title: 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.
abstract: BACKGROUND
  Nucleated red blood cells (NRBC) can be used as a marker of erythropoietic stress and help optimize transfusion therapy in patients with beta thalassemia major. The aim of this study was to determine this correlation; and compare two automated systems (Sysmex XE-2100, and Advia 2120i) with manual microscopy and flow cytometry (FCM).
  
  
  METHODS
  Absolute NRBC counts and percentages (NRBC%) from 51 patients were analyzed with both automated and reference methods. The results were compared with levels of pre-transfusion hemoglobin and ferritin levels.
  
  
  RESULTS
  The mean age of the included patients (31 female, 20 male) were 12.9 ± 7.5 years. Mean levels of hemoglobin and ferritin were 9.5 ± 1.2 g/dL and 1896 ± 1194 ng/mL respectively. The NRBC% of two instruments did not significantly differ and correlated well (p < 0.0001, r2 = 0.984). NRBC% obtained with the XE-2100 and Advia 2120i versus manual microscopy also yielded high correlations (r2 = 0.951 and r2 0.981, respectively); however, absolute NRBC counts versus FCM yielded lower coefficients (r2 = 0.723 and r2 = 0.694, respectively). High serum ferritin levels were correlated with both NRBC% and counts with both instruments (p < 0.001) and hemoglobin levels lower than 9.0 g/dL had a negative correlation with NRBC% and NRBC counts with the Advia 2120i (p < 0.05, r = -0.495) but not with the XE-2100.
  
  
  CONCLUSIONS
  Monitoring of NRBC% with both instruments can help optimize transfusion therapy for patients with beta thalassemia major. Following the NRBC% is more efficient than absolute counts.
authors.forename: Musa
authors.initials: M
authors.lastname: Karakukcu
authors.forename: Cigdem
authors.initials: C
authors.lastname: Karakukcu
authors.forename: Ekrem
authors.initials: E
authors.lastname: Unal
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ozturk
authors.forename: Zahid
authors.initials: Z
authors.lastname: Ciraci
authors.forename: Turkan
authors.initials: T
authors.lastname: Patiroglu
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Ozdemir
mesh_terms: D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D001331:Automation; D002648:Child; D002675:Child, Preschool; D004900:Erythroblasts; D004906:Erythrocyte Count / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005293:Ferritins / Q000097:blood; D005434:Flow Cytometry / Q000295:instrumentation / Q000379:methods; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008853:Microscopy / Q000295:instrumentation / Q000379:methods; D015203:Reproducibility of Results; D017086:beta-Thalassemia / Q000097:blood*
chemical_list: D006454:Hemoglobins; D005293:Ferritins