An easily ignored indicator – NRBC

September 20, 2023

An easily ignored indicator – NRBC

The hematology test is one of the most basic testing items in clinical testing. In addition to parameters such as white blood cells (WBC), red blood cells (RBC), and platelets (PLT), there is also an important parameter item called nucleated red blood cells (NRBC) which obtains more attention in the laboratory.

What is NRBC ?

Nucleated red blood cells (NRBC), also known as immature red blood cells, are early-stage red blood cells that have not yet removed their nuclei and have not yet fully matured. Newborns born within a month can produce existing NRBC in the peripheral blood due to the underdeveloped hematopoietic system. Under normal circumstances, there is no NRBC in the peripheral blood of healthy adults. If NRBC is present, it is highly likely to indicate a pathological state.^[1-3]

Clinical significance

The appearance of NRBC in adult peripheral blood is a pathological change, so NRBC has important clinical significance in the screening and prognosis of various diseases. Here are the pathological types of NRBC.

New clinical applications of NRBC

In recent years, domestic and foreign studies have shown that detecting NRBC in peripheral blood often indicates a high risk of death for patients. Generally, NRBC can be detected in peripheral blood 1 to 3 weeks before the patient's death^{[4] [5].}The higher the NRBC content, the greater the risk of death. (Fig.2)In addition, some scholars have found that NRBC may be correlated with parameters of hypoxia and inflammatory damage, which also confirms that NRBC is a strong predictor of increased mortality.^{[6] [7}^]The increase in peripheral blood NRBC levels indicates poor prognosis and increased risk of death in patients, which has a certain guiding significance for early detection of poor prognosis in clinical practice.^[8]

In the daily work of the laboratory, WBC counting is susceptible to the influence of NRBC, resulting in inaccurate WBC count^[9^]， DIRUI BF-7200Plus Automatic Hematology Analyzer, adopts semiconductor laser flow cytometry combined with nucleic acid fluorescence staining technology to detect NRBC. The WNR channel can count NRBC at the same time as WBC. BF-7200Plus can provide a 3D Scatter plot.

The forward scattered light (FSC): reflects the size of the cell volume, used to distinguish the size of the cell.

The sideways scattered light(SSC): reflects the internal fine structure and particulate matter of the cell, the test results with secondary accelerated sheath flow technology are more accurate.

The sideways fluorescence(SFL): reflects the nucleic acid content of blood cells, improves the sensitivity of the identification of naive cells, and ensures the accuracy of the detection results from the methodology.

Therefore, BF-7200Plus can accurately detect NRBC and can be widely used in clinics.

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Reference:

[1] Hao Rongzhen, Li Xianghong. Research progress on nucleated red blood cells [J]. Maternal and Child World, 2019 (9): 290-293

[2] Lu Zuojie, Nong Shaoyun. Clinical significance of nucleated red blood cells in peripheral blood smears [J]. International Journal of Medical Laboratory, 2013,34 (19): 2605-2607

[3] Fu Jinfeng, Zhu Ping, Hao Suyuan. The significance of fetal nucleated red blood cell detection [J]. Chinese Journal of Eugenics and Genetics, 2006 (10): 114-115

[4] Stachon A, Sondermann N, Imohl M, et al. Induced red blood cells indicate a high risk for in hospital mortali [J]. JLab Clin Med, 2002140 (6): 407-412

[5] Stachon A, KempfR, Holland Letz T, et al. Daily monitoring of nucleated red blood cells in the blood of Surgical intensive care patients [J]. ClinChim Aeta, 2006366 (1/2): 329-335

[6] StachonA, Segbers E, Holland Letz T, et al. Reduced red blood cells in the blood of medical intensive care patients indicate increased morality risk: a prospective cohort study [J]. CriCare, 2007, 11 (3): R62-69

[7] Yuan Yuan, Fang Meidan, Wang Jing. Clinical value of peripheral blood nucleated red blood cells in evaluating the prognosis of critically ill patients. Clinical Laboratory, 2017,27 (16): 2326-2328

[8] Wei Jie, Xie Zhenfeng, Wu Xiaoman, Deng Xiaoyan, Chen Bo, Peng Liang. Analysis of cases of peripheral blood nucleated erythrocytosis and preliminary study of its relationship with disease outcome. Medical Laboratory and Clinic, 2017,17 (2): 1-3

[9] Li Jianying. Study on automatic count of nucleated red cells in peripheral blood by blood cell analyzer [J]. Chinese Journal of Laboratory Medicine,2005,28(6):606-609.