The combined detection of umbilical cord nucleated red blood cells and lactate: early prediction of neonatal hypoxic ischemic encephalopathy

Abstract Background: The coexistence of these two conditions can mimic severe sepsis in critically ill patients which may leave severe thyrotoxicosis unrecognized. Its higher incidence in Asian population suggests a possible genetic propensity. Clinical Case: A 38-year-old Filipino female sought consult due to changes in behavior. Two months prior, patient had persistent heavy menstrual bleeding but refused work-up. There was progressive weakness and pallor in the interim but no consult was done until she had an aggressive behavior hitting everyone she sees. Patient has Graves disease, maintained on methimazole 15 mg/day and propranolol 30 mg/day. Patient was advised to undergo radioactive iodine therapy but was lost to follow-up for 2 years. Likewise, no medication adjustment nor monitoring of biochemical parameters was done during the same period. On admission, patient was disoriented, tachycardic and febrile. She was generally pale with petechiae on the extremities and blood clots on her lips. Internal examination of the introitus revealed fresh blood with clots. Pregnancy test was negative. Initial laboratory evaluation revealed severe anemia (3.3 g/dl) and thrombocytopenia (3000/uL). Peripheral smear showed mild anisocytosis of red blood cells with no blasts nor atypical lymphocytes and platelet clumps seen. Patient received 1 unit platelet apherese and 2 units packed red blood cells (PRBC) and was started on broad spectrum antibiotic. Neurologic evaluation was negative for craniopathies. Baseline cranial CT scan was not done due to absence of lateralizing signs and was managed as a case of hypoxic ischemic encephalopathy from severe blood loss. Patient was biochemically hyperthyroid with TSH 0.065 uIU/ml, FT4 2.67 ng/dl and 10-fold elevated anti-TPO. Methimazole was then resumed at 20 mg/day and propranolol at 30 mg/day. Neck ultrasound showed an enlarged thyroid with diffuse parenchymal disease. Furthermore, patient had negative Coombs test, normal fibrinogen and procalcitonin. Patient was weakly positive for ANA at 1:160 dilution but negative for other markers in the lupus panel. Consistent with ITP, patient was started on IV hydrocortisone. In the interim, patient had less vaginal bleeding but with persistent bicytopenia which required multiple platelet and PRBC transfusions. A bone marrow biopsy was contemplated. However, on the 7th hospital day, patient had sudden onset of right sided paresthesia with dysarthria and hematomas on extremities. MRI of the brain revealed a large intraparenchymal hemorrhage and patient eventually succumbed to it. Conclusion: Bone marrow dysfunction secondary to the hyperthyroid state may explain the lack of response to standard therapy of ITP. There is short platelet lifespan, which is rather metabolic in nature, from increased reticuloendothelial phagocytic activity by upregulation of Fc receptor activity in patients with hyperthyroidism.

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A Clinical Study for Prediction of Perinatal Asphyxia using Nucleated Red Blood Cells as an Indicator in Umbilical Cord Blood of Newborns

International Journal of Contemporary Medical Research [IJCMR] ◽

10.21276/ijcmr.2020.7.1.25 ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Jyoti Biswas ◽

Alka Bhambri ◽

Vedika A. Bhat

Keyword(s):

Clinical Study ◽

Cord Blood ◽

Red Blood Cells ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Blood Cells ◽

Perinatal Asphyxia ◽

Nucleated Red Blood Cells

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Deep learning-based adaptive detection of fetal nucleated red blood cells

10.1101/2020.03.06.980227 ◽

2020 ◽

Author(s):

Chao Sun ◽

Ruijie Wang ◽

Lanbo Zhao ◽

Lu Han ◽

Sijia Ma ◽

...

Keyword(s):

Cord Blood ◽

Red Blood Cells ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Blood Cells ◽

Gradient Centrifugation ◽

Accurate Method ◽

Peripheral Blood Cell ◽

Nucleated Red Blood Cells ◽

Imaging Characteristics

AbstractAimthis study, we established an artificial intelligence system for rapid identification of fetal nucleated red blood cells (fNRBCs).MethodDensity gradient centrifugation and magnetic-activated cell sorting were used for the separation of fNRBCs from umbilical cord blood. The cell block technique was used for fixation. We proposed a novel preprocessing method based on imaging characteristics of fNRBCs for region of interest (ROI) extraction, which automatically segmented individual cells in peripheral blood cell smears. The discriminant information from ROIs was encoded into a feature vector and pathological diagnosis were provided by the prediction network.ResultsFour umbilical cord blood samples were collected and validated based on a large dataset containing 260 samples. Finally, the dataset was classified into 3,720 and 1,040 slides for training and testing, respectively. In the test set, classifier obtained 98.5% accuracy and 96.5% sensitivity.ConclusionTherefore, this study offers an effective and accurate method for fNRBCs preservation and identification.

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Nucleated red blood cells as a novel indicator of CD34 + cell content in umbilical cord blood

Transfusion ◽

10.1111/trf.15080 ◽

2018 ◽

Vol 59 (2) ◽

pp. 681-685

Author(s):

David Galel ◽

Clarence Crisostomo ◽

Jennifer Ortega ◽

Kirstin Peters ◽

Sara Neveu ◽

...

Keyword(s):

Cord Blood ◽

Red Blood Cells ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Blood Cells ◽

Cell Content ◽

Nucleated Red Blood Cells

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Nucleated red blood cells and hematological scoring system – Future trends in early onset neonatal sepsis

Medpusle International Journal of Pathology ◽

10.26611/10512112 ◽

2019 ◽

Vol 12 (1) ◽

pp. 53-58

Author(s):

Shivendra Vikram Singh ◽

◽

Megalamane Supreetha ◽

Satyavathi R Alva ◽

◽

...

Keyword(s):

Red Blood Cells ◽

Neonatal Sepsis ◽

Blood Cells ◽

Early Onset ◽

Scoring System ◽

Future Trends ◽

Nucleated Red Blood Cells

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Nucleated Red Blood Cells as Markers of Perinatal Adaptation in Preterm Neonates Receiving Minimally Invasive Surfactant Therapy

American Journal of Perinatology ◽

10.1055/s-0041-1726317 ◽

2021 ◽

Author(s):

Itamar Nitzan ◽

Calum T. Roberts ◽

Risha Bhatia ◽

Francis B. Mimouni ◽

Arvind Sehgal

Keyword(s):

Minimally Invasive ◽

Right Ventricular ◽

Red Blood Cells ◽

Blood Cells ◽

Surfactant Therapy ◽

Preterm Neonates ◽

Oxygen Requirement ◽

Nucleated Red Blood Cells ◽

Intrauterine Hypoxia ◽

Ventricular Ejection Time

Objective The study aimed to assess the association of nucleated red blood cells (NRBC), a surrogate of intrauterine hypoxia, and elevated pulmonic vascular resistance (E-PVR) and oxygen requirement after minimally invasive surfactant therapy (MIST). Study Design Retrospective study of a cohort of preterm neonates that received MIST in a single unit. Results NRBC were measured in 65 of 75 (87%) neonates administered MIST during the period. In total, 22 of 65 (34%) infants had pre-MIST echocardiography (ECHO).Neonates with elevated NRBC (predefined as >5 × 109/L, n = 16) required higher post-MIST fraction of inspired oxygen (FiO2) than neonates with normal NRBC (<1 × 109/L, n = 17; FiO2 = 0.31 ± 0.10 and 0.24 ± 0.04, respectively, p = 0.02).NRBC correlated positively with % of time in right to left ductal shunt (r = 0.51, p = 0.052) and inversely with right ventricular stroke volume (r = −0.55, p = 0.031) and time to peak velocity to right ventricular ejection time ratio (r = −0.62, p < 0.001). Conclusion Elevated NRBC are associated with elevated FiO2 after MIST and elevated E-PVR. Intrauterine hypoxia may impact postnatal circulatory adaptations and oxygen requirement. Key Points

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Nucleated red blood cells participate in myocardial regeneration in the toad Bufo Gargarizan Gargarizan

Experimental Biology and Medicine ◽

10.1177/15353702211013297 ◽

2021 ◽

pp. 153537022110132

Author(s):

Shu-Qin Liu ◽

Xiao-Ye Hou ◽

Feng Zhao ◽

Xiao-Ge Zhao

Keyword(s):

Red Blood Cells ◽

Blood Cells ◽

Cardiac Injury ◽

Myocardial Regeneration ◽

Matrix Metalloproteinase 2 ◽

Enzyme Linked Immunosorbent Assay ◽

Cardiac Tissues ◽

Nucleated Red Blood Cells ◽

Model Animal

Heart regeneration is negligible in humans and mammals but remarkable in some ectotherms. Humans and mammals lack nucleated red blood cells (NRBCs), while ectotherms have sufficient NRBCs. This study used Bufo gargarizan gargarizan, a Chinese toad subspecies, as a model animal to verify our hypothesis that NRBCs participate in myocardial regeneration. NRBC infiltration into myocardium was seen in the healthy toad hearts. Heart needle-injury was used as an enlarged model of physiological cardiomyocyte loss. It recovered quickly and scarlessly. NRBC infiltration increased during the recovery. Transwell assay was done to in vitro explore effects of myocardial injury on NRBCs. In the transwell system, NRBCs could infiltrate into cardiac pieces and could transdifferentiate toward cardiomyocytes. Heart apex cautery caused approximately 5% of the ventricle to be injured to varying degrees. In the mildly to moderately injured regions, NRBC infiltration increased and myocardial regeneration started soon after the inflammatory response; the severely damaged region underwent inflammation, scarring, and vascularity before NRBC infiltration and myocardial regeneration, and recovered scarlessly in four months. NRBCs were seen in the newly formed myocardium. Enzyme-linked immunosorbent assay and Western blotting showed that the levels of tumor necrosis factor-α, interleukin- 1β, 6, and11, cardiotrophin-1, vascular endothelial growth factor, erythropoietin, matrix metalloproteinase- 2 and 9 in the serum and/or cardiac tissues fluctuated in different patterns during the cardiac injury-regeneration. Cardiotrophin-1 could induce toad NRBC transdifferentiation toward cardiomyocytes in vitro. Taken together, the results suggest that the NRBC is a cell source for cardiomyocyte renewal/regeneration in the toad; cardiomyocyte loss triggers a series of biological processes, facilitating NRBC infiltration and transition to cardiomyocytes. This finding may guide a new direction for improving human myocardial regeneration.

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