After a 21 month search for what is going wrong with the blood,
the answer seems to be here: Doctors believe that if there is
significant blood hemolysis, it will show up in the blood count.
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." Or more probably compensated
AUTOIMMUNE 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 (Note below update)
- School of Public Health
- The Ohio State University
Source