Features of erythropoiesis in patients with burn disease, depending on the severity of the disease

Burn disease is accompanied by the development of anemia of critical conditions, the pathogenesis of which is multifactorial and includes blood loss, hemolysis, systemic inflammatory response, inhibition of erythropoiesis, and impaired iron metabolism. The diagnosis of these disorders is traditionally based on standard peripheral blood parameters. However, an in‑depth assessment of erythropoiesis, including reticulocyte parameters and bone marrow examination, remains an insufficiently studied but important task for understanding the development of anemia and its pathogenetic correction.

The purpose of the study. To study the features of clinical blood analysis and myelogram indicators in patients with burn disease upon admission, depending on the severity of the burn disease, in order to improve the diagnosis of anemia syndrome.

Material and methods. The study included 58 men with burn disease. Depending on the Franck index (FI), patients were divided into two groups: Group 1 (FI90, unfavorable prognosis, n=31). The examination was performed 3–5 days after the injury. Clinical blood analysis was performed on a Sysmex XN‑1000 hematology analyzer (Japan) with an assessment of erythrocyte and reticulocyte parameters. Additionally, patients underwent aspiration bone marrow biopsy followed by myelogram counting using the traditional method of light microscopy and automated examination of bone marrow punctate using a Sysmex XN‑1000 hematology analyzer.

The results of the study. Significantly lower concentrations of RBC were found in patients of the 2nd (FI>90) group compared with the 1st (FI¹²/ l and 4,12 [3,64; 4,35]×10¹²/l (p=0,05) and higher values of the indicator RDW‑SD – 46,9 [45,1; 49,7] fl and 44,8 [43,5; 46,1] fl (p=0,017), respectively. There was a tendency to decrease HGB, HCT and WBC with an increase in the severity of burns. The erythrocyte indices (MCV, MCH, MCHC) corresponded to the normochromic normocytic type of anemia in both groups. Evaluation of reticulocyte parameters revealed an increase in IRF mainly due to high‑fluorescence forms (HFR) without statistically significant intergroup differences. The RPI index tended to decrease in patients of the 2nd group (FI>90), remaining within the reference values. The analysis of the myelogram in patients of the 2nd group (FI>90) revealed a statistically significant increase in the number of basophilic erythroblasts – 0,6 [0,4; 1,6]% compared with the 1st group (FI90) and the absence of significant differences in the number the sum of erythrocaryocytes, which is consistent with the data of the classical myelogram.

Conclusion. A comprehensive analysis of peripheral blood and bone marrow parameters allows an in‑depth assessment of the nature and degree of erythropoiesis disorders in burn disease, which may be important for predicting the course of anemia syndrome and developing pathogenetically sound approaches to its correction.

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