Says Patricia P. Wilcox, M.S. "Not true. There can be significant hemolysis which is invisible if all you do is a standard blood count, but shows up nicely as an elevated reticulocyte count ... This is called compensated hemolytic anemia."

According to Robbins' Pathologic Basis of Disease, 5th Edition (1994), Chapter 13 (Diseases of Red Cells and Bleeding Disorders), page 584:

"With an increased demand for blood cells in the adult, the fatty marrow may become transformed to red, active marrow. Moreover, this is accompanied by increased productive activity throughout the marrow. These adaptive changes are capable of increasing red cell production (erythropoiesis) seven- to eight-fold. Thus ... such loss of red cells as may occur in hemolytic disorders produces anemia only when the marrow compensatory mechanisms are outstripped."

So a reticulocyte count might be a good screening tool for red blood cell damage/destruction due to exposure to certain types of solvents, e.g. glycol ethers, in patients who are not so badly damaged that they can no longer replace red cells as fast as they are losing them (i.e., they still have normal red blood cell count, hemoglobin, and hematocrit).

Mark Cullen et al. looked for changes in peripheral blood and bone marrow in solvent-exposed printers and spray painters, and found substantial bone marrow abnormalities that were undetectable in peripheral blood counts -- they focused on glycol ethers as a likely suspect ...

Cullen et al. found a one-to-one correspondence between blood/bone marrow abnormalities and red blood cell pyruvate kinase (PK) deficiency in solvent-exposed workers.

[Note: Wilcox found this interesting because PK is polymorphic among humans -- several percent of us have a variant form of the enzyme -- and the majority of a small sample of folks with multiple chemical sensitivities that she looked at had altered PK activity and elevated reticulocyte counts after solvent exposures ...]

I'm not sure how well the reticulocyte count would reflect benzene exposure, which reportedly suppresses production of new red blood cells rather than simply killing existing red cells. A more usual marker of "benzene poisoning" is an abnormally low lymphocyte count, says Wilcox

• Patricia P. Wilcox, M.S. 12-27-99
  
• School of Public Health
  
• The Ohio State University

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