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Fragmented red blood cell counts of neonates with new-onset gastrointestinal disturbances

Journal of Perinatology volume 43, pages 1173–1175 (2023)Cite this article

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We previously reported high fragmented red cell (FRC) counts from neonates with necrotizing enterocolitis (NEC), infection, or iron deficiency [1, 2]. The FRC count is an automated quantification of red blood cells (RBC) smaller than those populating the RBC size-gate. RBC species within the FRC gate include schistocytes, created when RBC circulate through areas where the endothelium is damaged and intraluminal fibrin strands cause red cells to become tethered and torn [1,2,3,4]. Abnormally small RBC (microcytes) also appear in the FRC gate. These are created during iron deficiency, alpha thalassemia, or hereditary spherocytosis (HS) [1,2,3,4].

Because of heterogeneity of the RBC species comprising the FRC count, an elevated FRC count would not be specific for diagnosing NEC. However, among neonates with a new-onset gastrointestinal (GI) problem, a high FRC count might indicate NEC or infection or iron deficiency, while a normal count might indicate a non-inflammatory GI problem (e.g. feeding intolerance). We retrospectively assessed FRC counts of neonates with a new-onset GI problem where a CBC, blood culture, and abdominal x-rays were ordered.

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Fig. 1: Dot plots showing fragmented red blood cell (FRC)/µL (y-axis) according to postnatal age in days (x-axis) from 159 neonates with a new-onset GI disturbance.

Data availability

The data used in this study are available upon request from the corresponding author.

References

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Acknowledgements

The authors thank Molly Adams and Jillyn Spencer, Intermountain Healthcare Women and Newborn Research Department, for assistance with Institutional Review Board communications. We also thank Shelby Moench, System Director, Human Research Protections Program, Intermountain Institutional Review Board.

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA

    Timothy M. Bahr, Allison J. Judkins, Shelley M. Lawrence, Robin K. Ohls & Robert D. Christensen

  2. Obstetric and Neonatal Operations, Intermountain Healthcare, Salt Lake City, UT, USA

    Timothy M. Bahr, Erick Henry & Robert D. Christensen

  3. Student, University of Utah, Salt Lake City, UT, USA

    Thomas R. Christensen

  4. Intermountain Healthcare Central Laboratory, Intermountain Medical Center, Murray, UT, USA

    Sterling T. Bennett

  5. Intermountain Healthcare, Primary Children’s Hospital Salt Lake City, Salt Lake City, UT, USA

    Theodore J. Pysher

  6. Department of Pathology, University of Utah, Salt Lake City, UT, USA

    Sterling T. Bennett & Theodore J. Pysher

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  1. Timothy M. Bahr
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  2. Thomas R. Christensen
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  3. Erick Henry
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  4. Allison J. Judkins
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  7. Shelley M. Lawrence
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  8. Robin K. Ohls
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  9. Robert D. Christensen
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Contributions

All authors listed met criteria for authorship. TMB, TRC, EH, and RDC contributed to the design and data collection. All authors, including AJJ, STB, TGP, SML, and RKO, contributed to writing and editing the manuscript and all approved the final draft.

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Correspondence to Timothy M. Bahr.

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The authors declare no competing interests.

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The Institutional Review Board of Intermountain Healthcare judged this to be exempt from the need for individual informed consent. They reviewed this manuscript prior to submission for publication and judged it compliant with institutional privacy-protection policies.

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Bahr, T.M., Christensen, T.R., Henry, E. et al. Fragmented red blood cell counts of neonates with new-onset gastrointestinal disturbances. J Perinatol 43, 1173–1175 (2023). https://doi.org/10.1038/s41372-022-01587-z

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