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
