Reticulocytosis - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Reticulocytosis: what is it?

Reticulocytosis is an increase in the level of reticulocytes in the peripheral blood by more than 1%. Reticulocytosis is a sign of increased erythropoiesis (the process of blood cell formation).

Reticulocytes are young forms of erythrocytes. They are formed from normoblasts after they have lost their nucleus. Therefore, reticulocytes are non-nuclear immature erythrocytes. After entering the bloodstream, they begin to ripen. This process takes 1-2 days. They enter the vascular bed directly from the bone marrow, in which they are born. Therefore, the number of reticulocytes reflects the ability of this organ to regenerate. With an increase in the level of reticulocytes, we can talk about increased erythropoietic activity of the bone marrow.

The size of reticulocytes exceeds the size of mature erythrocytes. Their cytoplasm contains a basophilic reticulum, which looks like small grains, filaments and glomeruli. These elements are adhered ribosomes and mitochondria.

Depending on the degree of maturity, the following reticulocytes are distinguished:

• Precursor cells of erythrocytes containing the nucleus. They are called erythronormoblasts.
• Reticulocytes containing tangled grain.
• Reticulocytes containing coarse grit.
• Reticulocytes containing filamentous grain.
• Reticulocytes containing single grains.

The overwhelming majority of reticulocytes (about 80% of all cells) contain granularity in the form of threads and individual grains. The indicator of the norm of reticulocytes is their content in the blood from 0.2 to 1% of the total number of erythrocytes. Within a few hours, these reticulocytes will mature to full-fledged erythrocytes, and new reticulocytes will come in their place. When their number is exceeded by more than 1%, doctors talk about reticulocytosis.

There is evidence that the level of reticulocytes in a woman's body exceeds the level of reticulocytes in a man's body. In addition, in children, after birth (over several days), the level of reticulocytes in the blood can be from 5 to 10%, but then it decreases.

Content:

• Reticulocytosis symptoms
• Causes of reticulocytosis
• Diagnosis of reticulocytosis
• Treatment of reticulocytosis

Reticulocytosis symptoms

Reticulocytosis by itself is not a pathology. Moreover, in a number of cases this laboratory indicator is considered by specialists as a sign of good bone tissue regeneration (true reticulocytosis). However, in this case, the number of reticulocytes should increase not only in the peripheral blood, but also in the bone marrow itself.

If reticulocytosis develops against the background of aplastic anemia, then the patient will complain of the following symptoms:

• Increased fatigue and tiredness.
• Pale skin.
• Noise in ears.
• Dizziness.
• Dyspnea.
• Frequent nose and gum bleeding.
• Diseases such as stomatitis, pneumonia, skin and urinary tract infections.

Hemolytic crisis is a syndrome that is accompanied by intravascular or intraorgan destruction of red blood cells.

The following signs indicate a hemolytic crisis:

• Tachycardia, shortness of breath, dizziness, pallor of the skin, or its icteric color.
• Nausea, vomiting, abdominal pain, fever.
• Impaired consciousness and convulsions.
• Enlargement of the spleen in size.
• Darkening of the urine.

The symptoms of latent bleeding depend on its intensity. Common signs include dizziness, shortness of breath, thirst, pale skin, fainting, or lightheadedness. The rate at which these symptoms increase will depend on the intensity of the bleeding.

Malaria, which is accompanied by reticulocytosis, can begin acutely, or manifest itself as a slight increase in body temperature, headaches, and malaise. On the 3-5th day of the patient's illness, seizures begin to pursue, which alternately are replaced by chills, fever and sweating. These paroxysms are repeated up to 10-14 times, after which there is an improvement. However, the disease tends to recur.

Polycythemia with reticulocytosis develops slowly and slowly. Most often it is diagnosed by accident, when a blood test is performed. The patient is periodically worried about heaviness in the head, dizziness, his vision may deteriorate, sleep disorders appear. The most pathognomic symptom of polycythemia is vascular congestion, when the skin becomes cherry-red, especially noticeable on the face, neck, hands and mucous membranes. In this case, the patient's hard palate has a normal color, and the soft palate acquires a cyanotic shade.

Acute hypoxia with reticulocytosis develops quickly, in a few minutes. If oxygen starvation is not stopped, then irreversible consequences occur in organs and tissues and a person may die. This condition is manifested by the insufficiency of all organ systems. First of all, the central nervous system suffers, breathing and heart rate slows down, blood pressure decreases. Organ failure turns into coma and agony, after which the person dies.

Causes of reticulocytosis

The reasons for reticulocytosis can be as follows:

• Reticulocytes can reach a level of 60% with hemolytic anemias. Hemolytic crises lead to significant surges of reticulocytes in the blood.
• 3-5 days after acute blood loss, all patients develop a reticulocytic crisis.
• An increase in the level of reticulocytes may indicate hidden bleeding, for example, in patients with peptic ulcer disease, typhoid fever and other lesions of the gastrointestinal tract.
• Malaria and polycythemia will lead to reticulocytosis.
• If the patient has been diagnosed with iron deficiency anemia, then 3-5 days after the start of treatment, the level of reticulocytes in the blood will increase. This indicates the effectiveness of the therapy. A similar situation is observed in the treatment of pernicious anemia.
• Hypoxia of the body provokes an increase in the level of reticulocytes in the blood.
• The penetration of tumor metastases into the bone marrow leads to reticulocytosis.
• Against the background of massive destruction of erythrocytes, the level of reticulocytes can increase up to 50%.
• Taking certain medications can trigger the development of reticulocytosis. These drugs include: Corticotropin, antipyretic and antimalarial drugs, Furazolidone, Levodopa.

True reticulocytosis is indicated by an increase in the number of reticulocytes in the peripheral blood and in the bone marrow.

False reticulocytosis is indicated by an increase in the level of reticulocytes in the peripheral blood, but with their normal level in the bone marrow.

The following reasons can provoke false reticulocytosis:

• The presence of Jolly's bodies or malarial plasmodium in the blood.
• High leukocytosis.
• Hemoglobin is deformed.
• The presence of giant platelets in the blood.
• Hyperthrombocytosis.

Diagnosis of reticulocytosis

There are certain indications for performing a reticulocyte test:

• The need to assess erythropoiesis in hemolysis or bleeding.
• Evaluation of the bone marrow performance for recovery after the patient undergoes treatment with cytostatics or after an operation for transplantation of this organ.
• Evaluation of the potential for erythropoietin production in patients undergoing kidney transplant surgery.
• Doping control by people who are professionally involved in sports.
• Diagnosis of anemia, regardless of its cause.
• Search for the reasons leading to a decrease in the level of red blood cells.
• Search for the reasons that lead to the insufficiency of the function of hematopoiesis of the bone marrow.
• Search for the reasons that lead to a violation of the regenerative capacity of the hematopoietic organs during the treatment of anemia. Evaluation of the effectiveness of the treatment of anemia.
• Evaluation of the effectiveness of therapy using erythropoietin or erythrosuppressants.

The counting of reticulocytes can be carried out in several ways: using the method of luminescence microscopy, counting the number of reticulocytes in a blood smear with the introduction of special dyes, counting the number of reticulocytes using a hemolytic analyzer.

Treatment of reticulocytosis

In order for the level of reticulocytes in the blood and in the bone marrow to return to normal, it is necessary to eliminate the cause that provoked their increase.

With aplastic anemia, a person must be hospitalized. To prevent infectious complications, he must be in an isolated box. Most often, patients with aplastic anemia are prescribed immunosuppressive therapy. At the same time, the patient receives injections of immunoglobulin and cyclosporin A. If necessary, platelet or erythrocyte mass is transfused to him, plasmapheresis is performed. Removal of the spleen is possible. Bone marrow transplantation significantly improves the patient's survival prognosis.

In case of a hemolytic crisis, assistance to the victim should be provided immediately. He is urgently hospitalized, the volume of lost blood is replenished and harmful products of hemolysis in the blood are eliminated. For this, albumin, a solution of glucose, vitamin B2, sodium chloride, Desferal are injected intravenously. With the help of Furosemide, diuresis is stimulated to prevent the development of renal failure. To enhance the diuretic effect, Euphyllin is prescribed. Be sure to use glucocorticoids to suppress the body's immune response. If necessary, the patient is given a blood transfusion. Removal of the spleen is recommended to prevent a recurrence of the crisis.

Latent bleeding should be detected and stopped in a timely manner.

Treatment of malaria requires fluid therapy, drinking plenty of fluids, and adherence to bed rest. Quinine is used to eliminate infection from the body.

To normalize the volume of circulating blood, it is required to perform bloodletting in volumes up to 500 ml 2-3 times a week. The removed blood volumes are replenished using saline or rheopolyglucin. In severe cases of polycythemia, cytostatics are prescribed or therapy with radioactive phosphorus is performed.

Acute hypoxia requires elimination of the causative factor and maintenance of body cells with oxygen. In this case, oxygen is injected into the lungs under pressure (hyperbaric oxygenation).

Treatment of reticulocytosis is reduced to eliminating the pathological cause, if any. Often, an increase in the level of reticulocytes occurs during treatment of iron deficiency anemia and is a favorable prognostic sign. In this case, it is not necessary to carry out any therapeutic measures. After some time, reticulocytosis will self-stop.

Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist

Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".