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Year : 2020  |  Volume : 33  |  Issue : 3  |  Page : 949-955

Clinical significance of nucleated red blood cell count in pediatric patients with transfusion-dependent beta thalassemia

1 Department of Clinical Pathology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Correspondence Address:
Amira M.F. Shehata
Department of Clinical Pathology, Faculty of Medicine, Menoufia University, Menoufia 32511
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mmj.mmj_14_20

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Objectives The aim of this study was to assess the count of nucleated red blood cells (NRBCs) as a potential marker of erythropoietic stress and transfusion therapy adequacy. To achieve this goal, we evaluated the performance of the Sysmex XN-1000 hematology analyzer and flow cytometry (FC) in counting NRBCs in comparison with manual microscopic counting (MC). Background NRBCs recognition by manual and automatic technologies has been widely evaluated. As transfusion of packed red blood cells is a principal supportive intervention for patients with thalassemia major, monitoring markers of an adequate transfusion therapy is essential in their management. Patients and methods NRBC percentages from 61 thalassemia major patients were analyzed by automated technologies, Sysmex XN-1000 analyzer and FC, and the results were compared with traditional MC as a reference method. Markers of ineffective erythropoiesis were estimated for all patients. Results Pretransfusion hemoglobin levels showed significant negative correlation with NRBC% obtained by Sysmex XN-1000 (r=−0.302, P = 0.018). Furthermore, NRBC% was positively correlated with reticulocyte% (r = 0.852, P < 0.001) and serum soluble transferrin receptor (r = 0.303, P = 0.017). The comparison of NRBCs% given by both automated methods versus MC showed strong and significant correlation (r2 = 0.999, P < 0.001). The degree of the agreement between methods was analyzed by the Bland–Altman plot; the mean bias between MC versus XN-1000 analyzer and MC versus FC were1.1 and − 0.4, respectively. Conclusion Monitoring of NRBC% by Sysmex XN-1000 analyzer has many advantages over manual counting and can help to optimize transfusion therapy for patients with beta thalassemia major.

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