The autoimmune hemolytic anemia from
2-butoxyethanol poisoning doesn't show up as you would expect. This is
really a mystery. Everything can look OK in the initial tests: CBC, WBC,
PTL, Hemoglobin and Hematocrit ... just a borderline normal RBC
And even when all the red blood cells must be premature, and there is a
trace of blood in the urine ... still enough of the results for all being
One man wasn't even making enough red blood cells per 'retic
years after exposure ... yet still other tests are saying he is OK
- A mystery!
Details here healthboards.com/boards/showthread.php?p=1170909#post1170909
do a 'retic ratio?'
It is part of the hemotology tests, if they order it
What was the count for the red blood cells?
Just at borderline normal or slightly under normal?
Was there any blood showing up in urine (protein ?) ... even
One of the workers exposed to 2-butoxyethanol 15 years ago has
a retic ratio of 0.3 % & the normal range is 0.5 -
What does this mean?
Other counts looking mostly good:
WBC 6.3 (normal range for a male is 4.5-10.8)
RBC 4.45 (normal range for a male is 4.5-6.0)
HGB 14.0 (normal range for a male is 13-18)
HCT 43.1 (normal range for a male is 40-50)
PLT 216 (normal range is 150-450)
He has very, very low blood pressure (wonder what the volume
of blood is?) There is concern for liver, and he has had rapid
weight loss; he has collapsed a couple of times. This lower
than normal level of 'retric' could be from lack of nutrition,
so I don't think we can tell what was happening with the blood
now that other ailments are getting severe. Or, is he just
not making enough blood? What other tests are needed?
He also says he can only sleep about 15 minutes at night; he
can't keep any moisture in his skin; his temper is always
going off ... he is at his wits end. One time after he had
collapsed they put him on a special heart machine and found
the 3 of his heart chambers were double their normal size.
These are also said to have thick, dark blood (Thick from
fagility of red blood cells? Dark from lack of oxygen, most
What other tests would be necessary to see if autoimmune
hemolytic anemia is going on?
|Positive Coombs' test,
direct or indirect
Elevated bilirubin levels
Low serum haptoglobin
Hemoglobin in the urine
Elevated absolute reticulocyte count
|Why is the test
done: Elevated absolute reticulocyte count
To determine if red blood cells are being
created in the bone marrow at an appropriate
A special stain can be used to identify
reticulocytes, because they contain remnants of
RNA. Fully mature red blood cells are
terminally-differentiated cells lacking nuclei
and nucleic acids. The number of reticulocytes
in the blood is proportional to their rate of
synthesis and release by the bone marrow. The
body will respond to bleeding or hemolytic
anemia (breakdown of red blood cells) by an
increased rate of red blood cell synthesis under
normal circumstances. A lower-than-normal
percentage of reticulocyte is suggestive of a
nutritional deficiency. (However not in this
case; bone marrow & immune system has been
working overtime, & it is getting harder to
make enough red blood cells or immune cells
Low red blood cell count and hemoglobin
This man has had blood showing up in his urine regularly,
What did the CBC with differentials show? I think this is part
of what is tested for, too?
|The differential count
estimates the number of the various types of WBCs. This
can help detect infection, anemia, and leukemia; or
follow the progress of treatment.
There are various types of WBCs (also called leukocytes)
that normally appear in the blood. The differential
determines the relative percentages of the different
types of cells in the blood, notes any abnormal
appearance of the cells, and the presence of any
abnormal immature cells.
Neutrophils are mainly phagocytic cells (that is, they
engulf and destroy invading organisms). They also
release some enzymes and substances that affect the
function of other cells called cytokines.
B lymphocytes (B cells) synthesize and secrete
T lymphocytes (T cells) -- one type of T cell is called
a helper cell; it secretes proteins that increase B cell
function and the functions of cytotoxic T lymphocytes.
Cytotoxic T lymphocytes recognize and destroy
virus-infected and other abnormal cells.
Monocytes recognize a variety of microorganisms,
especially gram-negative bacteria. Activated monocytes
turn into macrophages that can engulf and destroy
microorganisms and secrete a variety of cytokines that
modulate the activity of other leukocytes.
Eosinophils and basophils release substances that cause
vasoconstriction, smooth muscle contraction, and an
increased permeability of small blood vessels.
Eosinophils are stimulated by parasites and some
bacteria. Basophils are stimulated by allergens.
Slim has to share - in his own words - an EVOS worker
far as I know he doesn't have a diagnosis of hemolysis or
hemolytic anemia. (But it should be there ... hiding out)
Re: This autoimmune hemolytic anemia
doesn't show up in regular bloodwork
My mother died from autoimmune hemolytic anemia
almost 30 yrs ago. If what I'm told is right, not much was known about it
then, and it went undiagnosed. She was admitted to the hospital and 4 days
later she died. I understand people don't normally die from this. I was
told she was given too many blood transfusions too fast and that lead to
I looked up a few websites on this, but most were so technical I could not
understand them. What is it caused from? Anyone know? Offdahook4now
When did your mom feel fatigue? Thank you for caring enough to want to know
more. The chemical, 2-butoxyethanol also is known as ethylene glycol
monobutyl ether and I suspect people in the early 1940's and before could
have been harmed by it.
It was invented by the chemical companies in the 1930s
What did your mom do? Or more precisely, what was she doing the day she
felt a horrible fatigue hit ... with flu-like symptoms and usually other
symptoms like grouchiness & glandular problems and headaches can start
up shortly thereafter. Even concern for liver and kidney function, etc.
I did have a lady share with me that her father had something similar and
that they have to warm the blood and give it slowly over an 8 hour period.
Two other transfusions not done this way failed, and a 3rd time of that
would have killed him.
My mother was a housewife. She had a severe case
of anemia when she gave birth to my oldest sister and would have died if
it were not for the blood transfusions she was given then.
She had very bad allergies and took shots for them. She often complained
of headaches. She said she saw an aura before getting them and that it
felt like someone was beating her over the head with a hammer.
She had been seeing a dr for her flu like symptoms for a month or more.
The day she was rushed to the hospital she was very jaundiced and
if I was told right, she was vomiting blood. She was only 41 yrs old.
I have all of her medical records. She did get better on the 2nd day of
her hospitalization and told us she was coming home. I guess the effects
of the blood transfusions (giving them too fast) hit her on the 6th day.
She went into cardiac arrest four times, but the last time was the end for
I have always wanted to know more about this, but have never found anyone
who knew anything about it. Thank you for your interest.
through this info, please - On this thread I share a lot of information with a gulf war vet as
to what the symptoms are, etc.
Please read through this
If she had flu-like symptoms for a month + it is most likely that whatever
cleaning product she was using ... or maybe she was doing a painting
project or something ... was continually re-exposing her to the chemical
She had several symptoms, so check to see if there was blood showing up in
her urine and if there was a 'retic' ratio taken (reticulocyte count)
which will only reveal too high early on ... or too low, much later on.
Read through pages 7-10 of this thread
The Walter Reid Army Medical Center said that hemolytic anemia was very
rare. I suggest it is as common as CFS, CFIDS, and 'gulf war syndrome'
plus the many, many others that have the symptoms but not the official
When someone is chemically poisoned by a chemical such as 2-butoxyethanol,
some tests do not read right. In particular, there are too many immature
red blood cells and many other tests are not reading OK, including the one
which would indicate blood anemia. ‘Dear
I will get her medical records out and look at them. I do know
that her urine was a dark brown color, and I also read in the
reports that it was thick, almost jelly like. I do not know if
that was before she was admitted to the hospital or after. I'll
look at the records. We were also told at the time (1975) that
this was a very rare disease.
I thought I read somewhere about steriods possibly having
something to do with this. That is why I mentioned the allergy
My grandfather, her father, has always had a problem with low
platletts and I wonder if this has anything to do with her?
By the way, I read the posts on the Gulf War syndrome. My
husband is also a GW vet and is suffering from symptoms.
And I appreciate the time you're taking to explain or help me to
understand this. I have had so many unanswered questions
throughout the years about this.
Blood draws are said to be thick and
When did her urine
start showing up dark like this? For it to be
thick like jelly at
the time of admission to the hospital, it means
that there was an immense amount of red blood
cells being prematurely destroyed by her immune
system, poor dear. Whatever was the exposure for
her, she had no idea what it was ... nor did the
medical profession, most likely ... or so that
has been the case as to this chemical's
exposure, that is for sure!
Many times at time of blood draws, the lab tech
will notice that these have blood that is
thicker and darker than normal. (Dark because
there isn't enough oxygen in the blood... not
red blood cells)
Many people can go back to the very day of their
exposure to 2-butoxyethanol based on a
combination of flu-like symptoms, fatigue, dark
urine and eyes watering and burning?
Just wondering ... were you born before or after
your mother's fatigue?
I would also note any urinalysis that your mom
had. They may not have checked some stuff on red
blood cells like 'retic' ratio ... but hopefully
they did. Maybe you can help shed some light on
I suspect your
husband to be harmed by the same chemical. What
does his urinalysis say?
Here is some of
her medical records. This is just a small bit of
it. To answer your question, I was born in 1965.
My mom was born in 1934 and died 1975. She was
tired a lot due to her anemia.
I apologize for the length of this but maybe you
can tell me what it means.
This lady presented to the ER with a hemoglobin
of apx. 5. A diagnosis of Coombs. positive,
autoimmune hemolytic anemia was made. The
patient was started on Prednisone 100 mgs daily
with an extremely poor response. Apparently the
hemoglobin got down to apx 3. At this point, it
was felt that blookd transfusions were nec.
despite the hazards involved. The patient was
transfused. Today she was transferred to ICU and
further transfusions were carried out. The
patient developed repertory arrest, cardaic
arrest associated with massive hematuria.
Diagnostic considerations at this time remained
that of hemolytic crisis, microangiopathic
hemolysis, massive transfusion reaction.
Combination of massive hemoglbinuiri and
hypotension pre-disposed to acute tubular
insufficiensy which seems well established at
the present time in that the patient is oliguric.
She also remains in shock. EKG reveal sinus
tachycardia. There is diffused bleeding from the
GI tract, vagina, urinary tract and there are
multiple superficial puncture sites
There are alot of
tests, but I don't know what they mean or how to
read them. I'll list some of them and maybe you
can make sense of them.
6/ 12/ 75
WBC x 10 5 2 .6
4 7 .4 Corrected wbc
HCE 1 1.0
MVC 1 0 1
MCH 3 1.0
NUCL RBC (11) ( something else I can't read)
Polchromasia 4 +
evaluated for folic acid
4-16 NG/ml ?
More tests: I believe urine
Pecific gravity 011
WBC/HPP ( or HFF) 10-12
RBC/HPP ( of HFF) unreadable
Crystals ( 8-10 course granulear c??)
Casts/LPF 60-70 ceblular cast???
Looks like they
also gave her bone marrow.
This 41 yr old female presented to the ER
complaining of headaches. Originally the pain
was occipital in nature radiating to the frontal
region, it became subsequently generalized at
the time of admission. The pt tried bed rest for
3 days before she came to the ER. PT said that
she was aking darvocat 10 #4 and Empirin with
only mild relief and also there was nausea and
vomiting the day before admission. The patient
had a long history of migraine headaches. The pt
also gave a history or anemia since the age of
12. She had several courses of b complex and
b12. She also has numerous allergies. She gave a
history of having some transfusions when she was
going through childbirth. The pt was also taking
antihistamines and allergyg shots.
The physical exam at the time of admission
revealed the temp to be 97.4, pulse of
120/minute, resp. rate 24/minute, bp 144/78. The
pt appeared markedly anemic, slightly obese, and
severely jaundiced. The conjuctivae were pale.
The sclerae were icteric. The fundi did not
reveal any evidence of hemmorage, exudate, or
papilledema. The neck was supple, no thyroid
enlargement. There was no palpable
lymphadenopathy in the cervical, axillary, or
inguinal region. The thorax was essentially
normal. Lungs were clear. The heart showed no
evidence of ardiomegaly. There was ?????
moderate tachycardia of 124/minute. The blood
vessels showed the pulses were palapable in all
superficial blood vessels. There was no evidence
of hepatosplenomegaly. Genitourinary did not
reveal any evidence of tenderness in the
cardiophranic angle. Musculoskeletal did not
reveal any abnormality. Extremities showed no
varicosities, pitting edema or ulceration.
Neurological exam was normal.
Initial workup in
the ER revealed a white blood count of 23,700,
red blood count was 1,550,000, hemoglobin of 5.7
gm, hematocrit of 15.9 % slightly microcytic
indices, RETICULOCYTES of 17.6%, many sperocyes,
jaundiced plasma. The differential showed 2
myelocytes, 1 metamyelocytes, 7 bands, 76 PMN's,
9 lymphocytes, 3 monocytes, 2 eosinophils, and 2
nucleated red blood cells. The CPK was normal.
The electrolytes were within normal limits.
Direct Coombs was 2+. URNINALYSIS SHOWED A SMALL
AMOUNT OF HEMOGLOBIN. The total bilirubin was
7.7, direct bilirubin was 1.0. The creatinine
was 0.8, SGOT of 38, LDH of 1207. Diagnosis of
Coombs positive hemolytic anemia was
There is much more, but maybe this is enough to
figure it out?
I think we need some help here
|URNINALYSIS SHOWED A
SMALL AMOUNT OF HEMOGLOBIN
This is blood in urine, right?
I did notice that the Red Blood Cell count was
Notice they talk about 2
nucleated red blood cells in one of the samples,
those are immature red blood cells?
generic range of Red Blood cells for
to 5.4 million cells/mcl
Because men have more muscle, the
regular normal range for them are for
to 6.1 million cells/mcl
I notice that they were checking the
I noticed on one
person's hematology report that the 'retic' was
normal at 0.5%-2% So is 34 a count or is that
Definition: A test that measures the
percentage of reticulocytes (slightly
immature red blood cells) in blood.
special stain can be used to identify
reticulocytes, because they contain
remnants of RNA. Fully mature red
blood cells are
lacking nuclei and nucleic acids. The
number of reticulocytes in the blood
is proportional to their rate of
synthesis and release by the bone
marrow. The body will respond to
bleeding or hemolytic anemia
(breakdown of red blood cells) by an
increased rate of red blood cell
synthesis under normal circumstances.
I only studied this chemical. . . and people
known and suspected to be harmed by it. I'm not
a medical person.
|offdahook4now, “I found a very good
site that explains reticulocytes. Sometimes they are expressed in
percentages and/or whole numbers:”
If your mother
died of acute autoimmune hemolytic anemia and her reticulocyte count was
34%, 31% ...
then is extremely high
is a percent. I found another reference to reticulocytes saying they were
31.0 % on another date.”
Ok, this is the
first place that covers up the hemolytic anemia. It would be called compensated
hemolytic anemia because the bone marrow 'covers' up the premature
destruction of red blood cells by making more red blood cells. When
doctors check the blood counts, and hemoglobin and hematocrit, they look
"OK" and they don't check further.
Why doctors don't find the fatigue? Doctors believe that
if there is significant blood hemolysis, it will show up in the
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 , about 2.5 days after exposure ... 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),
"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.
... says Wilcox, "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"
Patricia P. Wilcox, M.S., M.P.H. (master of public health), the
above quote was when she was a student at
School of Public Health
The Ohio State University
With this chemical's harm it causes
a lot of other things that are very serious, and although the
fatigue of CFS, CFIDS, 'gulf war syndrome' groups is this, in my opinion,
based on other symptoms that go with this chemical's harm, ... the doctors
say they don't know the cause of the fatigue and turn their attention to
the other more serious ailments: central nervous system damage, the
headaches, the bones, the joints, multiple cancers even. Everything else
gets the 'credit' for harming someone. (Blood sugar will often go sky high
& get 'blamed' for an acute attack of autoimmune hemolytic anemia ...
or blood pressure, for instance) At this point doctors think it is the
diabetes that causes kidney damage. Maybe they should look back to what
caused the high blood sugar in the first place.
Does the CDC or
anyone else say a death is from 2-butoxyethanol poisoning? No, the root
cause is missed. But it doesn't have to be. Check every cancer group that
is being studied for the percentage whose root cause is 2-butoxyethanol
poisoning. Which subjects have blood in urine?? and red blood cells that
are not the right ratio of mature and immature? Depending on the time
since initial exposure, then what is the 'retic' ratio. If your mom had
lived and never been exposed to a chemical such as this again, over time
her 'retic' ratio would have dropped and dropped because the bone marrow
becomes less and less able to keep up with making the new red blood cells
that the body needs. Because the red blood cells may never live to be 120
days old, a person would feel fatigue: not enough mature red blood cells
to carry and store the iron, the oxygen. That's my lay person's take on
If there comes a
time when there is no blood showing in urine, but someone has had fatigue
for a LONG, LONG time, then check the peripheral blood. Also those
harmed by 2-butoxyethanol can have enlarged, swollen and ulcerated glands:
spleen, gall bladder, pancreas .. and many times they have operations to
have them removed, which is risky when someone has impaired immune system.
One worker on the Exxon Valdez oil spill cleanup had many swollen glands
all through his chest and testicals, too. His peripheral blood smear was
abnormal about 8 years later. On the 12-27-97 death certificate it listed
the following as cause of death
was 55 years old when he died,
due to e-coli Sepsis,
due to Neutropenia,
due to B-Cell Lymphoma, S/P Chemo
with significant contributing to cause of death being
Acute Renal Failure, Liver Failure
This man was a
native who lived about 100 miles north of Valdez. There is also a small
village of natives some miles out of Prince William Sound whose beaches
were sprayed with this as well. Of the 12 elders in the village of Chenega,
9 have died in their middle years of kidney &/or liver ailments. Their
beach was sprayed with the 'bioremediation' chemical concoction: Inipol
EAP 22, an Exxon formulation created to 'cleanup the beaches' after the
1989 Exxon Valdez oil spill. C6H14O2/CH3(CH2)2CH2OCH2CH2OH this is the
Chemical formula for 2-butoxyethanol. Studying this chemical has led me to
want to learn how it harms people.
I feel so for
your situation. Even when your mom was alive, she would have 'looked' OK,
but been very, very ill. . . Not able to express the love she had for you,
or to do things with you and for the family. (The central nervous system
damage can cause a lot of rage and anger outbursts. Many people loose
their jobs, their marriages; children and spouses feel alienated and don't
realize that their family member is ill. I can't even imagine the burden
this places on the health systems, the social services) Some people have
probably gone ballistic & harmed someone else. There may be people who
are incarcerated today from effects of chemical poisoning (?) ... or in
the psychiatric ward (This chemical's harm mimics true psychiatric
And you feel
your husband may be affected? I am so sorry to hear this. What I've
noticed from families whose husband and dad is affected is that he can't
nurture and care for his children and wife the way he otherwise would. It
is a BIG loss to our nation. Even when he can work, he wouldn't be able to
be at his best. I say, the human toll of this chemical needs to be looked
into. Our human resource is our most valuable resource.
Just a quick comment on 'allergies' Many times this
is not an allergy, but a body's response to too much of some kind of
I would like
to restate the 'package' of hemolytic anemia symptoms AND add on
symptoms (per yahoo medical definition and per research on
Rapid heart beat
is one sign of hemolytic anemia
Do you have a
There are about
being pale; jaundiced; enlarged spleen; chills; shortness of breath; dark
2-butoxyethanol over-exposure there will be all types of glandular
problems (endocrine disruption) and there can be high or low blood
pressure; high or low blood sugar ... showing this chemical's
There are a lot
of other noticeable symptoms, such as these with the central nervous
Short term memory loss
changes to 'grumpy' - Extreme Irritability
All the time
Some get MS
2-butoxyethanol CHRONIC EFFECTS -
TARGET ORGANS, per research:
SENSE ORGANS AND
SPECIAL SENSES (Other olfaction effects)
(Altered sleep time)
(ANALGESIA) LUNGS, THORAX OR RESPIRATION (DYSPNAE)
LUNGS, THORAX OR
RESPIRATION (Other changes)
(Nasea or vomiting)
KIDNEY, ureter, bladder (hematuria - blood in urine)
bladder (other changes)
(uterus, cervix, vagina)
(Other effects on female)
FERTILITY (Pre-implantation mortality)
FERTILITY (Post-implantation mortality)
FERTILITY (Litter size)
DEVELOPMENTAL ABNORMALITIES (Musculoskeletal system)
DEVELOPMENTAL ABNORMALITIES (Cardiovascular system)
GROSS METABOLIC (Weight loss or
decreased weight gain)
GROSS METABOLIC (Changes in: metabolic acidosis)
(Carcinogenic by RTECS criteria)
(Equivocal tumorigenic agent by RTECS criteria)
can get more information
Many times on products which contain 2-butoxyethanol,
you will note the warning, "defats the skin" Maybe that is why
there are so many joint problems, and neurological problems ... defating
the insulators around nerve endings; defating the join cartilage?