Reticulopenia - Causes, Symptoms And Treatment

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

Reticulopenia: what is it?

Reticulopenia is a decrease in the level of reticulocytes in the blood. Normally, their number is from 0.2 to 1.2% of the total number of erythrocytes. Reticulocytes are young forms of erythrocytes that contain granular inclusions.

Reticulopenia is indicated not only by a decrease in the number of reticulocytes below 0.2%, but also by their complete absence in the blood. Reticulopenia can develop in both an adult and a child. The absence of immature reticulocytes in human blood is not a normal variant and often indicates serious diseases, for example, anemia or damage to the bone marrow by metastases of cancerous tumors.

Content:

• Causes of reticulopenia
• Reticulopenia symptoms
• Diagnosis of reticulopenia
• Treatment of reticulopenia

Causes of reticulopenia

The reasons for a decrease in the level of reticulocytes in the blood can be as follows:

• Aplastic or hypoplastic anemia. Aplastic anemia is characterized by inhibition of the function of the red bone marrow, which naturally leads to a decrease in the number of reticulocytes in the blood.
• Iron-deficiency anemia. Reticulopenia develops with moderate and severe disease.
• B12-deficiency anemia. Lack of vitamin B12 in the body negatively affects the function of the bone marrow, therefore, the maturation of red blood cells is disturbed.
• Thalassemia leads to reticulopenia, since in this disease the structure of erythrocytes is damaged, with the destruction of their cells and the development of hemolytic crises. Thalassemia is a hereditary disorder.
• Sideroblastic anemia.
• Damage to the bone marrow by metastases of a cancerous tumor of a different localization.
• Radiation sickness or radiation therapy. At the same time, young forms of all blood cells will be absent in the bone marrow, and not only erythrocytes.
• Autoimmune diseases involving the organs of the hematopoietic system in the process.
• Kidney disease. The kidneys have a direct impact on the processes of hematopoiesis. If there is any serious damage to these organs, then the production of erythropoietin is disrupted. Without erythropoietin, normal erythropoiesis is impossible, which leads to a decrease in the number of reticulocytes in the blood. Renal failure, as an acute course, is especially dangerous for the hematopoietic system. In this case, erythropoiesis is inhibited, and the life span of erythrocytes is significantly reduced. This also applies to their young forms - reticulocytes.
• Alcoholism. With alcoholism, the body suffers as a whole, and the bone marrow, in particular. Naturally, the renewal of blood cells in such conditions is simply impossible.

• Addison-Birmer anemia (relapse of the disease). This is pernicious anemia, accompanied by a lack of vitamin B12 and folic acid. With this disease in humans, the number of reticulocytes in the blood first increases, and the relapse of the pathology is characterized by a decrease in all immature blood cells.
• Myxedema. This disease develops against the background of a deficiency in the body of thyroid hormones. The blood picture proceeds according to the type of hypochromic anemia.

Reticulopenia symptoms

By itself, reticulopenia does not have any symptoms. This condition develops only under the influence of a number of pathological reasons. Therefore, it is the symptoms of the underlying disease that come to the fore.

The main symptoms of aplastic anemia, which causes reticulopenia, are dizziness, severe weakness, fainting, shortness of breath, chest pain. There is an increased tendency to bleeding. The human immune system becomes weakened, which increases the likelihood of developing infectious and purulent processes.

Iron deficiency anemia will be indicated by increased fatigue, drowsiness, dizziness, dryness and pallor of the skin, brittle nails and hair, and inflammation in the oral cavity. A person becomes emotionally unstable, his memory and attention deteriorate, he starts to get sick more often.

B12-deficiency anemia is indicated by symptoms such as weakness, malaise, headaches, dyspeptic symptoms, tinnitus. The person has a tendency to obesity. The disease most often develops smoothly and is not noticeable to humans.

The symptoms of thalassemia depend on the type of disease. In general, they boil down to bone pathologies, enlargement of the spleen and liver in size, pale skin and other anemic manifestations.

With sideroblastic anemia, all the characteristic anemic symptoms develop: pallor of the skin, increased fatigue. This disease is associated with the risk of developing diabetes mellitus, arrhythmias, and pulmonary failure. The transmission of the disease by inheritance is possible. In this case, her symptoms will bother the child from childhood.

With the penetration of metastases into the bone marrow, in addition to reticulopenia, the patient will experience anemia, frequent dizziness, and increased weakness. The pain spreads to the lower back and ribs, to the pelvic bones. As the abnormal cells grow, the pain will increase. The person will begin to lose weight, often get sick.

With radiation sickness, all organ systems are affected. A person develops a headache, weakness increases, body temperature rises, diarrhea may manifest. Often, blood pressure drops sharply, which leads to loss of consciousness.

In acute renal failure, which leads to reticulopenia, the amount of urine excreted sharply decreases. The patient develops diarrhea, vomiting and nausea, he becomes drowsy, may fall into a coma.

With myxedema, a person experiences dryness and pallor of the skin, the swelling of the face and limbs increases. Hair becomes dry and begins to fall out. Low body temperature is often observed, blood pressure drops, and cholesterol levels rise.

Diagnosis of reticulopenia

Three diagnostic methods can be used to calculate the level of reticulocytes in the blood:

• Determination of the content of reticulocytes in the blood in a smear after adding a special dye to it. This is the simplest and most inexpensive diagnostic method. It is available to any laboratory. For staining reticulocytes, alkaline reagents can be used, for example, azure solution, which allows you to identify the granular structure of young erythrocytes. Then the doctor counts their numbers under a microscope.
• Determination of the content of reticulocytes in the blood using fluorescent microscopy. This is a precise technique that requires special dyes and a fluorescent microscope in the laboratory.
• Determination of the level of reticulocytes using modern hemolytic analyzers. This method allows not only to reveal the relative percentage of reticulocytes in the blood, but also to give additional information to the doctor regarding the quantitative content of cells of different forms (immature fractions, cells with high, medium and low RNA content).

For any of the above methods, blood donation will be required. Some factors can distort the results of the analysis:

• Wrong choice of anticoagulant.
• Prolonged pressure on a limb with a tourniquet.
• Patient taking sulfonamides.
• Recently performed erythrocyte transfusion procedure.
• Hemolysis of a blood sample.

All these factors need to be considered when conducting research. To clarify the cause of reticulopenia, additional diagnostic tests are needed.

Treatment of reticulopenia

It is impossible to cure reticulopenia. This condition will be self-controlled after it is possible to get rid of the cause that led to a decrease in the number of reticulocytes in the blood.

Therefore, the doctor may prescribe the following therapeutic measures:

• If the patient has aplastic anemia, then he is prescribed blood transfusion, immunosuppressive therapy. You can get rid of the disease thanks to a bone marrow transplant.
• Treatment of iron deficiency anemia involves adherence to a diet with the inclusion of animal products (red meat, eggs, liver) in the menu. It is obligatory to take preparations containing iron. Already 3-4 days after the start of therapy, the patient's reticulopenia should be replaced by reticulocytosis. This will indicate that the treatment was correct. Over time, the level of reticulocytes in the blood will return to normal.
• Treatment of B12-deficiency anemia involves parenteral administration of vitamin B12. In case of severe pathology, red blood cell transfusion is possible.
• Treatment for thalassemia differs depending on the form of the disease. With b-thalassemia minor, therapy is not required. Although some babies need blood transfusions from birth, iron and glucocorticoids are given if they develop hemolytic crises. Any form of the disease requires the intake of folic acid and B vitamins. If a donor is found, then patients with thalassemia require bone marrow transplantation.
• With sideroblastic anemia, the patient is prescribed vitamin B6 for up to 2 months. The severe course of the pathology requires a blood transfusion.
• The presence of metastases in the bone marrow requires emergency treatment. The patient will necessarily need to undergo a course of chemotherapy, after which he is prescribed radiation exposure to the brain. Only organ transplantation can save the patient.
• Treatment of radiation sickness requires placing the patient in a sterile box. He is injected with drugs that neutralize the effects of radiation. The most powerful detoxification therapy is carried out on the first day of radiation sickness. In addition to forced diuresis, transfusion of erythrocyte and platelet mass, plasmapheresis may be required. The body will recover for a long time, sometimes throughout life.
• Treatment of acute renal failure should begin with the elimination of the cause that led to the impaired renal function. It is necessary to replenish the volume of circulating blood, to bring blood pressure back to normal. To stimulate diuresis, the patient is prescribed osmotic diuretics and Furosemide. Antibacterial drugs can be used as needed. Hemodialysis is an emergency treatment.
• Treatment for Addison-Birmer anemia requires lifelong vitamin B12 and folate intake. Moreover, atrophy of the gastric mucosa leads to the fact that in tablet form, these drugs may not be absorbed. Therefore, the patient is prescribed their parenteral administration.
• Treatment of myxedema requires taking thyroid hormones. At the same time, therapy is carried out aimed at eliminating the symptoms of the disease.

Thus, a wide variety of treatment regimens may be required to normalize the level of reticulocytes in the blood. Therapy depends on the underlying disease and should be carried out only after a qualitative examination of the patient.

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".