Experimental Study on Separation of Fetal Nucleated Red Blood Cell from the Whole Blood Using Microfluidic Chip / 医用生物力学

Objective To seperate fetal nucleated red blood cells (fNRBCs) from the whole maternal peripheral blood effectively by designing a circular channel microfluidic chip. Methods A microfluidic chip is designed by utilizing the margination in blood flow and the specific adhesion characteristics of immuno-agent anti-CD147. With the whole umbilical cord blood, the effects of different shear forces on the enrichment of fNRBCs was studied by immunofluorescence counting. Results Increasing shear rate in microfluidic chip could improve the number of captured fNRBCs compared with the static adhesion. With the increase of shear rate of blood flow, the number of the captured cells increased at first, and then decreased. Conclusions The use of microfluid chip can effectively seperate fNRBCs from the whole blood. The results provide an experimental reference for the non-invasive prenatal diagnosis research and the exploration on the mechanism of fetal cell migration.

Performance of a Hematological Scoring System in Predicting All-Cause Mortality in Patients with Acute Myocardial Infarction

Abstract Background: The presence of nucleated red blood cells (NRBCs) and increases in mean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR) in peripheral circulation are associated with poorer prognosis in patients with acute coronary disease. Objective: We developed a scoring system for in-hospital surveillance of all-cause mortality using hematological laboratory parameters in patients with acute myocardial infarction (AMI). Methods: Patients admitted for AMI were recruited in this prospective study. Exclusion criteria were age younger than 18 years, glucocorticoid therapy, cancer or hematological diseases and readmissions. NRBCs, MPV and NLR were measured during hospitalization. The scoring system was developed in three steps: first, the magnitude of the association of clinical and laboratory parameters with in-hospital mortality was measured by odds ratio (OR), second, a multivariate logistic regression model was conducted with all variables significantly (p < 0.05) associated with the outcome, and third, a β-coefficient was estimated by multivariate logistic regression with hematological parameters with a p < 0.05. Results: A total of 466 patients (mean age were 64.2 ± 12.8 years, 61.6% male) were included in this study. A hematological scoring system ranging from 0 to 49, where higher values were associated with higher risk of in-hospital death. The best performance was registered for a cut-off value of 26 with sensitivity of 89.1% and specificity of 67.2%, positive predictive value of 26.8% (95% CI: 0.204 - 0.332) and negative predictive value of 97.9% (95% CI: 0.962 - 0.996). The area under the curve for the scoring system was 0.868 (95% CI: 0.818 - 0.918). Conclusions: Here we propose a hematological scoring system for surveillance tool during hospitalization of patients with acute myocardial infarction. Based on total blood count parameters, the instrument can evaluate inflammation and hypoxemia due to in-hospital complications and, consequently, predict in-hospital mortality.

Comparison of hematological parameters among newborns with meconium stained amniotic fluid and clear amniotic fluid

Background: Meconium stained amniotic fluid is an indirect marker of fetal hypoxia. Fetal hypoxia affects bone marrow and affects production of cell lines. Indirect marker of erythropoietin activity is nucleated red blood cells count. Aim of the study is to compare hematological parameter in newborn born with meconium stained liquor and clear amniotic fluid. Also, to determine cut off levels of nucleated RBC as marker of fetal hypoxia in meconium stained amniotic fluid(MSAF).Methods: The study was conducted over a period of 2 years from January 2012 to January 2014 in Department of Pediatrics, Sri Aurobindo medical college and hospital, Indore. One hundred newborns with meconium stained amniotic fluid (study group) and one hundred newborns with clear amniotic fluids (control group) were studied in this period. Cord blood samples were collected and hematological parameters were compared.Results: Hemoglobin % and WBC counts were seen in study group in comparison to control group, which is statistically significant (P<0.05). The reported NRBC/100 WBC between the two groups was statistically analyzed. The mean NRBC count in study group were 8.09'6.09 which was statistically higher than the corresponding values in control group 2.07'2.25 (P<0.05).Conclusions: Study concluded that the hemoglobin levels , WBC and NRBC counts in babies with meconium stained amniotic fluid is higher than those babies delivered with clear amniotic fluid and NRBC can be taken as a surrogate marker of hypoxia in a resource limited setting.

Sysmex XN-9000 hematology analyzer in examining peripheral blood nucleated red blood cells: An evaluation of clinical application / 第二军医大学学报

[Abstract] Objective To evaluate the clinical value of Sysmex XN-9000 hematology analyzer for detecting peripheral blood nucleated red blood cells (NRBC). Methods A total of 16 273 peripheral blood samples were collected and examined by Sysmex XN-9000 hematology analyzer and microscopic manual detection. The sensitivity, specificity and positive prediction value and negative predictive value of NRBC were measured by manual measurement under microscope. The 248 specimens positive by both methods were used as subjects, and the correlation between the two methods for detecting NRBC was analyzed. The disease types of 277 patients positive of NRBC were analyzed by microscopic examination. Results The sensitivity of NRBC detected by Sysmex XN-9000 hematology analyzer was 89.5%, specificity was 99.6%, positive predictive value was 80.5%, and negative predictive value was 99.8%. There was a positive correlation between the percentages of NRBC detected by the two methods (rs＝0.813, P0.001). Among the 277 NRBC-positive patients, 173 had hematological diseases and 104 had no hematologic diseases, and there were significant differences in NRBC counts between the two groups (median: 0.38×109/L vs 0.16×109/L, P0.05), and the percentages of NRBC were not significantly different (median: 2.95% vs 3.60%, P＝0.835 1). Among patients with hematological diseases, NRBC was mainly present in patients with acute lymphoblastic leukemia (31 cases), acute myeloid leukemia (55 cases), malignant lymphoma (39 cases) and multiple myeloma (18 cases). Among patients without hematologic diseases, NRBC was mainly present in those with solid cancer (24 cases) and cirrhosis hemorrhage (36 cases). Conclusion The Sysmex XN-9000 hematology analyzer can detect NRBC with high accuracy, and it thus has a promising clinical application value.

Glóbulos rojos nucleados y estado metabólico en recién nacidos con estado fetal no reactivo intraparto / Umbilical nucleated red blood cells count and metabolic status in newborns with intrapartum fetal distress

Resumen Objetivo: Comparar el conteo de los glóbulos rojos nucleados en sangre de cordón umbilical y estado metabólico en recién nacidos con estado fetal no reactivo intraparto. Métodos: Se eligieron pacientes de bajo riesgo con frecuencia cardiaca fetal normal al momento del ingreso para la atención del parto. Se determinó el conteo de glóbulos rojos nucleados, pH y déficit de base de la arteria y vena umbilical de recién nacidos con (grupo A) o sin diagnóstico (grupo B) de estado fetal no reactivo por cardiotocografía. Resultados: De las 200 muestras seleccionadas, 9,5 % pertenecían a recién nacidos con diagnóstico de estado fetal no reactivo debido a cambios en la cardiotocografia. Los valores promedio de pH y déficit de base de la arteria y vena umbilical fueron significativamente más altos en los recién nacidos del grupo A que en los recién nacidos del grupo B (p < 0,05). El conteo de glóbulos rojos nucleados en los recién nacidos con estado fetal no reactivo fue 11,47 ± 4,93 x 100 leucocitos y en los recién nacidos sin estado fetal no reactivo fue de 5,71 ± 1,21 x 100 leucocitos (p < 0,05). No se encontró una correlación significativa entre el conteo de glóbulos rojos nucleados y los valores de pH y déficit de base en la sangre de la arteria y vena umbilical en el grupo de recién nacidos con y sin estado fetal no reactivo. Conclusión: Los recién nacidos con estado fetal no reactivo intraparto tienen conteos más elevados de glóbulos rojos nucleados comparado con aquellos sin alteraciones.

Abstract Objective: To relate umbilical nucleated red blood cells count and metabolic status in newborns with intrapartum non-reassuring fetal state. Materials and method: All low-risk pregnant women with a normal fetal heart rate at admission to labor and delivery were eligible for participation. Nucleated red blood cells, pH, and base deficit of umbilical artery and vein newborn with (group A) or without diagnosis (Group B) of non-reassuring fetal state by cardiotocography. Results: Of 200 samples selected, 19 (9.5 %) were from newborns with a diagnosis of non-reactive fetal status due to changes in cardiotocography (group A). Mean values of pH and umbilical arterial and venous base deficit were significantly higher in group A than in group B (p < 0.05). Nucleated red blood cells count was 11.47 +/- 4.93 x 100 white cells in group A and 5.71 +/- 1.21 x 100 white cells in group B (p < 0.05). No significant correlation was found between nucleated red blood cells count and pH and umbilical arterial and venous base deficit values in the groups of newborns with and without intrapartum fetal distress (p = ns). Conclusion: Newborns with non-reassuring fetal state have nucleated red blood cells count was higher than in newborns without alterations.

The research progress in the relationship between the number of nucleated red blood cells and neonatal diseases / 临床儿科杂志

Nucleated red blood cells (nRBCs) are immature red blood cells, which are rarely in circulating blood in elder children, but often present in neonatal blood. The clinical significance in neonates is unclear. Numerous studies have shown that many kinds of acute and chronic stimuli can lead to an increase in the number of nRBCs in circulating blood. This article reviews various pathological processes related to the production and release of nRBCs, and emphasizes the effects of acute and chronic hypoxia and immune regulation on it.

Relation Between Absoute Nucelated Red Blood Cell Count at Birth and Retinopathy of Prematurity

PURPOSE: The aim of this study is to prove the association between potential fetal hypoxia and retinopathy of prematurity (ROP) development and absolute nucleated red blood cell (aNRBC) is used to evaluate it in premature infants without any hypoxic or ischemic history. METHODS: Medical records of 43 premature infants with ROP who were admitted to the neonatal intensive care unit at Wonkwang University Hospital from January 2004 to December 2014 were analyzed retrospectively. We excluded 15 infants who had a confounding medical condition that could have increased the aNRBC count. Finally, 28 premature infants affected by ROP were enrolled and compared with 28 pair-matched controls. The aNRBC counts at birth in these infants were compared. Statistical analysis was performed with a paired t-test for continuous data, and a Fisher's exact test for categorical data. P24 hours), prenatal betamethasone, surfactant or respiratory distress syndrome between the ROP and the control infants. In addition, neither group differed in major morbidities such as patent ductus arteriosus, periventricular leukomalacia, intraventricular hemorrhage (> or =Grade 2), or bronchopulmonary dysplasia. Regardless of the severity of ROP, the aNRBC counts at birth in premature infants with ROP were not higher than in the control infants. CONCLUSION: The aNRBC counts at birth may not be related directly to the development of ROP.

Cord Blood Nucleated RBC as a Predictor of Perinatal Asphyxia, Severity and Outcome.

Objective: To study the correlation of cord blood nucleated red blood cell (NRBC)/100 white blood cell (WBC) count with perinatal asphyxia in terms of severity and short-term outcome. Material and methods: A prospective, comparative case-control study was undertaken in a tertiary care hospital from January 2011 to December 2012, which included a total of 200 neonates with 100 asphyxiated babies (case group) and 100 normal babies (control group). The cord blood was collected immediately after delivery for measurement of NRBC/100 WBC, and pH. Early neonatal outcome of both groups was also evaluated in relation to the NRBC/100 WBC count. Statistical analysis was performed with chi-square and student t-test. Results: The mean NRBC/100 WBC count was 50.82 ± 23.85 (range from 5 to 106) in case group and 1.67 ± 1.005 (range from 0 to 13) in control group (p < 0.001). Also a statistically significant correlation existed between severity of asphyxia (stage of hypoxic-ischemic encephalopathy [HIE]), poor outcome and higher number of NRBC/100 WBC count (p < 0.001). Conclusion: It is an inexpensive and easily available procedure to evaluate perinatal asphyxia, specially in a resource poor country like ours, where blood gas analysis facilities are not available in majority of places. Also, it is a good predictor of short-term outcome of asphyxiated babies.

A study on the measurement of the nucleated red blood cell (nRBC) count based on birth weight and its correlation with perinatal prognosis in infants with very low birth weights / 소아과

PURPOSE: The aim of this study was conducted to investigate the mean nRBC count in very low births weight infants (VLBWIs) and to determine the usefulness of the nRBC as an independent prognostic factors of perinatal complications in VLBWIs. METHODS: This study was conducted on 112 VLBWIs who were hospitalized in the neonatal intensive care unit (NICU) of the author's hospital within the period from March 2003 to and May 2008. Based on the infants' nucleated red blood cells (nRBC) counts at birth, on the third day after birth, on the seventh day after birth, in the second week after birth, and in the fourth week after birth in the medical records, the correlation between nRBC or absolute nRBC counts with birth weight, gestational age, and other perinatal outcomes were retrospectively investigated. RESULTS: In VLBWIs, their mean nRBC and absolute nRBC counts were showing a gradual decrease after birth, and they were consisteantly kept at low values since one week after and inversely proportional to the birth weights. The mean nRBC counts based on the stage after birth showed a significant correlation with perinatal death, necrotizing enterocolitis, and severe intraventricular hemorrhage. CONCLUSION: The increase in the nRBC count showed a significant correlation with having a severe intraventricular hemorrhage, necrotizing enterocolitis, and perinatal death in VLBWIs. If an increase or no decrease in the nRBC count after birth is observed, newborn-infant care precautions should be required.