Nucleated Red Blood Cells (NRBC) is an immature form of red blood cell. The presence of NRBC in the bloodstream can indicate serious problems with RBC or bone marrow production. Learn more about NRBC and what to do if you have them in your blood.
What Is Nucleated RBCs (nucleated RBCs)?
As the red blood cells grow older, they lose their nucleus. This is a part of a cell that stores DNA. They can carry more oxygen and hemoglobin.
Nucleated Red Blood Cells (NRBCs or normoblasts). are immature RBCs that still have a nucleus. Nucleated red cells cannot “squeeze through” the portholes of the bone marrow to enter circulation.
In children and adults in good health, NRBCs can only be found in the bone marrow. This is where they mature and develop. The presence of NRBCs in the blood indicates a disruption of the blood bone marrow membrane or an increase in red blood cell production.
NRBCs can be found in the blood of fetuses or newborns, particularly if there is a growth retardation, lack of oxygen, etc.
Nucleated blood cells are still immature blood cells. Their presence in adults indicates a health problem.
NRBC Blood Test
NRBC tests are often ordered as a result of abnormal complete Blood Count (CBC) results to detect abnormalities in blood cells. The test may be used when someone has symptoms or signs of a condition that affects blood cell production and lifespan.
When using automatic counters for CBC analyses, NRBCs may be mistakenly classified as white blood cell. It can negatively impact patient care and outcomes. The NRBCs should be manually counted in these cases.
If your results from the complete blood count indicate that there are problems, then your doctor may order a NRBC test. To avoid errors, the NRBC count must be manually confirmed.
Normal NRBC Levels
The number of nucleated RBCs is quantified as the number per 100 White Blood Cells. Counts of 1 NRBC/100 white blood cells are required to be reported.
Normal results are 0 WBCs/100 NRBCs.
Abnormal Nucleated Red Blood Cell Levels
Normal oblastemia is a condition characterized by the presence of nucleated RBCs. It has many causes.
Causes
These causes are often associated with elevated NRBCs. However, a lab result that is high does not suffice to diagnose these conditions. Working with your doctor, or another health care professional, to get an accurate diagnosis is the best way to improve your health.
Low oxygen
The presence of nucleated red blood cells in the blood is caused by conditions that decrease the oxygen supply to tissues ( Hypoxia). These include:
- Hemorrhage is a blood loss.
- Anemia (hemolyticanemia, Iron Deficiency Anemia, Megaloblastic Anemia)
- Thalassemia major
- Severe lung disease
- Congestive heart failure
Low oxygen levels due to blood loss or other health conditions can cause NRBCs to appear in the blood.
Spleen dysfunction
Normaly, the spleen removes nucleated red blood cells (RBCs) that have escaped from bone marrow. Nucleated RBCs can be present in blood when spleen functions are affected. They include:
- Sickle Cell Anemia
- The overproduction of platelets is a rare condition called essential thrombocytosis.
- Hemolytic Anemia
- Malaria
- Splenectomy is the surgical removal of a spleen.
Conditions that affect spleens can prevent NRBCs being removed from blood.
Bone marrow disease
Conditions which damage bone marrow may cause the blood-bone marrow barriers to be broken and NRBCs released into circulation.
- Blood cancers include (e.g. Preleukemia (includes leukemia), lymphoma (including multiple myeloma), and myelodysplasia.
- Neuroblastoma is a cancer of the immature nerve cells.
- Gaucher disease is the accumulation of fat in certain organs (especially the liver and spleen).
- Tuberculosis
- Collagen Vascular disease (e.g. lupus)
- Fungal infections
- Sarcoidosis is an inflammation of the skin, lungs, lymph nodes, and eyes.
RBC production outside of the bone marrow
Anemia or bone marrow damage can cause the liver and spleen to produce red blood cells, which could release NRBCs in the circulation.
- Myelophthisis is a severe anemia caused by a failure of the bone marrow.
- Myeloid Metaplasia (progressive marrow scarring).
- Chronic hemolytic Anemia
- Polycythemia vera is characterized by excessive RBC production.
- Leukemia
Other
Other causes of NRBC (normoblastemia), include:
- Uremia is the presence of urea (in the blood).
- Sepsis is a severe reaction to infection
- Liver Disease
- Diabetic ketoacidosis
- Inflammatory Bowel Disease
- Kidney Transplant
- Burns
- Chemotherapy
- Lead poisoning
- Pregnancy
The cause of normoblastemia in some patients is unknown, but it may be due to the breakdown of blood-bone marrow barriers.
Consequences
A poor prognosis is associated with the presence of nucleated red blood cells (RBCs) in the blood.
In two studies involving over 600 intensive-care patients, NRBCs were linked to increased mortality.
How to Reduce Nucleated RBCs
To reduce nucleated RBCs, it is important to treat any underlying condition. Working with your doctor, determine an accurate diagnosis to help you improve your health.
We strongly recommend against changing your diet, exercise routine, or supplements without consulting with a doctor, as there may be unexpected interactions.
You may have anemia.
Exercise : Moderate physical exercise signals to the body to increase production of red blood cells to increase oxygen supply to muscles.
Exercises that are more intense or strenuous can cause damage to red blood cells. It is for this reason that many endurance athletes suffer from anemia.
- Make sure that you do not have a nutrient deficit. You should ensure that your body has all the nutrients necessary to produce red cells (iron and folate).
- Reduce or eliminate your alcohol consumption. Alcohol consumption decreases the production of red blood cells.
- Ibuprofen and other NSAIDs can cause stomach injuries and blood loss.
- Avoid antacids or other drugs that suppress the stomach’s acid. These drugs lower iron levels and cause low RBCs.
- Lead paints and other products containing lead should be avoided to prevent damage to red blood cells.
- You can boost your testosterone by getting a good night’s sleep and losing weight .
Reduce NRBCs by addressing the root cause. Exercise regularly and take enough iron, copper, B vitamins and other nutrients if you suffer from anemia. Avoid alcohol and NSAIDs.
These supplements, according to some studies may help anemia.
- Vitamin B12
- Folate
- Iron
- L-glutamine
- Glutathione
- Vitamin D
- Spirulina
- Vitamin E
- Selenium
- Beta-carotene
Please note that these supplements have not been approved by the FDA. As the data to support their use are still considered to be insufficient, you should speak to your doctor to make informed decisions about your health.
Takeaway
Nucleated Red Blood Cells (NRBCs), also known as immature blood cells, are produced by the bone marrow. Their presence in blood is a sign of a problem with the bone marrow or red blood cells production.
If other blood tests (such as CBCs) show that there are problems with blood cells, your doctor may order a NRBC test. Normal results are 0 NRBCs/100WBCs or a complete lack of NRBCs.
Anemia, low oxygen levels, spleen dysfunction and bone marrow disorders are all possible causes of NRBCs. By addressing the cause, you can reduce NRBCs.
Exercise regularly, eat nutritious food, and limit alcohol consumption if you suffer from anemia. Avoid NSAIDs, drugs that suppress stomach acids, and folate. Also, consider iron, selenium and spirulina. Vitamins B12, D and E are also recommended.
