Pathogenetic features of anemia of chronic diseases in patients with malignant neoplasms and rheumatic pathology

Сахин, В.Т.; Григорьев, М. А.; Крюков, Е. В.; Kazakov, S.P.; Сотников, А В; Гордиенко, А. В.; Рукавицын, О А

doi:10.17650/1818-8346-2020-15-4-82-90

Cited by 8 publications

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References 20 publications

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“…В настоящее время точные причины, приводящие к подавлению эритропоэза у этой категории пострадавших, не ясны. Одной из причин считается негативное влияние провоспалительных цитокинов, таких как интерлейкин-6 и фактор некроза опухоли альфа, на созревание эритроидных предшественников [20]. Также имеются немногочисленные исследования, в которых показано подавление эритропоэза после ожоговой травмы с одновременной активацией миелопоэза на фоне повышенной секреции катехоламинов [21].…”

Section: рис 1 фотографии пунктата костного мозга на третьи сутки пос...unclassified

Features of Erythro- and Thrombopoiesis in Patients with Burn Disease, Depending on the Clinical Outcome

Сахин,

Убушаева,

Казаков

et al. 2024

Гематология. Трансфузиология. Восточная Европа

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Цель. У выживших и умерших пострадавших с ожоговой болезнью выполнить сравнительный анализ состояния эритроцитарного и мегакариоцитарного ростков в пунктате костного мозга. Оценить наличие взаимосвязи между состоянием эритро- и тромбоцитопоэза и тяжестью состояния по шкале APACHE II, а также общей площадью ожогов и площадью глубоких ожогов. Материалы и методы. Обследованы 23 пациента мужского пола, возраст – 33 [24–47] года, поступивших в специализированный стационар на 2-е [1–3] сутки после получения ожоговой травмы. В зависимости от клинического исхода пациенты разделены на две группы. В 1-ю группу включены 12 выживших пострадавших, возраст – 33 [25–38] года, общая площадь ожогов (TBSA) 27 [17–39]%, площадь глубоких ожогов 9,2 [0–16]%, APACHE II 6,5 [5–7] балла, индекс Франка (FI) 47 [30–62] баллов. Во 2-ю группу включены 11 умерших пострадавших, возраст – 26 [23–43] лет, общая площадь ожогов 57 [45–71]%, TBSA 32 [22–35]%, APACHE II 24,3 [21,5–28] балла, FI 137 [129–175] баллов. Выполнялся клинический анализ крови с определением эритроцитов, тромбоцитов, лейкоцитов, гемоглобина и микроскопическим исследованием пунктата костного мозга. У каждого показателя рассчитывали медиану (Mе) и межквартильный интервал (IQR). Достоверность различий между исследуемыми выборками определяли с помощью U-критерия Манна – Уитни (р<0,05). Определялся коэффициент корреляции Спирмена (r). Результаты. У пострадавших с летальным исходом в гемограмме, в сравнении с выжившими, выявлено снижение числа эритроцитов, тромбоцитов и концентрации гемоглобина (p<0,05). При анализе миелограммы у пациентов 2-й группы, в сравнении с 1-й группой, установлено достоверное снижение цитоза – 30 [29–58] и 103 [85–237] × 109/л соответственно, числа базофильных нормобластов (БНБ) – 0,15 [0,13–0,2] и 0,95 [0,34–1,4] ×109/л, полихроматофильных нормобластов (ПНБ) – 2,4 [1,5–2,8] и 14,6 [6,9–22,2] ×109/л, мегакариоцитов – 3,6 [1–6,2] и 25 [12,5–50] ×109/л. Выявлена корреляция между цитозом костного мозга и FI (r=–0,72), TBSA (r=–0,77), APACHE II (r=–0,61), площадью глубоких ожогов (r=–0,68), между мегакариоцитами, FI (r=–0,74), TBSA (r=–0,79), площадью глубоких ожогов (r=–0,83), APACHE II (r=–0,8), между ПНБ FI (r=–0,85), TBSA (r=–0,89), площадью глубоких ожогов (r=–0,85), APACHE II (r=–0,72). Заключение. Низкий цитоз костного мозга, а также сниженное число БНБ, ПНБ и мегакариоцитов на 1–3-и сутки после ожога являются предикторами неблагоприятного исхода ожоговой болезни. Выявлена взаимосвязь между низким цитозом костного мозга, числом мегакариоцитов и ПНБ с FI, APACHE II, TBSA и площадью глубоких ожогов, что отражает возможность их использования для оценки тяжести ожоговой травмы и состояния пострадавшего. Purpose. In survivors and dead victims with burn disease, perform a comparative analysis of erythrocyte and megakaryocyte germ cells in the bone marrow punctate. To assess the relationship between the state of erythro- and thrombocytopoiesis and the severity of the condition on the APACHE II scale, as well as the total area of burns and the area of deep burns. Materials and methods. 23 male patients aged 33 [24–47] years who were admitted to a specialized hospital for 2 [1–3] days after receiving a burn injury were examined. Depending on the clinical outcome, patients are divided into two groups. The 1st group included 12 survivors, aged 33 [25–38] years, total area of burns (TBSA) 27 [17–39]%, area of deep burns 9.2 [0–16]%, APACHE II 6.5 [5–7] points, Franc index (FI) 47 [30–62] points. The 2nd group included 11 dead victims, age 26 [23–43] years, total area of burns 57 [45–71]%, TBSA 32 [22–35]%, APACHE II 24.3 [21.5–28] points, FI 137 [129–175] points. A clinical blood test was performed with the determination of erythrocytes, platelets, leukocytes, hemoglobin and microscopic examination of bone marrow punctate. Median (Me) and interquartile interval (IQR) were calculated for each parameter. The reliability of the differences between the studied samples was determined using the Mann – Whitney U-test (p<0.05). The Spearman correlation coefficient (r) was determined. Results. The number of erythrocytes, platelets and the concentration of hemoglobin decreased in the victims with a fatal outcome in comparison with the survivors (p<0.05). Also, in group 2, in comparison with group 1, there are less cytoses (30 [29–58]) and 103 [85–237], ×109/l), the number of basophilic normoblasts (BNB) (0.15 [0.13–0.2] and 0.95 [0.34–1.4], ×109/l), polychromatophilic normoblasts (PNB) (2.4 [1.5–2.8] and 14.6 [6.9–22.2], ×109/l), megakaryocytes (3.6 [1–6.2] and 25 [12.5–50], ×109/l). Correlation between bone marrow cytosis and FI (r=–0.72), TBSA (r=–0.77), APACHE II (r=–0.61), deep burns area (r=–0.68), between megakaryocytes, FI (r=–0.74), TBSA (r=–0.79), deep burns area (r=–0.83), APACHE II (r=–0.8), between PNB FI (r=–0.85), TBSA (r=–0.89), deep burns area (r=–0.85), APACHE II (r=–0.72). Conclusion. Low cytosis of the bone marrow, as well as a reduced number of PNB, PNB and megakaryocytes on 1–3 days after the burn indicates an unfavorable outcome of burn disease. The relationship between low bone marrow cytosis, the number of megakaryocytes and PNB with FI, APACHE II, TBSA and the area of deep burns was revealed, which reflects the possibility of their use to assess the severity of burn injury and the condition of the victim.

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Section: рис 1 фотографии пунктата костного мозга на третьи сутки пос...unclassified

Features of Erythro- and Thrombopoiesis in Patients with Burn Disease, Depending on the Clinical Outcome

Сахин,

Убушаева,

Казаков

et al. 2024

Гематология. Трансфузиология. Восточная Европа

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Anemia of chronic diseases as an interdisciplinary problem

Бондарчук

Golovko

Ovchinnikov

2021

Russian Military Medical Academy Reports

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Anemia is believed to be a medico-social problem affecting a great part of population. Anemia of chronic diseases represents a considerable number of these disorders, which is particularly challenging for long-standing inflammatory processes, systemic diseases and neoplasms. Pathogenesis of this type of anemia is characterized by complex and miltifactorial nature. Pathogenesis is based on disturbance of erythropoietin synthesis and erythropoiesis precursor cells sensitivity, hyperproduction of factors inhibiting erythropoiesis (tumor necrosis factor, interleukins), disturbance of iron metabolism and other hemopoiesis co-factors. Anemia aggravates associated underlying disease course. Quality of life and overall survival deteriorate. Treatment efficacy for anemia influences the time of patient recovery, as well as success of treatment of other diseases. Iron deficiency and erythropoiesis disturbance, similar to hypoferric anemia, are of great importance. However, iron therapy may aggravate patients condition, hence differential diagnosis of this anemia type and true iron deficiency anemia has a great practical value. In the treatment of anemia in the presence of chronic diseases and anemia in the presence of hematologic diseases, the goal of the treatment is generally limited by the improvement of patients quality of life, target value of hemoglobin for transfusion or erythropoiesis stimulating therapy remaining the subject for discussion. Hemoglobin target determination in individuals with cardiac and pulmonary insufficiency who are on chemotherapy, is critically important, because it is this category of patients that does not demonstrate generally accepted target values of hemoglobin, the level of which is not always indicative of hypoxia absence. The review presents current data on diagnosis, treatment of chronic disease anemia (1 figure, 2 tables, bibliography: 12 refs).

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INFLUENCE OF INTERLEUKIN-1β, INTERFERON-GAMMA ON THE DEVELOPMENT OF ANEMIA OF CHRONIC DISEASES IN PATIENTS WITH MALIGNANT TUMORS

Сахин¹,

Kryukov

Гордиенко

et al. 2021

Mediko-farmacevtičeskij žurnal "Pulʹs"

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Relevance. Anemia of chronic diseases has a significant impact on the quality of life of patients with malignant neoplasms, as well as on the course of the underlying disease and prognosis. Aim. To study the characteristics of the secretion of interleukin-1β (IL-1β), interferon-γ (INF-γ) in patients with malignant neoplasms with and without anemia of chronic diseases. To study the effect of these cytokines on hemoglobin synthesis, erythropoiesis and some indicators of iron metabolism. To propose a working version of the classification of anemia of chronic diseases based on the leading pathogenetic factor in the development of anemia. Material and methods. The study involved 42 (27 patients with anemia - 19 men, 8 women, average age 65.1 ± 8.1 years, 15 without it, 10 men, 5 women, average age 61.1 ± 10.1 years) patients with II- Stage IV malignant neoplasm. A comparative analysis was carried out between groups with and without anemia and a correlation analysis between IL-1β, INF-γ and indicators of hemogram, iron metabolism, C-reactive protein (CRP), hepcidin. Results. In patients with malignant neoplasms and ACD, in comparison with patients in the control group, a more pronounced inflammation was proved, accompanied by an increase in the synthesis of ferritin, CRP and IL-1β, INF-γ (p <0.05). For IL-1β, a moderate correlation was found with the concentration of iron (r = 0.46), CST (r = 0.48), hemoglobin (r = -0.61) and a strong correlation with the concentrations of hepcidin (r = 0.8), ferritin (r = 0.78), CRP (r = 0.87). A weak correlation was found between IL-1β and the number of erythrocytes, TIBC and transferrin. For IFN-γ, a moderate correlation was established with erythrocytes (r = -0.68), hemoglobin (r = -0.57), CST (r = -0.57), ferritin (r = 0.57) and a strong correlation connection with CRP (r = 0.83), hepcidin (r = 0.9), transferrin (r = -0.83). A weak correlation has been established between INF-γ and the concentration of iron, TIBC. Conclusions. In patients with malignant neoplasms and ACD, a more pronounced inflammation was proved, accompanied by an increase in the synthesis of ferritin, CRP and IL-1β, INF-γ. The influence of the investigated cytokines on erythropoiesis, synthesis of hemoglobin and hepcidin, and iron metabolism has been proved. This reflects the pleiotropic effect of these cytokines and the complex pathogenesis of ACD in patients with malignant neoplasms, including erythropoiesis disorders, changes in iron metabolism, and increased synthesis of proinflammatory cytokines. A working version of the classification of ACD (with a predominant iron deficiency, with impaired regulatory mechanisms of erythropoiesis, with insufficient production of erythropoietin) has been proposed.

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Pathogenetic features of anemia of chronic diseases in patients with malignant neoplasms and rheumatic pathology

Cited by 8 publications

References 20 publications

Features of Erythro- and Thrombopoiesis in Patients with Burn Disease, Depending on the Clinical Outcome

Features of Erythro- and Thrombopoiesis in Patients with Burn Disease, Depending on the Clinical Outcome

Anemia of chronic diseases as an interdisciplinary problem

INFLUENCE OF INTERLEUKIN-1β, INTERFERON-GAMMA ON THE DEVELOPMENT OF ANEMIA OF CHRONIC DISEASES IN PATIENTS WITH MALIGNANT TUMORS

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