The Clinical Significance of Leukoerythroblastic Anemia

The presence of nucleated red blood cells (NRBCs) has been identified as a poor prognostic indicator. We investigated the relationship of NRBC trends in patients with and without trauma.

We retrospectively reviewed surgical intensive care unit admissions over 4 years, categorizing trauma and nontrauma patients and subdividing them into 3 groups: group A, all-zero NRBC; group B, positive NRBC value returning to zero; and group C, positive NRBC value that did not return to zero. We analyzed all groups for outcomes of length of stay and mortality.

Group A was the largest and had the shortest length of stay and least mortality. Group C had the highest mortality rate. No statistical difference was observed with mortality.

Any positive NRBC was associated with poor outcome, and increasing NRBC was associated with increasing mortality. Trends in NRBC values showed that returning to zero was protective.

The presence of nucleated red blood cells (NRBCs) in the blood of patients with a variety of severe diseases is known to be highly associated with increased mortality. Blood analyzers to routinely measure NRBC concentrations are now available. However, the prognostic significance of such measurements has not been evaluated. Using a Sysmex XE-2100 (Sysmex; Norderstedt, Germany), we measured NRBC concentrations in 15,541 blood samples from 4,173 patients at a university clinic over the course of 12 weeks. NRBCs were found at least once in 7.5% of all patients. The highest incidence (20.0%) was found in patients from the intensive care unit of the general and accident surgery. The incidence of NRBC increased with age. The mortality of NRBC-positive patients (n = 313) was 21.1% (n = 66); this was significantly higher (P <.001) than the mortality of NRBC-negative patients (1.2%, n = 3860). Mortality increased with increasing NRBC concentration. With regard to in-hospital mortality, NRBCs in blood showed sensitivity and specificity of 57.9% and 93.9%, respectively. NRBCs were detected for the first time, on average, 21 days (median 13 days) before death. The routine analysis of NRBCs in blood is of high prognostic power with regard to in-hospital mortality. This parameter may serve as an early indicator of patients at increased risk. (J Lab Clin Med 2002;140:407-12)

J Lab Clin Med 2002;140:407-12.