Cutoff Value for Correcting White Blood Cell Count for Nucleated Red Blood Cells: What is it? Why is it Important?

Abstract Nucleated red blood cells (RBCs) are normally observed in the peripheral blood of neonates and during pregnancy. Under other conditions, the presence of nucleated RBCs in circulating blood indicates disorder in the blood-producing mechanism. The increased presence of nucleated RBCs, however, falsely elevates the leukocyte count, as measured by most automated hematology analyzers, warranting a manual correction of the leukocyte count. For a long time, cutoff values for correcting white blood cell (WBC) count for the presence of nucleated RBCs have been used regularly, particularly in developing countries. However, because those values are largely subjective, they can vary widely between laboratories worldwide. These varied cutoff values include 1, 5, 10, 20, and 50; it appears that the numbers 5 and 10 are the most common values used in corrections; the reasons require further elucidation. In this article, we discuss the merits of correcting the WBC count for nucleated RBCs at certain cutoff points.

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Reversible Neutropenia Associated with Ampicillin Therapy in Pediatric Patients

Drug Intelligence & Clinical Pharmacy ◽

10.1177/106002808101501015 ◽

1981 ◽

Vol 15 (10) ◽

pp. 802-806 ◽

Cited By ~ 4

Author(s):

Kusum Kumar ◽

Ashir Kumar

Keyword(s):

Bone Marrow ◽

Blood Cell ◽

Red Blood Cells ◽

White Blood Cell ◽

Blood Cells ◽

Pediatric Patients ◽

Bone Marrow Examination ◽

High Dose ◽

Maturation Arrest ◽

High Doses

Hematologic abnormalities associated with penicillin compounds are uncommon, and neutropenia associated with ampicillin is reported even less frequently. Neutropenia developed in three pediatric patients after high-dose (150–400 mg/kg) ampicillin therapy over a period of 3 to 12 days. In all cases, the white blood cell and neutrophil counts returned towards normal within 4 to 11 days after discontinuation of the antibiotic. Bone marrow examination revealed a maturation arrest in one and slight shift to the left in the maturation of granulocytic cells in another. Other marrow components were normal. Red blood cells, reticulocytes, platelets, and hemoglobin did not show any abnormal alteration in any of the patients. Physicians administering ampicillin, particularly in high doses, should be alert to the possible development of neutropenia; however, all reported neutropenias have been reversible.

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Risk Factors of White Blood Cell Progression Among Patients With Chronic Lymphocytic Leukemia at Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia

Cancer Informatics ◽

10.1177/11769351211069902 ◽

2022 ◽

Vol 21 ◽

pp. 117693512110699

Author(s):

Gedam Derbew Addisia ◽

Awoke Seyoum Tegegne ◽

Denekew Bitew Belay ◽

Mitiku Wale Muluneh ◽

Mahider Abere Kassaw

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Blood Cell ◽

White Blood Cell ◽

Blood Cells ◽

White Blood Cells ◽

Lymphocytic Leukemia ◽

Bahir Dar ◽

Felege Hiwot Referral Hospital ◽

Wbc Count

Background: Leukemia is a type of cancers that start in the bone marrow and produce a serious number of abnormal white blood cells. Bleeding and bruising problems, fatigue, fever, and an increased risk of infection are among symptoms of the disease. The main objective of this study is to identify the determinant of the progression rate of white blood cells among patients with chronic lymphocytic leukemia at Felege Hiwot Referral Hospital (FHRH), Bahir Dar, Ethiopia. Methods: A retrospective study design was conducted on 312 patients with chronic lymphocytic leukemia at FHRH, Bahir Dar, Ethiopia under treatment from 1 January 2017 to 31 December 2019. A linear mixed-effects model was considered for the progression of the white blood cell data. Results: The estimated coefficient of the fixed effect intercept was 84.68, indicating that the average white blood cell (WBC) count of the patients was 84.68 at baseline time by excluding all covariates in the model ( P-value <.001). Male sex ( β = 2.92, 95% confidence interval [CI] 0.58, 0.5.25), age ( β = .17, 95% CI 0.08, 0.28), widowed/divorced marital status ( β = 3.30, 95% CI 0.03, 6.57), medium chronic lymphocytic leukemia (CLL) stage ( β = −4.34, 95% CI −6.57, −2.68), high CLL stage ( β = −2.76, 95% CI −4.86, −0.67), hemoglobin ( β = .15, 95% CI 0.07, 0.22), platelet ( β = .09, 95% CI 0.02, 0.17), lymphocytes ( β = .16, 95% CI 0.03, 0.29), red blood cell (RBC) ( β = .17, 95% CI 0.09, 0.25), and follow-up time ( β = .27, 95% CI 0.19, 0.36) were significantly associated with the average WBC count of chronic lymphocytic leukemia patients. Conclusions: The finding showed that age, sex, lymphocytic, stage of chronic lymphocytic leukemia, marital status, platelet, hemoglobin, RBC, and follow-up time were significantly associated with the average WBC count of chronic lymphocytic leukemia patients. Therefore, health care providers should give due attention and prioritize those identified factors and give frequent counseling about improving the health of chronic lymphocytic leukemia patients.

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White Blood Cell Reduced Red Blood Cells

Encyclopedia of Trauma Care ◽

10.1007/978-3-642-29613-0_101696 ◽

2015 ◽

pp. 1787-1787

Keyword(s):

Blood Cell ◽

Red Blood Cells ◽

White Blood Cell ◽

Blood Cells

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Retrospective evaluation of serum/plasma iron, red blood cell distribution width, and nucleated red blood cells in dogs with acute trauma (2009–2015): 129 cases

Journal of Veterinary Emergency and Critical Care ◽

10.1111/vec.12886 ◽

2019 ◽

Vol 29 (5) ◽

pp. 521-527

Author(s):

Eric J. Fish ◽

Sonya C. Hansen ◽

Elizabeth A. Spangler ◽

Philippe R. Gaillard ◽

Shirley Fan ◽

...

Keyword(s):

Blood Cell ◽

Red Blood Cells ◽

Red Blood Cell ◽

Blood Cells ◽

Cell Distribution ◽

Retrospective Evaluation ◽

Distribution Width ◽

Acute Trauma ◽

Nucleated Red Blood Cells ◽

Red Blood Cell Distribution

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Association of Metabolic Syndrome with White Blood Cell Subtype and Red Blood Cells

Endocrine Journal ◽

10.1507/endocrj.53.133 ◽

2006 ◽

Vol 53 (1) ◽

pp. 133-139 ◽

Cited By ~ 28

Author(s):

Jeong A KIM ◽

Youn Seon CHOI ◽

Jeong Ik HONG ◽

Su Hyun KIM ◽

Hoe Hyun JUNG ◽

...

Keyword(s):

Metabolic Syndrome ◽

Blood Cell ◽

Red Blood Cells ◽

White Blood Cell ◽

Blood Cells ◽

Cell Subtype

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A Microfluidic Device for Simultaneous Extraction of Plasma, Red Blood Cells, and On-Chip White Blood Cell Trapping

Scientific Reports ◽

10.1038/s41598-018-33738-8 ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 13

Author(s):

Da-Han Kuan ◽

Chia-Chien Wu ◽

Wei-Yu Su ◽

Nien-Tsu Huang

Keyword(s):

Blood Cell ◽

Red Blood Cells ◽

Microfluidic Device ◽

White Blood Cell ◽

Blood Cells ◽

Simultaneous Extraction ◽

Cell Trapping ◽

On Chip

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Platelet-white blood cell (WBC) interaction, WBC apoptosis, and procoagulant activity in stored red blood cells

Transfusion ◽

10.1111/j.1537-2995.2010.02950.x ◽

2010 ◽

Vol 51 (5) ◽

pp. 1086-1095 ◽

Cited By ~ 26

Author(s):

Friederike K. Keating ◽

Saulius Butenas ◽

Mark K. Fung ◽

David J. Schneider

Keyword(s):

Blood Cell ◽

Red Blood Cells ◽

White Blood Cell ◽

Blood Cells ◽

Procoagulant Activity

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PERFORMANCE EVALUATION OF NUCLEATED RED BLOOD CELL (NRBC) COUNT USING A FULLY AUTOMATED HAEMATOLOGY ANALYZER VERSUS MANUAL COUNTING

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i5.5706 ◽

2021 ◽

Vol 71 (5) ◽

pp. 1806-10

Author(s):

Tanweer Ahmed ◽

Asad Mahmood ◽

Nasir Uddin ◽

Helen Mary Robert ◽

Muhammad Ashraf ◽

...

Keyword(s):

Blood Cell ◽

Red Blood Cells ◽

Red Blood Cell ◽

Blood Cells ◽

Linear Regression Analysis ◽

Cell Counting ◽

Nucleated Red Blood Cells ◽

Manual Counting ◽

Blood Cell Counting ◽

Nucleated Red Blood Cell

Objective: To evaluate the performance of Nucleated RBC (NRBC) Count using a fully automated haematology analyzer versus manual counting. Study Design: Cross-Sectional Study. Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology, from Sep 2019-Jun 2020. Methodology: Routine fresh whole blood samples were run on Sysmex XN-3000 automated haematology analyzer and 384 samples with results of ≥0.1% Nucleated red blood cells were included in this study. Manual NRBC counting was carried out twice on Leishman-stained peripheral blood smears from all 384 samples. Comparison between manual and automated nucleated red blood cell counting methods was statistically analyzed through linear regression analysis & coefficient correlation. The degree of agreement between two methods was analyzed through Bland-Altman plot. Finally, concordance between the two methods was also analyzed at 5 different ranges of nucleated red blood cells. Results: Linear regression analysis revealed a (r2) value of 0.97. Regression equation was calculated as XN = 0.76MC ± 1.28, with 95% limits of agreement between ± 40.42% and -24.47%. A mean bias of 7.97% was demonstrated through Bland-Altman plot. Concordance analysis revealed a concordance rate of 93.74% (360/384). Nucleated red blood cell counting between two methods were more concordant when nucleated red blood cell counts were <200%. Conclusion: Nucleated red blood cells counting by XN-3000 automated hematology analyzer is statistically comparable to manual nucleated red blood cell counting. We suggest that automated counting can be adopted in routine hematology laboratory as a replacement of manual NRBC counting.

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