Saturday, March 8, 2014

Nucleated RBC/Erythroblastemia (nRBC)

Nucleated RBC/Erythroblastemia (nRBC)

Background Information of Nucleated RBC/Erythroblastemia (nRBC)

Nucleated RBCs (NRBCs) are immature RBCs (erythroblast) not normally seen in the peripheral blood beyond the neonatal period, as the size of the nucleus will decrease as the erythroblast progress into matured RBCs in the bone marrow during erythropoiesis. This is because erythroblast that escapes  the bone marrow are normally cleared by the spleen promptly, hence their presence in the peripheral blood suggests a hyposplenic state.  

The presence of numerous NRBCs increases the WBC (usually lymphocytes due to their resemblance) count in automated hematology analyzers. Most analyzers generate suspect flags to help identify abnormal cells, and the samples involved should be reviewed manually.

Laboratory professionals have a crucial responsibility to detect NRBCs when they review CBC/FBC and WBC differential results obtained by automated hematology analyzers.The number of NRBCs in a 100- or 200-WBC differential count is reported as the number of NRBCs per 100 WBCs. In addition, the corrected WBC count is reported.

Clinical Significance

marrow stress can also induce enhanced release of excessive erythroblasts hence overwhelm the ability of a normal spleen to clear them from circulation. This typically occurs with hypoxia and patients with hemolytic anemia, anemia under treatment, megaloblastic anemia and undergoing chemotherapy treatment. Hence, excessive appearance in PBF signifies bone marrow damage or stress and potentially serious underlying disease. 

Cellular Description

Nucleated RBC/Erythroblastemia (nRBC) are looks moderately similar as a normal RBC but is larger in size with darkly-stained surroundings and the presence of a darkly stained almost round nucleus.

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