Nucleated Red Blood Cells: What Does a Value of 0.2 Mean?

Q: Nucleated Red Blood Cells: What Does a Value of 0.2 Mean?

Dear Mr. S： Basically, your questions should be directed to your hematologist, and you should follow their recommendations for further examinations. Below are brief responses to your inquiries： 1. Does "bone marrow fibrosis" on the report mean a confirmed diagno

Nucleated red blood cells (NRBC) 0.2?

Hello, Doctor: In the past few weeks, I underwent a health check-up, and the report indicated an abnormality in one of the blood test results, specifically the nucleated red blood cell (NRBC) count, which was 0.2 (where the normal value should be 0).
Below are the results of the complete blood count (CBC):
+-------------------------+------------+--------------------+------+
| Complete Blood Count | Test Result | Reference Value | Interpretation |
+-------------------------+------------+--------------------+------+
| White Blood Cell Count (W.B.C) | 5.25 | (4-10 μL) | |
+-------------------------+------------+--------------------+------+
| Red Blood Cell Count (R.B.C) | 5.25 | (4.5~6 10^6/μL) | |
+-------------------------+------------+--------------------+------+
| Hemoglobin (Hb) | 15.1 | (13.5~17.5 g/dl) | |
+-------------------------+------------+--------------------+------+
| Hematocrit (Hct) | 43.9 | (41~53%) | |
+-------------------------+------------+--------------------+------+
| Mean Corpuscular Volume (MCV) | 83.6 | (80~100 fL) | |
+-------------------------+------------+--------------------+------+
| Mean Corpuscular Hemoglobin (MCH) | 28.8 | (26~34 pg) | |
+-------------------------+------------+--------------------+------+
| Mean Corpuscular Hemoglobin Concentration (MCHC) | 34.4 | (31~37 g/dL) | |
+-------------------------+------------+--------------------+------+
| Platelet Count | 282 | (150~450 10^3/ μL) | |
+-------------------------+------------+--------------------+------+
| Neutrophils (%) | 58.2 | (40~70 %) | |
+-------------------------+------------+--------------------+------+
| Lymphocytes (%) | 34.7 | (20~56 %) | |
+-------------------------+------------+--------------------+------+
| Monocytes (%) | 4.6 | (0~12 %) | |
+-------------------------+------------+--------------------+------+
| Eosinophils (%) | 1.5 | (0~5 %) | |
+-------------------------+------------+--------------------+------+
| Basophils (%) | 1.0 | (0~2 %) | |
+-------------------------+------------+--------------------+------+
| Myeloblasts | 0.0 | (<0 %) | |
+-------------------------+------------+--------------------+------+
| Promyelocytes | 0.0 | (<0 %) | |
+-------------------------+------------+--------------------+------+
| Blasts | 0.0 | (<0 %) | |
+-------------------------+------------+--------------------+------+
| Band Neutrophils (%) | 0.0 | (<0 %) | |
+-------------------------+------------+--------------------+------+
| Metamyelocytes | 0.0 | (<0 %) | |
+-------------------------+------------+--------------------+------+
| Atypical Lymphocytes (A-Lym) | 0.0 | (<0%) | |
+-------------------------+------------+--------------------+------+
| Nucleated Red Blood Cells (NRBC) | 0.2 | 0 | * |
+-------------------------+------------+--------------------+------+
I initially searched online for information regarding this condition and its possible associations with diseases, which made me a bit concerned.
Consequently, I visited the hematology department of the same hospital for a follow-up.
The physician reviewed the test results, asked me some questions (such as past illnesses, family history of genetic conditions, and whether I experience dizziness; my responses were "cold, recently suffered a severe sports injury," "family member has acquired epilepsy," and "no"), and then provided me with a billing statement, a blood draw request form, and a follow-up appointment slip, mentioning, "We will monitor this." I am currently waiting for my next appointment.
I noticed that the billing statement mentioned "myelofibrosis." Today, I did further research on Google and found that some individuals in China with similar conditions consulted doctors who indicated there was no issue.
Therefore, I have the following questions for you, Doctor:
1.
Does the mention of "myelofibrosis" on the billing statement imply a diagnosis, or is it merely a procedural requirement to select an item even if the condition is not confirmed?
2.
In Taiwan, is it common for health checks to utilize machine testing? If so, is there still a possibility that the machine could misidentify other types of cells as nucleated red blood cells?
3.
Can I inquire during my next appointment whether the testing was done by machine or manually?
4.
Based on these results, what recommendations do you have?
References:
[1] Constantino, B.
and Cogionis, B.
(2000).
Nucleated RBCs—Significance in the Peripheral Blood Film.
*Laboratory Medicine*, 31(4), pp.223-229.
[2] Dai, X.
P.
(2016).
*Nucleated Red Blood Cells in Blood Tests: Abnormalities in Blood Tests with Nucleated Red Blood Cells.* [Online] https://bit.ly/2mOggG8.
Accessed July 28, 2018.
[3] Baidu Zhidao (2016).
*My 15-year-old son has a nucleated red blood cell count of 0.03; what does it mean?* [Online] http://bit.ly/2v1lint.
Accessed July 28, 2018.
[4] Baidu Zhidao (2016).
*What situations arise when nucleated red blood cells are present in specimens?* [Online] http://bit.ly/2K0X0hZ.
Accessed July 28, 2018.
[5] Li, L.
(2016).
*Elevated Nucleated Red Blood Cells.* [Online] http://bit.ly/2AilfbG.
Accessed July 28, 2018.
[6] Zhao, Y.
(2016).
*Nucleated Red Blood Cell Count of 0.01.* [Online] http://bit.ly/2NOCaVe.
Accessed July 28, 2018.
[7] Zhao, L.
(2016).
*Nucleated Red Blood Cell Percentage of 0.1.* [Online] http://bit.ly/2mPNV2q.
Accessed July 28, 2018.

s da, 20~29 year old female. Ask Date: 2018/07/28

Dr. Xiao Yongxun reply Family Medicine

Dear Mr.
S:
Basically, your questions should be directed to your hematologist, and you should follow their recommendations for further examinations.
Below are brief responses to your inquiries:
1.
Does "bone marrow fibrosis" on the report mean a confirmed diagnosis, or is it just a necessary selection for procedural reasons, even if the condition is not yet confirmed?
Answer: The mention of "bone marrow fibrosis" on the report may indicate a suspected diagnosis by the hematologist, or it could be that a test was requested and a relevant diagnosis name is required for insurance coverage to be approved.
There may be other reasons as well.
Therefore, you should consult your hematologist.
2.
In Taiwan, are health checks typically conducted using machines? If so, is there still a chance that the machine could misidentify other types of cells as nucleated red blood cells?
Answer: There are many items included in health checks.
In your case, regarding the blood analysis report, it is indeed possible that machine testing was used, as well as manual examination under a high-powered microscope.
Although the likelihood of errors is low, it is still possible, and retesting or further examinations may be necessary.
Therefore, please discuss your concerns with your hematologist at the hospital.
3.
Can I ask during my next appointment whether the testing was done by machine or manually?
Answer: Each hospital's laboratory should have very strict operational procedures, whether the testing is done by machine, manually, or a combination of both.
If you have questions, please seek clarification from your hematologist.
4.
What recommendations would you have after reviewing such results?
Answer: Maintain a calm demeanor and discuss and collaborate with your hematologist.

Reply Date: 2018/07/28

More Info

Understanding the presence of nucleated red blood cells (NRBCs) in your blood test results can be concerning, especially when the normal value is expected to be zero. A value of 0.2 NRBCs per 100 white blood cells (WBCs) indicates that there are some nucleated red blood cells present in your peripheral blood, which is not typical for adults. In healthy adults, NRBCs are usually found only in the bone marrow and are not released into the bloodstream.

What Does a Value of 0.2 Mean?
The presence of NRBCs can be indicative of several underlying conditions. In adults, the most common reasons for elevated NRBCs include:
1. Bone Marrow Stress or Damage: Conditions that cause the bone marrow to release immature red blood cells into circulation can lead to the presence of NRBCs. This can occur in cases of severe anemia, hypoxia (low oxygen levels), or bone marrow disorders.

2. Hypoxia: Situations where the body is deprived of adequate oxygen can stimulate the bone marrow to produce more red blood cells, including immature forms like NRBCs. This can happen in chronic lung diseases or severe respiratory distress.

3. Hemolytic Anemia: In conditions where red blood cells are destroyed prematurely, the body may respond by producing more red blood cells, including NRBCs, to compensate for the loss.

4. Bone Marrow Disorders: More serious conditions such as myelofibrosis, leukemia, or other malignancies can also lead to the release of NRBCs into the bloodstream.

Addressing Your Concerns
1. Bone Marrow Fibrosis: The mention of "bone marrow fibrosis" on your report does not necessarily mean you have a confirmed diagnosis. It could be a preliminary consideration based on your NRBC count and other clinical findings. Your hematologist will likely conduct further tests, such as a bone marrow biopsy, to confirm or rule out this condition.

2. Testing Methods: In Taiwan, blood tests are typically performed using automated machines that analyze blood samples. While these machines are quite accurate, there is still a small chance of misidentification, particularly if the sample is not prepared correctly or if there are overlapping cell types. It is reasonable to ask your doctor whether the NRBC count was determined by machine or manual examination.

3. Follow-Up Questions: During your next appointment, it is absolutely appropriate to inquire about the testing methods used and the implications of your NRBC count. Understanding whether the results were derived from automated analysis or manual microscopy can provide insight into the reliability of the findings.

4. Next Steps: Given your current results, it is essential to maintain open communication with your healthcare provider. They may recommend additional tests, such as a complete blood count (CBC) with reticulocyte count, peripheral blood smear, or even imaging studies to assess for any underlying conditions. It is also important to monitor for any symptoms such as fatigue, weakness, or signs of bleeding, which could indicate a more serious issue.

Conclusion
In summary, a value of 0.2 NRBCs in your blood test indicates that there is a slight presence of these cells, which warrants further investigation. While it can be associated with various conditions, it is crucial to work closely with your healthcare provider to determine the underlying cause and appropriate management. Regular follow-ups and additional testing will help clarify your situation and ensure that any potential issues are addressed promptly.

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