43-year-old female. Recent right sided abdominal pain radiating under the rib and debilitating fatigue. When I try to get out of the house, I lose energy within just a few minutes. And severe bone pain all over the body. I can honestly barely do the minimum.
No appendix by the way. CT w/ and w/o contrast was normal.

I recently had lab work done. Most of the lab including UA came back in normal range as well as liver function test, no anemia,thyroid controlled with synthroid, vitamin B1 and B12 and D all normal.

Here is what came back odd.  For the first time ever nucleated red blood cells showed up on my lab work. Total for nRBC came back .10%.  My monocytes were high which elevated my total WBC above normal. So they were both high but not EXTREME. My doctor doesn't really have an answer as to what I should do next. I'm waiting to hear back from his office.  

I know basically nrbc factors don't typically show up on CBCs of adults but are you familiar with circumstances where these types of labs would come back and it is not something significant?

I have access to a blood disorders specialist but hate to call in a favor if it's not really warranted.

I know this was a long one so thanks for reading.

Hello Tiffany:

nRBC appear in peripheral blood when there is rapid breakdown of RBC and bone marrow works overtime to replace and replenish lost RBC. In the process some immature cells are pushed out hence nRBC.
Another reason is if spleen is not functioning optimally. The count is really low though.

You haven't mentioned how much is the total WBC count and monocytes count.
High monocytes can be due to chronic infection and some other diseases. Was your Hb normal.
If you were in late teens, I would suspect mononucleosis, however this is uncommon in adults. Please wait for response from your doctor and if there is nothing significant maybe consult a hematologist.


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Neha Dahiya MD


Help patients understand the medical terminology of their lab results and / or tissue biopsy reports.


I am a pathologist and director of clinical laboratory services. I have been a practicing pathologist for last 9 years in a 350 bed multi specialty hospital laboratory in India.

Indian association of pathologists and microbiologists.
International Academy of Cytology
International association of Pathologists - Indian division
Indian association of Cytology

MD (pathology) MBA

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