 3.80; 95%CI: 1.45–10.0; p = 0.007]) and non-coronary disease patients (61.45% vs 33.3% [OR 3.19; 95%CI: 1.63–6.21; p<0.001]). In a multivariable model, the inclusion of NRBC to the APACHE II score resulted in a significant improvement in the discrimination (p = 0.01). Conclusions NRBC are predictors of all-cause in-hospital mortality in patients admitted to a cardiac ICU. This predictive value is independent and complementary to the well validated APACHE II score.
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Affiliation(s)
| | | | | | | | | | - Wellington Jorge Nunes Filho
- Coronary Care Unit of PROCAPE (Pernambuco Cardiac Emergency Hospital), University of Pernambuco (UPE), Recife, Pernambuco, Brazil
| | - Edgar Paulo Damasceno
- Coronary Care Unit of PROCAPE (Pernambuco Cardiac Emergency Hospital), University of Pernambuco (UPE), Recife, Pernambuco, Brazil
| | - Antônio Fernandes Brunet
- Coronary Care Unit of PROCAPE (Pernambuco Cardiac Emergency Hospital), University of Pernambuco (UPE), Recife, Pernambuco, Brazil
| | | | - Rodrigo Pinto Pedrosa
- Coronary Care Unit of PROCAPE (Pernambuco Cardiac Emergency Hospital), University of Pernambuco (UPE), Recife, Pernambuco, Brazil
| | - Dário Celestino Sobral Filho
- Coronary Care Unit of PROCAPE (Pernambuco Cardiac Emergency Hospital), University of Pernambuco (UPE), Recife, Pernambuco, Brazil
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Low immature platelet fraction suggests decreased megakaryopoiesis in neonates with sepsis or necrotizing enterocolitis. J Perinatol 2013; 33:622-6. [PMID: 23448941 DOI: 10.1038/jp.2013.21] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 12/29/2012] [Accepted: 01/22/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE In order to conclude on the megakaryopoietic activity during thrombocytopenia in sepsis or necrotizing enterocolitis (NEC), we analyzed the immature platelet fraction (IPF). STUDY DESIGN Serial measurements of platelet counts and IPF in neonates with blood culture-proven late-onset sepsis (n=21) or surgical NEC (n=12) at T0: prior to the diagnosis of sepsis/NEC; T1: at diagnosis; T2: days 3 to 5 after onset; T3: days 8 to 12 after onset. RESULT In parallel to declining platelet counts, the median absolute IPF significantly decreased between T0 and T2 in neonates with sepsis or NEC. We found a significant positive correlation between the platelet count and absolute IPF (r=0.71; P<0.001). In patients with low IPF (<2 per nl), the platelet count did not subsequently increase. Neonates with NEC who died exhibited significantly lower IPF compared with survivors (P<0.05). CONCLUSION Low absolute IPF values during the course of neonatal sepsis/NEC suggest suppression of megakaryopoietic activity.
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