Nucleated red blood cell count in beta thalassemia major: a case report

Nucleated red blood cell count in beta thalassemia major




Beta thalassemia major, hematology, nucleated red blood cells


The complete blood cell count (CBC) is one of the most frequently requested laboratory tests, but some values included in the test may be overlooked. This case discusses a potentially underutilized value: nucleated red blood cell (NRBC) count. NRBCs are described as immature forms of erythrocytes that are normally found in the bone marrow but not in the peripheral blood of adults.  In this case report, we were able to explain the abnormally high white blood cell (WBC) count in a patient with thalassemia major by measuring the NRBC that can normally be found. Thus, we have saved time and money by avoiding unnecessary research.


Khalil MS, Timbs AT, Henderson SJ, Schuh A, Old JM. Eight Cases of Hb Winnipeg [HBA2: c.226G>T (or HBA1)]: A Detailed Study. Hemoglobin 2021;45:256-58.

Purtle SW, Horkan CM, Moromizato T, Gibbons FK, Christopher KB. Nucleated red blood cells, critical illness survivors and postdischarge outcomes: a cohort study. Crit Care 2017; 21:15.

Richard A, McPherson MD, Matthew R, Pincus MD. Henry's Clinical Diagnosis and Management by Laboratory Methods. 22nd ed. Elsevier Inc; 2011. pp. 520–31.

Bruegel M, Nagel D, Funk M, Fuhtmann P, Zander J, Teupser D. Comparison of five automated hematology analyzers in a university hospital setting: abbott Cell-Dyn-Sapphire, Beckman Coulter DxH 800, Siemens Advia 2120i, Sysmex XE-5000, and Sysmex XN-2000. Clin Chem Lab Med 2015;53:1057-71.

Karakukcu M, Karakukcu C , Unal E, Ozturk A , Ciraci Z , Patiroglu T et al. The Importance of Nucleated Red Blood Cells in Patients with Beta Thalassemia Major and Comparison of Two Automated Systems with Manual Microscopy and Flow Cytometry. Clin. Lab 2015;61:1289-95.

Kwon MJ, Nam MH, Kim SH, Lim CS, Lee CK, Cho Y et al. Evaluation of the nucleated red blood cell count in neonates using the Beckman Coulter Uni Cel DxH 800 analyzer. Int J Lab Hematol 2011;33:620-8.

Danise P, Maconi M, Barrella F, Palma AD, Avino D, Rovetti A et al. Evaluation of nucleated red blood cells in the peripheral blood of hematological diseases. Clin Chem Lab Med 2011;50:357-60.

Danise P, Amendola G, Di Concilio R, Cillari E, Gioia M, Palma AD et al. Nucleated red blood cells and soluble transferrin receptor in thalassemia syndromes: relationship with global and ineffective erythropoiesis. Clin Chem Lab Med 2009;47:1539-42.

Rachmilewitz EA, Thorell B. Characterization of the normoblast population in beta-thalassemia blood by rapidflow cytofluorimetry. Scand J Haematol 1978;20: 440-6.

Sher G, Viitisallo B, Schisano T, Pantalony D, Van Hove L. Automated NRBC count, a new parameter to monitor, in real time, individualized transfusion needs in transfusion dependent thalassemia major. Lab Hematol 1997;3:129-37.

Shehataa AM, Wanasa SA, El‑Hawyb MA, Khalifaa KA. Clinical significance of nucleated red blood cell count in pediatric patients with transfusion-dependent beta thalassemia. Menoufia Medical Journal 2020;33:949–55.

Lippi G, Pavesi F, Cattabiani C, Avanzini P, Pipitone S. Influence of in vitro hemolysis on nucleated red blood cells and reticulocyte counts. Int J Lab Hematol 2013;35:225-8.

Kim H, Hur M, Choi SG, Moon HW, Yun YM, Hwang HS et al. Performance evaluation of Sysmex XN hematology analyzer in umbilical cord blood: a comparison study with Sysmex XE-2100. Clin Chem Lab Med 2014;52:1771-9.

Khodaiji, S. Newer CBC Parameters of Clinical Significance. Hematopathology 2019. pp 3–25.




How to Cite

Karabulut, A., & Eskin, F. (2022). Nucleated red blood cell count in beta thalassemia major: a case report: Nucleated red blood cell count in beta thalassemia major. The Injector, 1(3), 132–135.



Case Report