Nucleated red blood cells in the blood of medical intensive care patients indicate increased mortality risk: a prospective cohort study

Stachon, Axel; Segbers, Elmar; Holland‐Letz, Tim; Kempf, Reiner; Hering, S.; Krieg, Michael

doi:10.1186/cc5932

Cited by 72 publications

(114 citation statements)

References 28 publications

(36 reference statements)

Supporting

Mentioning

100

Contrasting

Unclassified

Order By: Relevance

“…6 Appearance of peripheral NRBC in human heatstroke has never been described; however, in critically ill human patients, appearance of NRBCs in the peripheral blood has been associated with a variety of severe diseases and poor prognosis. [7][8][9][10][11][12] The high prevalence of peripheral NRBC at presentation in the dogs in the present study made it possible to assess their usefulness as a prognostic marker for prediction of secondary complications and outcome. At presentation, significantly higher rNRBC and aNRBC were observed in nonsurvivors compared with survivors.…”

Section: Discussionmentioning

confidence: 99%

Peripheral Nucleated Red Blood Cells as a Prognostic Indicator in Heatstroke in Dogs

Aroch

Segev

Loeb

et al. 2009

Veterinary Internal Medicne

View full text Add to dashboard Cite

Background: Heatstroke in dogs is often fatal and is associated with a high prevalence of secondary complications. Peripheral nucleated red blood cells (NRBC) occur in dogs with heatstroke, but their association with complications and the outcome is unclear.Hypothesis: Peripheral NRBC are common in dogs with heatstroke and have prognostic significance. Animals: Forty client-owned dogs with naturally occurring heatstroke. Methods: Prospective, observational study. Dogs were followed from presentation to discharge or death. Serum biochemistry and coagulation tests were performed at presentation. CBC and evaluation of peripheral blood smears were performed at presentation and every 12 hours. The relative and the absolute NRBC numbers were calculated.Results: Presence of NRBC was observed in 36/40 (90%) of the dogs at presentation. Median relative and absolute NRBC were 24 cells/100 leukocytes (range 0-124) and 1.48 Â 10 3 /mL (range 0.0-19.6 Â 10 3 /mL), respectively. Both were significantly higher in nonsurvivors (22) versus survivors (18) and in dogs with secondary renal failure and DIC versus those without these complications. Receiver operator curve analysis of relative NRBC at presentation as a predictor of death had an area under curve of 0.92. A cut-off point of 18 NRBC/100 leukocytes corresponded to a sensitivity and specificity of 91 and 88% for death.Conclusions and Clinical Importance: Relative and absolute numbers of peripheral NRBC are clinically useful, correlate with the secondary complications, and are sensitive and specific markers of death in dogs with heatstroke, although they should never be used as a sole prognostic indicator nor should they replace clinical assessment.

show abstract

Section: Discussionmentioning

confidence: 99%

Peripheral Nucleated Red Blood Cells as a Prognostic Indicator in Heatstroke in Dogs

Aroch

Segev

Loeb

et al. 2009

Veterinary Internal Medicne

View full text Add to dashboard Cite

show abstract

“…Reporting nRBCs as a quantitative result will not only preclude it as an interfering substance but may prove to be clinically useful. For example, Stachon et al 25 discovered that nRBCs in a patient sample could be an indication of poor prognosis due to endotoxemia or hypoxia in critically ill patients. This marker can be used to help clinicians decide whether or not to transfer the patient to other units within the hospital.…”

Section: Challenges Of Clia-waivermentioning

confidence: 99%

“…This marker can be used to help clinicians decide whether or not to transfer the patient to other units within the hospital. 25 In addition, nRBCs may indicate hemolytic disease in newborns or intrauterine hypoxemia resulting in further clinical investigation. 26-28 …”

Section: Challenges Of Clia-waivermentioning

confidence: 99%

Point-of-Care Hematology and Coagulation Testing in Primary, Rural Emergency, and Disaster Care Scenarios

Curtis¹,

Kost²,

Louie³

et al. 2012

Point of Care: The Journal of Near-Patient Testing &Amp; Technology

View full text Add to dashboard Cite

The purpose of this article is to review current principles and criteria for obtaining Clinical Laboratory Improvement Amendments of 1988 (CLIA ’88) waiver, identify existing point-of-care (POC) coagulation and hematology technologies, and analyze regulatory challenges regarding CLIA-waiver for those and future devices. CLIA ’88 documentation requires tests performed by laboratories with a Certificate of Waiver to be so simple that the likelihood of erroneous results by the user is negligible, or poses no unreasonable risk of harm to the patient if performed incorrectly as determined by the Secretary of Health and Human Services. “Simple” means that the test uses unprocessed samples, has a direct read-out of test results, does not have specifications for user training, and includes instructions for confirmatory testing when advisable. Currently the CLIA-waived hematology and coagulation POC devices only test for hemoglobin (Hb), hematocrit (Hct), and prothrombin time/international normalized ratio (PT/INR). The problem with these devices is the lack of multiplexing. POC coagulation and hematology devices face challenges for obtaining a waiver. These challenges include the lack of clinical needs assessment, miniturized assays that correct for interfering substances, and assays simple enough to be combined in a multiplex platform. Several scenarios demonstrate how POC coagulation or hematology devices can improve crisis care. Industry should perform needs assessment on clinicians and emergency responders to determine which analytes to incorporate on multiplex POC coagulation and hematology devices, and produce devices that address confounding factors.

show abstract

“…Generally, NRBCs are physiologically present in the blood of newborns and pregnant women . The detection of NRBCs in the peripheral blood can be a marker of many pathological conditions and is of significant prognostic value . In thalassemia patients, determining the number of NRBCs is beneficial for blood transfusion management .…”

Section: Introductionmentioning

confidence: 99%

“…In thalassemia patients, determining the number of NRBCs is beneficial for blood transfusion management . In hospitalized patients, especially in intensive care units, an increased number of NRBCs is associated with a higher rate of mortality . In addition, the accurate identification and enumeration of NRBCs is crucial for obtaining correct white blood cell (WBC) counts as NRBCs can interfere with the WBC count in automated hematology analyzers (HAs).…”

Section: Introductionmentioning

confidence: 99%

Automated nucleated red blood cell count using the Mindray BC‐6800 hematology analyzer

Houyhongthong

Nunphuak

Sripatumtong

et al. 2018

Int J Lab Hematology

View full text Add to dashboard Cite

The Mindray CAL8000 automated hematology system, which is composed of the BC-6800 and the SC-120, yields a precise NRBC count and can replace the traditional MM method for obtaining accurate and reproducible NRBC counts in high-value samples, such as patient monitoring samples used to determine the necessity of transfusion therapy in thalassemia patients. Moreover, this method offers several advantages, including a faster turnaround time, labor savings, and cost effectiveness.

show abstract

Nucleated red blood cells in the blood of medical intensive care patients indicate increased mortality risk: a prospective cohort study

Abstract: Introduction In critically ill patients, the appearance of nucleated red blood cells (NRBCs) in blood is associated with a variety of severe diseases. Generally, when NRBCs are detected in the patients' blood, the prognosis is poor.

Cited by 72 publications

References 28 publications

Peripheral Nucleated Red Blood Cells as a Prognostic Indicator in Heatstroke in Dogs

Peripheral Nucleated Red Blood Cells as a Prognostic Indicator in Heatstroke in Dogs

Point-of-Care Hematology and Coagulation Testing in Primary, Rural Emergency, and Disaster Care Scenarios

Automated nucleated red blood cell count using the Mindray BC‐6800 hematology analyzer

Contact Info

Product

Resources

About