Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 1;94(2):197-204.
doi: 10.1097/TA.0000000000003821. Epub 2022 Oct 31.

Multicompartmental trauma alters bone marrow erythroblastic islands

Lauren S Kelly  1 , Jennifer A Munley, Erick E Pons, Preston S Coldwell, Kolenkode B Kannan, Philip A Efron, Alicia M Mohr
Affiliations

Multicompartmental trauma alters bone marrow erythroblastic islands

Lauren S Kelly et al. J Trauma Acute Care Surg. .

Abstract

Background: Trauma is associated with widespread inflammation, neuroendocrine activation, and an inadequate bone marrow response to anemia. During late-stage erythropoiesis, erythroid progenitors/erythroblasts form clusters on the surface of specialized bone marrow macrophages where they are supported through terminal differentiation and enucleation. We hypothesized that these erythroblastic islands (EBIs) are adversely impacted by severe trauma.

Methods: Male Sprague-Dawley rats (n = 8/group) were subjected to either multiple injuries (PT) (lung contusion, hemorrhagic shock, cecectomy, and bifemoral pseudofractures), PT plus 2 hours of daily chronic restraint stress (PT/CS), or naive controls. Bone marrow was harvested on days 2 and 7. Nuclear-stained, enriched bone marrow EBIs were fixed and stained for CD71, VCAM-1, and CD163, and confocal images were obtained at 20 times magnification. Numbers of erythroid cells/EBI and ratio of reticulocytes/EBI were counted by a blinded observer. Differences were compared using analysis of variance, with significance defined as p < 0.05.

Results: PT and PT/CS had significantly reduced numbers of erythroid cells per EBI on day 2 when compared with naive (PT: 5.9 ± 1.0 cells [ p < 0.05], PT/CS: 6.8 ± 0.8 cells [ p < 0.05] vs. naive: 8.5 ± 0.8 cells). On day 7, the number of erythroid cells/EBI increased following PT (8.3 ± 0.4 cells) but remained reduced following PT/CS (5.9 ± 0.5 cells [ p < 0.05]). This correlated with an increased proportion of reticulocytes/EBI on day 7 following PT, which was not present following PT/CS (PT: 54% [ p < 0.05] vs. PT/CS: 28%).

Conclusion: Late-stage erythropoiesis was altered following multicompartmental PT early after injury, and these alterations persisted with the addition of daily chronic stress. Alterations in EBI structure and function after severe trauma and critical illness may serve as a promising new area of study to improve mechanistic understanding of persistent anemia after trauma.

PubMed Disclaimer

Conflict of interest statement

Disclosure Statement:

The authors report no proprietary, commercial or conflicts of interest in any product mentioned or concept discussed in this article.

Figures

Figure 1.
Figure 1.
Serial hemoglobin changes following polytrauma (PT) and polytrauma followed by chronic stress (PT/CS).
Figure 2.
Figure 2.
Serial plasma erythropoietin (A) and urinary norepinephrine (B) changes following polytrauma (PT) and polytrauma followed by chronic stress (PT/CS).
Figure 3.
Figure 3.
Representative confocal images of structural changes in erythroblastic islands following polytrauma and polytrauma/chronic stress on days two and seven as compared to naive.
Figure 4.
Figure 4.
Day two and day seven changes in erythroblastic island (EBI) composition following polytrauma (PT) and polytrauma/chronic stress (PT/CS). A) Number of erythroid cells/EBI. B) Proportion of reticulocytes/EBI.
See this image and copyright information in PMC

References

    1. Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, et al. The CRIT Study: anemia and blood transfusion in the critically ill--current clinical practice in the United States. Crit Care Med. 2004;32(1):39–52. - PubMed
    1. Chant C, Wilson G, Friedrich JO. Anemia, transfusion, and phlebotomy practices in critically ill patients with prolonged ICU length of stay: a cohort study. Crit Care. 2006;10(5):R140. - PMC - PubMed
    1. Bateman AP, McArdle F, Walsh TS. Time course of anemia during six months follow up following intensive care discharge and factors associated with impaired recovery of erythropoiesis. Crit Care Med. 2009;37(6):1906–1912. - PubMed
    1. Walsh TS, Garrioch M, Maciver C, Lee RJ, MacKirdy F, McClelland DB, et al. Red cell requirements for intensive care units adhering to evidence-based transfusion guidelines. Transfusion. 2004; 44:1405–1411. - PubMed
    1. Charles A, Shaikh AA, Walters M, Huehl S, Pomerantz R. Blood transfusion is an independent predictor of mortality after blunt trauma. Am Surg. 2007;73(1):1–5. - PubMed

Publication types

LinkOut - more resources