From the Guidelines
Nucleated red blood cells (NRBCs) are strongly correlated with impaired renal function, hemolysis, and increased morbidity, as they can indicate underlying disease severity and guide management of anemia and related conditions 1.
Correlations between NRBCs and Disease Severity
It is recommended to consider the following correlations:
- In renal failure, NRBCs can be a sign of erythropoietin deficiency, which is common in patients with chronic kidney disease, and can guide the use of erythropoiesis-stimulating agents, such as epoetin alfa or darbepoetin alfa 1.
- In hemolysis, NRBCs can indicate increased red blood cell turnover and bone marrow response to anemia, and can guide the management of anemia and the underlying cause of hemolysis, such as autoimmune hemolytic anemia 1.
- In terms of morbidity, the presence of NRBCs in the blood has been associated with increased risk of adverse outcomes, including mortality, in critically ill patients, and can prompt closer monitoring and aggressive management of underlying conditions, including anemia, sepsis, and organ dysfunction 1.
Management of NRBCs in Renal Failure and Hemolysis
In patients with renal failure, monitoring of NRBCs can be useful in assessing the need for erythropoiesis-stimulating agents, which can help to reduce the severity of anemia 1. In patients with hemolysis, NRBCs can guide the management of anemia and the underlying cause of hemolysis, such as autoimmune hemolytic anemia, which may require treatment with corticosteroids, such as prednisone, or other immunosuppressive medications 1. In critically ill patients, the presence of NRBCs can prompt closer monitoring and aggressive management of underlying conditions, including anemia, sepsis, and organ dysfunction, as supported by studies on the relationship between HbA1c and glucose levels in patients with kidney disease 1.
From the Research
Correlation between NRBCs and Impaired Renal Function
- There is no direct evidence in the provided studies to suggest a correlation between nucleated red blood cells (NRBCs) and impaired renal function.
Correlation between NRBCs and Hemolysis
- NRBCs can be used as a biomarker in the diagnosis of hemolysis, as they are often found in the peripheral blood of patients with hemolytic diseases 2.
- The presence of NRBCs in the blood may indicate a high demand for red blood cell production, which can be seen in cases of hemolysis 3, 2.
Correlation between NRBCs and Increased Morbidity
- The presence of NRBCs in the peripheral blood of critically ill patients is associated with a high risk of mortality and increased morbidity 3, 4.
- NRBCs can be used as a prognostic marker to predict changes in clinical condition and mortality in critically ill patients, including those with sepsis, trauma, and severe cardiovascular disease 2, 4.
- The incidence of NRBCs increases with age and is higher in patients with severe diseases, such as malignancies and sepsis 3, 4.
- The presence of NRBCs in the blood may indicate a poor prognosis and a high risk of in-hospital mortality 4, 5.