Retrospective study observes circulating nucleated red blood cells correlate with severe anemia in adults with sickle cell disease, indicating underlying dyserythropoiesis.
Key Points
To establish the prevalence and clinical significance of circulating nucleated red blood cells (cNRBCs) in adults with steady-state sickle cell disease.
Retrospectively analyzed 270 adults with sickle cell disease (SS or Sβ0-thalassemia genotypes) during steady-state disease.
Classified patients by cNRBC count per 100 white blood cells (WBCs) into high (>3), low (1–3), and negative (0) groups.
Compared clinical records, routine hematologic biomarkers, and in vitro CD34+ peripheral blood erythroid differentiation profiles.
cNRBCs were detected in 65.6% of patients, and high cNRBC+ patients were more frequently prescribed hydroxyurea (p=0.024).
cNRBC+ patients exhibited lower median hemoglobin (8.8 g/dL [IQR 7.8–10] high and 8.4 g/dL [IQR 7.4–9.4] low vs. 9.3 g/dL [IQR 8.3–9.9] cNRBC-; p=0.024), correlating negatively with reticulocytes and WBCs.
Cultured cells from high cNRBC+ patients showed accelerated in vitro erythroid differentiation, demonstrating cellular signs of dyserythropoiesis.