ReviewThe Hematologic System as a Marker of Organ Dysfunction in Sepsis
Section snippets
HEMATOLOGIC CHANGES IN SEPSIS-ADAPTATION VS DYSFUNCTION
There are 2 components to the host response, a nonspecific innate immune response and a specific or acquired immune response. The innate immune response (or acute phase response) is a highly evolutionarily conserved mechanism that serves to combat pathogens, minimize tissue injury, promote host recovery, and set the stage for the acquired immune response.3, 4 Innate immunity involves the coordinated activity of both cells and proteins (Figure 1). The principal cellular and soluble effectors are
Incidence
In patients with sepsis, the white blood cell count is normally elevated (leukocytosis). This observation is sup-ported in animal models of sepsis in which administration of endotoxin results in pronounced leukocytosis.5 The leukocyte differential count typically reveals increased numbers of neutrophils (neutrophilia).6 Occasionally, the degree of leukocytosis is extreme, with white blood cell counts of more than 50 × 109/L (leukemoid reaction). In some cases, sepsis is associated with a
Red Blood Cell Deformability
Sepsis-induced changes in the mechanical and membrane properties of red blood cells lead to decreased deformability.29, 30, 31 The mechanism is unclear but may involve membrane damage from reactive oxygen species derived from circulating leukocytes and ischemic tissues.32, 33 Red blood cell deformability is an important determinant of blood flow, particularly in the microcirculation.34, 35 Indeed, decreased deformability results in increased transit time and reduced flow. These changes may
Platelet Function
Platelets are activated during sepsis.75, 76 Activated platelets aggregate, provide a phospholipid-rich surface for coagulation complexes, release proinflammatory mediators, and interact with leukocytes and endothelial cells.75 In addition, platelets may generate procoagulant-rich microparticles, which contribute to a prothrombotic state.77, 78 At the present time, platelet function assays provide little diagnostic or therapeutic value and are not routinely performed in these patients.
Thrombocytopenia
Incidence.
CONCLUSION
Patients with sepsis who develop organ failure have an increased mortality rate. Prompt diagnosis of organ dysfunction is critical in identifying patients who may benefit from therapeutic intervention. In assessing patients for organ dysfunction, the hematologic system should not be overlooked. A thorough clinical evaluation and panel of laboratory tests that relate to this organ system should be as much a part of the work-up as taking the blood pressure, monitoring renal function, or measuring
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Dr Aird is a member of the advisory board of the National Initiative in Sepsis Education, an educational initiative that is sponsored by Vanderbilt University School of Medicine and Thomson Advanced Therapeutics Communications and supported in part by an unrestricted educational grant from Eli Lilly and Company.