title: [Erythroblasts in the peripheral blood of adult patient as an adverse prognostic sign--a case report].
abstract: Red blood cells (RBC) normally lose their nuclei before appearing in peripheral blood. After having undergone differentiation in bone marrow, blood cells must cross the blood-marrow barrier to enter the bloodstream. Erythroblasts, or nucleated red blood cells (NRBC), do not distort easily, so they cannot escape this barrier. Therefore, with the exception of the neonatal period, the presence of NRBCs in peripheral blood is always a pathologic finding. NRBCs may be found in the course of severe diseases and are associated with poor prognosis and higher mortality. The underlying pathophysiology of NRBCs in peripheral blood is not fully understood. It is hypothesized that their appearance could be provoked by either increased erythropoiesis or bone marrow micro-architectural damage mostly caused by inflammation and/or decreased tissue oxygenation. In addition, it is known that the mortality is higher in NRBC-positive patients as compared with NRBC-negative patients. Hereby we present a patient admitted to the hospital with the symptoms of cardiac failure and decompensated liver cirrhosis. The patient was already known to have liver cirrhosis of ethylic etiology, cardiac decompensation caused by hypertensive heart disease with permanent atrial fibrillation, chronic obstructive pulmonary disease, diabetes mellitus type 2, and cholelithiasis. During hospital stay, the patient developed acute pancreatitis and, soon after that, a stroke with left hemiparesis followed by cardiopulmonary arrest. Then he was transferred to the intensive care unit. Despite appropriate therapy, intensive care treatment and cardiopulmonary support, the patient's general state worsened, he developed multiple organ failure and died on day 10 of intensive care unit stay. Three days earlier, NRBCs were detected in peripheral blood and their concentration increased during the next two days before death. NRBCs are known to appear 1-3 weeks before death, but their appearance does not seem to be related to one particular cause of death. Still, detection of NRBCs is an independent risk of poor outcome, where the mortality increases with the increasing NRBC concentration. Detection of NRBCs in blood is a relatively early phenomenon prior to death, so screening for NRBCs may aid in the early identification of patients at high risk, and in making duly decision for NRBC-positive patients to obtain ongoing intensive care treatment.
authors.affiliation: Topusko Spa Resort, Topusko, Croatia. domagoj.mosler@gmail.com
authors.forename: Domagoj
authors.initials: D
authors.lastname: Mosler
authors.forename: Gordana
authors.initials: G
authors.lastname: Cavrić
authors.forename: Slavica
authors.initials: S
authors.lastname: Naumovski-Mihalić
authors.forename: Ika
authors.initials: I
authors.lastname: Kardum-Skelin
authors.forename: Dunja
authors.initials: D
authors.lastname: Sustercić
authors.forename: Biljana
authors.initials: B
authors.lastname: Jelić-Puskarić
authors.forename: Ingrid
authors.initials: I
authors.lastname: Prkacin
authors.forename: Ivica Premuzić
authors.initials: IP
authors.lastname: Mestrović
authors.forename: Tihomir
authors.initials: T
authors.lastname: Bradić
authors.forename: Aida
authors.initials: A
authors.lastname: Nazor
authors.forename: Elvira Lazić
authors.initials: EL
authors.lastname: Mosler
mesh_terms: D000368:Aged; D004900:Erythroblasts / Q000473:pathology*; D004906:Erythrocyte Count; D006333:Heart Failure / Q000097:blood / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications; D008297:Male; D009026:Mortality; D011379:Prognosis; D012307:Risk Factors