Massively elevated nucleated red blood cells ( 718 per 100 WBCs)

BACKGROUND: An elevated nucleated red blood cell (NRBC) count is an independent risk factor for postnatal bleeding complications in growth-restricted infants. The etiology of this phenomenon is unclear. OBJECTIVES: To demonstrate a correlation between massively elevated NRBC counts, coagulopathies and unusual or severe bleeding complications. METHODS: The medical records of all severely growth-restricted very low birth weight (VLBW) infants (gestational age <32 0/7 weeks and birth weight at or below the third percentile) admitted to the Neonatal and Pediatric Intensive Care Unit of the Children's Hospital of Lucerne over a 6-year period were reviewed. NRBC counts and coagulation profiles of infants with unusual and/or severe bleeding complications were compared with those of infants without such complications. RESULTS: From a total of 20 severely growth-restricted VLBW infants, 6 had severe or atypical bleeding complications. Among the infants with hemorrhagic complications, the NRBC counts were significantly higher than in the group without such complications (median 24.2 vs. 4.5 x 10(9)/l, p = 0.028). In 2 infants with severe bleeding complications, in whom coagulation studies were performed prior to the occurrence of the hemorrhagic complications, severe clotting abnormalities in addition to massively elevated NRBC counts were detected. CONCLUSIONS: In infants with massively elevated NRBC counts, coagulation studies should be performed. Early and aggressive support of the coagulation system may help to prevent severe bleeding complications in such patients.

Steurer MA, Berger TM. Massively elevated nucleated red blood cells and cerebral or pulmonary hemorrhage in severely growth-restricted infants--is there more than coincidence? Neonatology. 2008;94(4):314-9. Epub 2008 Sep 11.