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PubMed2006

Relationships between blood rheology and age, body mass index, blood cell count, fibrinogen, and lipids in healthy subjects.

We investigated the relationships between blood rheology assessed by microchannel method and the various hemorheologic factors in healthy subjects. One hundred seventy-six healthy volunteers (90 men and 86 women, mean age; 32.9+/-11.3 years) were participated in this study. Body weight, body mass index, red blood cell count, hematocrit, hemoglobin, white blood cell count, and platelet count, plasma fibrinogen, and fasting serum lipid and lipoprotein concentrations were measured. In order to assess blood rheology, blood passage time was determined by a microchannel method (Micro Channel Array Flow Analyzer). Age, body mass index, red blood cell count, hematocrit, hemoglobin, white blood cell count, total cholesterol, low-density lipoprotein cholesterol, and triglyceride were positively correlated with blood passage time in all subjects, respectively (p<0.01) and high-density lipoprotein cholesterol was inversely correlated with blood passage time (p<0.01). However, platelet count, and fibrinogen were not correlated with blood passage time. The present study showed that increased age, body mass index, red blood cell count, white blood cell count, total cholesterol, low-density lipoprotein cholesterol, and triglyceride and decreased high-density lipoprotein cholesterol were associated with impaired blood rheology measured by microchannel method in healthy subjects, suggesting that aging, obesity, erythrocytosis, leukocytosis, and dyslipidemia may be related to hemorheological disorders. This microchannel method may be useful to study blood rheology which may be associated with various risk factors of cardiovascular disorders.

Adolescent↗

PubMed2006

Diagnostic accuracy of CD4 cell count increase for virologic response after initiating highly active antiretroviral therapy.

OBJECTIVE: To derive and internally validate a clinical prediction rule for virologic response based on CD4 cell count increase after initiation of HAART in a resource-limited setting. DESIGN AND METHODS: A retrospective cohort study at two HIV care clinics in Gaborone, Botswana. The participants were previously treatment-naive HIV-1-infected individuals initiating HAART. The main outcome measure was a plasma HIV-1 RNA level (viral load) < or = 400 copies/ml (i.e. undetectable) 6 months after initiating HAART. RESULTS: The ability of CD4 cell count increase to predict an undetectable viral load was significantly better in those with baseline CD4 cell counts < or = 100 cells/microl [area under the ROC curve (AUC), 0.78; 95% confidence interval (CI), 0.67-0.89; versus AUC, 0.60; 95% CI, 0.48-0.71; P = 0.018]. The sensitivity, specificity, and positive and negative predictive values of a CD4 cell count increase of > or = 50 cells/microl for an undetectable viral load in those with baseline CD4 cell counts < or = 100 cells/microl were 93.1, 61.3, 92.5 and 63.3%, respectively. Alternatively, these values were 47.8, 87.1, 95.0 and 24.5%, respectively, if a increase in CD4 cell count of > or = 150 cells/microl was used. CONCLUSIONS: CD4 cell count increase after initiating HAART has only moderate discriminative ability in identifying patients with an undetectable viral load, and the predictive ability is higher [corrected] in patients with lower baseline CD4 cell counts. Although HIV treatment programs in resource-constrained settings could consider the use of CD4 cell count increases to triage viral load testing, more accurate approaches to monitoring virologic failure are urgently needed.

Adolescent↗

PubMed1980

Membrane filter-deoxyribonucleic acid method of somatic cell counting: collaborative study.

In the membrane filter-deoxyribonucleic acid test, somatic cells are trapped on a special filter. A chemical determination of the DNA of the trapped material gives an estimate of the number of cells. The MF-DNA was evaluated and compared with the direct microscopic somatic cell counts (DMSCCs) in 10 laboratories. Cell levels in the 10 bulk milk samples analyzed ranged from 380,000 to 1,700,000/mL. Regression analysis gave a relation of 0.181 absorbance at 490 nm, when 2.5 mL of milk was analyzed and 5.0 mL reagent was used for color development. The 95% confidence limits on the slope were 0.158-0.204. Analysis of variance showed that both procedures had significant (P less than 0.001) systematic errors, but that only the DMSCC method showed a significant laboratory X sample interaction (P less than 0.001). The repeatability standard deviation of the MD-DNA procedure was 117,000 cells/mL (14%), and the reproducibility standard deviation was 198,000/mL (23%). This compared favorably with the DMSCC method which has a repeatability of 162,000/mL (19%) and a reproducibility of 187,000/mL (34%). The error of the MF-DNA was constant at all cell counts, whereas there was a tendency for the error to increase in the DMSCC method at high cell counts. This method has been adopted as official first action.

Animals↗

PubMed1997

Survival after a very low (< 5 x 10(6)/l) CD4+ T-cell count in individuals infected with HIV.

OBJECTIVE: To describe survival after a CD4+ T-cell count of less than 5 x 10(6)/l and to identify possible baseline factors associated with outcome. DESIGN: A prospective cohort study. SETTING: A large teaching hospital in North London. PATIENTS AND PARTICIPANTS: Patients treated at the Royal Free Hospital, London, who had at least one reported CD4+ T-cell count of less than 5 x 10(6)/l and were being followed up for clinical care prior to the date of this cell count. MAIN OUTCOME MEASURE: Death. METHODS: Proportional hazards models, Kaplan-Meier analysis. RESULTS: One-hundred and sixty-nine patients were included in the study. The median survival after a very low CD4+ T-cell count was 0.95 years (95% confidence interval, 0.78-1.19), although 20% survived for over 2 years. Older age and a previous AIDS diagnosis were related to poorer outcome. A higher CD8+ T-cell count at baseline was also associated with a better prognosis. CONCLUSIONS: A CD4+ T-cell count of less than 5 x 10(6)/l did not necessarily mean imminent death, with a median survival after this count of just under 1 year. These results will enable clinicians to provide appropriate counselling for patients at this late stage and to plan terminal care.

Adolescent↗

PubMed1984

Normal values for peripheral blood white cell counts in women of four different ethnic origins.

Total and differential white cell counts were studied in 399 women living in the same community in Britain but drawn from four different ethnic groups. The groups were white (northern European), Indian, black (African and West Indian), and Oriental. The total white cell count and absolute neutrophil count were significantly lower in the black group than in each of the other groups. The absolute monocyte count was higher in whites than in each of the other groups. Contrary to earlier reports, the absolute eosinophil count in blacks was no higher than in whites, suggesting that the high eosinophil counts previously found had an environmental rather than a genetic cause. The eosinophil count of Indians was only marginally higher than that of whites and the difference was not significant, again suggesting that high eosinophil counts previously reported had an environmental cause. No ethnic variation was found in the absolute lymphocyte count. The lower white cell count and neutrophil count found in blacks is of considerable practical importance, and blacks should not be assessed in relation to reference ranges derived for whites. Nevertheless, the eosinophil count in healthy blacks is no higher than that of whites and counts above reference ranges for whites should be considered clinically important. The differences between white cell counts of Indians and Orientals and those of whites are minor and for practical purposes they can be assessed in relation to reference ranges derived for whites.

Adolescent↗

PubMed1978

The cell count of milk in relation to milk yield.

Quarter-milk cell counts and milk yields from 1000 cows in the province of Noord-Brabant were obtained over a 12-month period. The data from 933 animals, mainly heifers, were used to examine statistically the relationship between cell counts, as a criterion for sub-clinical forms of mastitis, and milk yield. Losses in milk were assessed by quarter, by pairs of quarters and by cow. The conclusions were that the losses in milk due to sub-clinical forms of mastitis, as indicated by cell count, can be substantial. The existence of a compensating increase in milk yield from a healthy gland, in response to the loss of milk from a neighbouring quarter with raised cell count, could not be demonstrated.

Animals↗

PubMedDate not supplied

[Day-to-day variation in cell counts in milk (author's transl)].

The article presents results from two series of milk samples where samples from individual cows were collected at each milking over a period of two weeks. Fat content, protein content and cell count were determined for each sample. The cell counts (in thousands per ml) were transformed to logaritmic values and statistically analysed. As much as 75 to 80% of the variation (expressed as proportion of the total sums of squares) was due to differences "among cows" and about 3% due to differences "among days" during the sampling period. Samples from morning milkings had about 20% lower cell counts than samples from afternoon milkings. The standard deviation among samples from two consecutive milkings of the same cow (after removal of systematic differences between days and between morning and afternoon milkings) was computed as about 30% of the mean (i.e. coefficient of variation approximately 0.3). By combining samples from two milkings the random "error" in cell count can be reduced to about 20% of the mean. The samples exhibited a highly significant, but nummerically small, positive within-cow correlation between fat content and cell count, and between protein content and cell count, while the corresponding correlation between milk yield and cell count was slightly negative (non-significant).

Animals↗

PubMed2000

Ten-year trends in CD4 cell counts at HIV and AIDS diagnosis in a London HIV clinic.

OBJECTIVE: To examine temporal trends (1986-1996) in the CD4 cell count at first HIV-1 positive test and initial AIDS diagnosis, and the influence of selected patient characteristics and treatment factors on these trends. DESIGN: A retrospective clinic-based study. SETTING: Three hospital-based clinics in West London. PATIENTS: A group of 5921 adult HIV-1-seropositive persons and 2835 reported patients with AIDS over a 10-year period from 1 January 1986 to 1 October 1996. METHODS: The CD4 cell count at HIV diagnosis (CD4HIV) was defined as the nearest CD4 cell count to within 2 months of HIV diagnosis; and the CD4 cell count at AIDS diagnosis (CD4AIDS) as the last CD4 cell count in the two months prior to the development of AIDS. Simple and multiple linear regression analysis were used to examine the influence of selected covariates on CD4HIV and CD4AIDS. RESULTS: The percentage of patients with an available CD4HIV and CD4AIDS increased from less than 5% in 1987 to 53% and 40%, respectively, in 1990, and 79% and 48%, respectively, in 1996. Patients with a missing CD4HIV or CD4AIDS were younger and less likely to have received antiretroviral therapy or prophylaxis for Pneumocystis carinii pneumonia (PCP). There was no significant change in CD4HIV over a 10-year period (median 334 x 10(6) cells/l), but a lower CD4HIV was associated with older age at presentation and injecting drug use. There was a delay in the onset of clinical AIDS, with a fall in the median CD4AIDS value from 99 x 10(6) cells/l prior to 1987, to 58 x 10(6) cells/l in 1990, 68 x 10(6) cells/l in 1994 and 60 x 10(6) cells/l in 1996; this decline in onset was seen for PCP as well as for cytomegalovirus and atypical mycobacterial infections. At all time periods, a lower CD4AIDS was associated with combined use of antiretroviral therapy and PCP prophylaxis. After adjustment for use of antiretroviral therapy and PCP prophylaxis prior to AIDS diagnosis, year of diagnosis was no longer associated with CD4AIDS. There was a significant trend towards an improved survival following AIDS diagnosis from 20.1 months prior to 1988, to 20.3 months (1989-1990), 21.0 months (1991-1992) and 22.1 (1993-1994) (P < 0.0005). CONCLUSIONS: The observed decline in CD4AIDS value was related to the introduction of antiretroviral therapy in 1988, and PCP prophylaxis in 1989. Temporal changes in the CD4 cell count at HIV and AIDS diagnosis among different demographic groups can provide insights into the changing natural history of the HIV epidemic and access to medical care. We recommend monitoring of the CD4 cell count at new HIV and AIDS diagnosis and at initiation of antiretroviral therapy as additional measures in national HIV/AIDS surveillance.

Acquired Immunodeficiency Syndrome↗

PubMed2007

Temporal trends in postseroconversion CD4 cell count and HIV load: the Concerted Action on Seroconversion to AIDS and Death in Europe Collaboration, 1985-2002.

OBJECTIVE: To determine whether early postseroconversion CD4 cell counts and human immunodeficiency virus (HIV) loads have changed over time. METHODS: Our analysis was based on 22 cohorts of people with known dates of seroconversion from Europe, Australia, and Canada (Concerted Action on Seroconversion to AIDS and Death in Europe Collaboration). We focused on individuals seroconverting between 1985 and 2002 who had the first CD4 cell count (n=3687) or HIV load (n=1584) measured within 2 years of seroconversion and before antiretroviral use. Linear regression models were used to assess time trends in postseroconversion CD4 cell count and HIV load. Trends in time to key thresholds were also assessed, using survival analysis. RESULTS: The overall median initial CD4 cell count was 570 cells/ microL (interquartile range [IQR], 413-780 cells/ microL). The median initial HIV load was 35,542 copies/mL (IQR, 7600-153,050 copies/mL; on log(10) scale, 3.9-5.2 log(10) copies/mL). The postseroconversion CD4 cell count changed by an average of -6.33 cells/ microL/year (95% confidence interval [CI], -8.47 to -4.20 cells/ microL/year; P<.001), whereas an increase was observed in log(10) HIV load (+0.044 log(10) copies/mL/year; 95% CI, +0.034 to +0.053 log(10) copies/mL/year). These trends remained after adjusting for potential confounders. The probability of progressing to a CD4 cell count of <500 cells/ microL by 24 months from seroconversion increased from 0.66 (95% CI, 0.63-0.69) for individuals who seroconverted before 1991 to 0.80 (95% CI, 0.75-0.84) for those who seroconverted during 1999-2002. CONCLUSION: These data suggest that, in Europe, there has been a trend of decrease in the early CD4 cell count and of increase in the early HIV load. Additional research will be necessary to determine whether similar trends exist in other geographical areas.

Adult↗

PubMed2006

Short communication: bulk tank total bacterial count in dairy sheep: factors of variation and relationship with somatic cell count.

A total of 9,353 records for bulk tank total bacterial count (TBC) were obtained over 1 yr from 315 dairy ewe flocks belonging to the Sheep Improvement Consortium (CPO) in Castilla-León (Spain). Analysis of variance showed significant effects of flock, breed, month within flock, dry therapy, milking type and installation, and logSCC on logTBC. Flock and month within flock were important variation factors as they accounted for 22.0 and 22.1% of the variance, respectively. Considerable repeatability values were obtained for both random factors. Hand milking and bucket-milking machines elicited highest logTBC (5.31), whereas parlor systems with looped milkline (5.01) elicited the lowest logTBC. The implementation of dry therapy practice (5.12) showed significantly lower logTBC than when not used (5.25). Variability in logTBC among breeds ranged from 5.24 (Awassi) to 5.07 (Churra). However, clinical outbreaks of contagious agalactia did not increase TBC significantly. A statistically significant relationship was found between logTBC and logSCC, the correlation coefficient between the variables being r = 0.23. Programs for improving milk hygiene should be implemented for both total bacterial count and somatic cell count variables at the same time.

Animals↗

PubMed2003

Nadir CD4+ T cell count predicts response to subcutaneous recombinant interleukin-2.

Community Program for Clinical Research on AIDS 059 was a multicenter study conducted among human immunodeficiency virus (HIV)-infected individuals with CD4+ cell counts > or =300 cells/mm3 who were randomly assigned to receive antiretroviral therapy with or without intermittent subcutaneously administered recombinant interleukin-2 (rIL-2). To identify factors associated with a response to IL-2, a secondary analysis was performed that included the subset of rIL-2 recipients who were able to complete all 3 initial treatment cycles. Predictors of a change in CD4+ cell count between baseline and 1 month after the start of treatment cycle 3 were examined in a multivariate model that included sex, race, body surface area, rIL-2 dose, HIV load, and both baseline and nadir CD4+ cell count. The combination of race and sex (P=.027) and the nadir CD4+ cell count (P=.005) were significant predictors of mean CD4+ cell count response. Baseline CD4+ cell count had no significant effect. The strong association between nadir CD4+ cell count and CD4+ cell count response suggests that immunologic losses resulting from HIV-mediated CD4+ cell depletion may be irreversible.

Adult↗

PubMed1982

Somatic cell counts, mastitis and milk production in selected Ontario dairy herds.

Somatic cell counts were performed monthly on bulk tank milk samples for all producers in the Ontario counties of Hastings, Lennox/Addington and Prince Edward throughout 1978 and 1979. Other data were obtained via a structured questionnaire and from the records of the Ontario Milk Marketing Board. Many producers have not adopted practices that have been advocated for the integrated control of mastitis. For example, 43.3% of producers surveyed used single service paper towels, 63.3% regularly used teat dip and 56.5% dry cow therapy. The mean of the average monthly somatic cell count for all producers for 1978 was 621.1 x 10(3) cells/mL. This latter value was used to divide the producers into case (higher than average) and control (lower than average) groups. Control herds averaged 95.9 liters more shipped milk per cow per month than case herds. Milk from control herds averaged 0.22 percentage points higher than case herds for each of average fat and lactose, and 0.16 percentage points higher for protein. The linear regression of monthly shipped milk on the respective monthly bulk tank somatic cell count indicated a loss of 13.26 L/cow/month for each 100,000 increase in somatic cell count.

Animal Husbandry↗

PubMed1982

The application of bulk tank somatic cell counts to monitoring mastitis levels in dairy herds.

The objective of this study was to investigate the feasibility of developing a system whereby measurements taken on bulk tank milk samples could be used to monitor the level of subclinical mastitis in dairy herds. The variables that were examined were the logarithmically transformed total somatic cell counts and percentages of cell volume in channel 8 (volumes from 89.2 to 178.3 microm(3)), the presence or absence of Streptococcus agalactiae and various husbandry/management factors including herdsize and the use of teat dips. Each of the use of actual monthly and rolling average bulk tank cell count determinations was investigated. It was found that the inclusion of all variables resulted in a correct classification of approximately 85% of herds and that no improvement was achieved by the use of rolling as opposed to actual monthly values. The inclusion of various husbandry/management practices improved the percentage correct classification to some extent over that achieved by the sole use of total somatic cell counts and percentages of cell volume in channel 8 when the herds were grouped on the basis of quarter infection rate (<10%, >10%) but not in the case of the cow infection rate categories (<20%, >20%). The use of both total cell counts and percentages of cell volume in channel 8 did not improve the overall predictive value over that achieved by the sole use of percentage of cell volume in channel 8 in the case of the quarter infection rate groupings but did to some extent in the case of the cow infection rate groupings. When the classification functions were applied prospectively and considering combinations of the two cell count determinations only, it was found that they were able to correctly classify, on the basis of the quarter infection rate groupings, approximately 75% of the study herds. It is concluded that the system described herein has limited application as a basis for selecting problem herds.

Animal Husbandry↗

PubMed1992

Accuracy and utility of differential white blood cell count in the neonatal intensive care unit.

The clinical utility of the complete blood cell count (including the differential white blood cell count) as a means to follow the course of infants in a neonatal intensive care unit was assessed. Utility was judged for three purposes: (1) predicting the onset of clinically unrecognized disease, (2) assessing the severity of current disease, and (3) following a trend during treatment. Neither conventional nor automated differential counts were useful for surveillance (predicting the onset of clinically unrecognized disease). The white blood cell count, the platelet count, and the absolute immature neutrophil count and immature/total neutrophil ratio were useful to assess the severity of current clinical events. The white blood cell count was superior to the differential count for following trends in patients' conditions. Information regarding nuclear immaturity derived from automated counts and the cost and slowness of the manual differential count are good indications for decreased use of conventional counts, increased use of certain features of the automated differential, or both, in neonatal intensive care units.

Automation↗

PubMed2004

CD4+ cell-count-guided treatment interruptions in chronic HIV-infected patients with good response to highly active antiretroviral therapy.

OBJECTIVE: To evaluate the safety of treatment interruption guided by CD4+ cell count in HIV-infected patients followed up prospectively. METHODS: Patients on highly active antiretroviral therapy with CD4+ cell counts > 500 x 10(6) cells/l discontinued therapy with instructions to start therapy again before their CD4+ count dropped below 200 x 10(6) cells/l. Any patients who resumed therapy would be eligible to interrupt treatment again once their CD4+ cell count increased above 500 x 10(6) cells/l. RESULTS: Data on 71 HIV infected patients is reported. Their median nadir CD4+ cell count before antiretroviral treatment was 352 x 10(6) cells/l [interquartile range (IQR), 294-445 x 10(6) cells/l]. The median CD4+ cell count at the time of first interruption was 790 x 10(6) cells/l (IQR, 657-1041 x 10(6) cells/l). The median follow-up after starting the first treatment interruption was 28.3 months (IQR, 21.4-37.0 months). During the follow-up 49 patients restarted therapy and 22 patients remain off therapy; 24 patients have interrupted therapy twice, nine patients have interrupted therapy three times and six patients four times. No AIDS-defining illnesses occurred during the follow-up. The median duration of the first interruption was 15 months (IQR, 6-26 months). The overall reduction of time on therapy was 71.1%. The duration of the first interruption and the reduction of time on therapy were related to nadir CD4+ cell count. The patients who resumed HAART rapidly regained CD4+ cells and achieved viral suppression. CONCLUSION: If carefully monitored, treatment interruptions guided by CD4+ cell count in patients with an initially high CD4+ cell counts are clinically safe, decrease exposure to the drugs and do not reduce the efficacy of therapy when this is re-started.

Adult↗

PubMed1984

Relationships between somatic cell counts and milk production.

The relationship between Dairy Herd Improvement program test-day milk yield and somatic cell counts in milk was analyzed in 34 dairy herds over 3 yr. Estimates of this relationship were more accurate when somatic cell counts were transformed to natural logarithms rather than actual. For 67,707 observations, test-day milk yield decreased with increasing somatic cell count. The decrease of milk yield for second and later lactations, as somatic cell count increased, was greater than for first lactations. When herds were partitioned according to herd milk production (greater than 7700, 6500 to 7700, and less than 6500 kg/yr), decrease of milk yield was linear with increasing somatic cell counts for herds averaging below 7700 kg milk. Regressions were linear, quadratic, and cubic for both parity groups in herds with high production, over 7700 kg/yr. Quarter samples were composited for each cow and cultured. Percentage of infected cows increased as somatic cell counts increased with greater infection rates above 400 X 10(3).

Animals↗

PubMed2003

Total lymphocyte count as a possible surrogate of CD4 cell count to prioritize eligibility for antiretroviral therapy among HIV-infected individuals in resource-limited settings.

OBJECTIVE: To characterize the value of total lymphocyte counts in predicting risk of death among patients initiating triple combination antiretroviral therapy. METHODS: Study subjects included antiretroviral-naive persons aged 18 years or older who initiated treatment with triple combination therapy between August 1 1996 and September 30 1999 in a population-based observational cohort of HIV-infected individuals. Total lymphocyte counts as well as CD4 count and plasma viral load were assessed at baseline. Separate Cox proportional hazards models were devised to evaluate the effect on survival of total lymphocyte count in lieu of or with CD4 count after adjustment for other prognostic factors including plasma viral load. RESULTS: A total of 733 antiretroviral-naive persons initiated triple drug combination antiretroviral therapy over the study period with a median follow-up of 29.5 months. In the first analysis, only baseline CD4 cell counts of 50-199 cells/microl or less than 50 microl were associated with an increased risk of mortality [adjusted relative risk (ARR) 2.90; 95% CI: 1.40, 5.98] and (ARR 6.30; 95% CI: 2.93, 13.54), respectively. When CD4 counts were excluded from the analysis as if unavailable, total lymphocyte count of between 0.8 and 1.4 G/I, and less than 0.8 G/I were both significantly associated with an increased risk of mortality (ARR 2.36; 95% CI: 1.16, 4.78) and (ARR 6.17; 95% CI: 2.93, 13.01), respectively. CONCLUSION: Total lymphocyte count may provide a simple and cost-effective alternative for prioritizing therapy initiation in resource-limited settings. Our results suggest that, if appropriately validated, judicious application of total lymphocyte counts could overcome one of the practical obstacles to more widespread provision of antiretroviral therapy in resource-poor settings.

Adolescent↗

PubMed2001

Neonatal nucleated red blood cell counts: relationship to abnormal fetoplacental circulation detected by Doppler studies.

Increased neonatal nucleated red blood cell counts are thought to be related to intrauterine hypoxemia. We sought to determine the effect of increasing circulatory impairment in fetuses on the neonatal nucleated red blood cell count. One hundred thirty-four singleton pregnancies were included in the study and were allocated to 4 study groups according to Doppler findings. The systolic-to-diastolic ratios of the umbilical artery, fetal aorta, middle cerebral artery, and uterine arteries were recorded. Fetuses were assigned to the following groups on the basis of the last Doppler examination before delivery: group 1, normal systolic-to-diastolic ratios in the examined vessels; group 2, a systolic-to-diastolic ratio greater than 2 SD above the mean for gestational age in the umbilical artery or fetal aorta and no abnormal Doppler findings in the uterine arteries; group 3, systolic-to-diastolic ratios greater than 2 SD above the mean for gestational age in all examined vessels; and group 4, absence of end-diastolic velocity in the umbilical artery or fetal aorta and systolic-to-diastolic ratios greater than 2 SD above the mean for gestational age in the uterine arteries. A blood sample from the umbilical artery was obtained within 1 minute after birth, and nucleated red blood cells per 100 white blood cells were counted by light microscopy. Nucleated red blood cell counts were higher in fetuses in group 4 (median, 72.0; range, 9-720; P < .001) and group 3 (median, 38.4; range, 7-201; P < .001) than in fetuses in group 1 (median, 5.1; range, 0-20). Neonates in group 4 had significantly lower birth weights (P < .001), lower arterial and venous pH values (P < .05), and lower Apgar scores after 5 minutes (P < .01) as well as an increased likelihood of cesarean delivery because of fetal distress (P < .001). The number of fetuses in group 4 with a cord blood base deficit of less than -8 mmol/L was increased. Nucleated red blood cell counts were comparable in fetuses in group 2 (median, 5.4; range, 0-37) and group 1. In groups 1 to 3 no brain-sparing effect occurred, whereas in 15 of 21 cases in group 4 a brain-sparing effect was present. Multivariate analysis revealed that Doppler results of the umbilical artery, fetal aorta, and uterine arteries were independent determinants of neonatal nucleated red blood cell count. Increasing abnormalities seen on fetoplacental Doppler studies are associated with increasing numbers of nucleated red blood cells at birth. Given the known relationship between abnormal Doppler flow and intrauterine hypoxemia, the neonatal nucleated red blood cell count might become an additional valuable tool in the surveillance of growth-restricted fetuses.

Aorta↗