Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2007;11(3):R62.
doi: 10.1186/cc5932.

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

Axel Stachon  1 , Elmar Segbers, Tim Holland-Letz, Reiner Kempf, Steffen Hering, Michael Krieg
Affiliations

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

Axel Stachon et al. Crit Care. 2007.

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.

Methods: In a prospective study, the detection of NRBCs was used for a daily monitoring of 383 medical intensive care patients.

Results: The incidence of NRBCs in medical intensive care patients was 17.5% (67/383). The mortality of NRBC-positive patients was 50.7% (34/67); this was significantly higher (p < 0.001) than the mortality of NRBC-negative patients (9.8%, 31/316). Mortality increased with increasing NRBC concentration. Seventy-eight point six percent of the patients with NRBCs of more than 200/microl died. The detection of NRBCs is highly predictive of death, the odds ratio after adjustment for other laboratory and clinical prognostic indicators being 1.987 (p < 0.01) for each increase in the NRBC category (0/microl, 1 to 100/microl, 101 to 200/microl, and more than 200/microl). Each step-up in the NRBC category increased the mortality risk as much as an increase in APACHE II (Acute Physiology and Chronic Health Evaluation II) score of approximately 4 points. The mortality of patients who were NRBC-positive on the day of relocation from the intensive care unit to a peripheral ward was 27.6% (8/27). This was significantly higher than the mortality of patients who were NRBC-negative on the relocation day (8.6%, 28/325; p < 0.01). On average, NRBCs were detected for the first time 14 days (median, 3 days) before death.

Conclusion: The routine analysis of NRBCs in blood is of high prognostic power with regard to mortality of critically ill patients. Therefore, this parameter may serve as a daily indicator of patients at high mortality risk. Furthermore, NRBC-positive intensive care patients should not be relocated to a normal ward but should obtain ongoing intensive care treatment.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Intensive care days on which nucleated red blood cells were detected for the first time in the blood of medical intensive care patients.
Figure 2
Figure 2
In-hospital mortality of medical intensive care patients in relation to the concentration of nucleated red blood cells (NRBCs) in the blood. Numbers in parenthesis denote the ratio of deceased patients to all patients with the respective NRBC concentration.
Figure 3
Figure 3
Concentration of nucleated red blood cells (NRBCs) in the blood of medical intensive care patients who have died from various causes. ◆ indicate the NRBC concentration of each individual deceased patient. The average concentration is indicated by horizontal bars. formula image denote the significance of the difference.
See this image and copyright information in PMC

References

    1. Budmiger H, Graf C, Streuli RA. [The leukoerythroblastic blood picture. Incidence and clinical significance] Schweiz Rundsch Med Prax. 1984;73:1489–1493. - PubMed
    1. Mettier SR. Hematologic aspects of space consuming lesions of the bone marrow (myelophtisic anemia) Ann Intern Med. 1940;14:436–448.
    1. Schwartz SO, Stansbury F. Significance of nucleated red blood cells in peripheral blood; analysis of 1,496 cases. J Am Med Assoc. 1954;154:1339–1340. - PubMed
    1. Delsol G, Guiu-Godfrin B, Guiu M, Pris J, Corberand J, Fabre J. Leukoerythroblastosis and cancer frequency, prognosis, and physiopathologic significance. Cancer. 1979;44:1009–1013. doi: 10.1002/1097-0142(197909)44:3<1009::AID-CNCR2820440331>3.0.CO;2-J. - DOI - PubMed
    1. Weick JK, Hagedorn AB, Linman JW. Leukoerythroblastosis. Mayo Clin Proc. 1974;49:110–113. - PubMed