Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지
DOI QR코드

DOI QR Code

Hidden Hematologic Disease in Trauma Patients: A Report of Two Cases

  • Jang, Sung Woo (Department of Surgery, Yonsei University Wonju College of Medicine) ;
  • Jung, Pil Young (Department of Surgery, Yonsei University Wonju College of Medicine)
  • Received : 2020.03.25
  • Accepted : 2020.06.02
  • Published : 2020.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

In trauma patients, coagulopathy and abnormal increases or decreases in cell counts are frequently observed, and are associated with high mortality and morbidity in the acute phase of trauma. Because major trauma is often life-threatening, and hematologic abnormalities are multi-factorial and transient, major blood loss is usually suspected to be the primary cause of these abnormalities, and much time and cost may be spent attempting to identify a focus of hemorrhage that might or might not actually exist. Persistent abnormalities in the complete blood count, however, require clinical suspicion of other hematologic diseases to minimize improper transfusions and to improve outcomes, including mortality. Physicians at trauma centers should be familiar with the clinical characteristics of hematologic diseases and should consider these diseases in trauma patients. In this report, we present cases of two hematologic disorders found in trauma patients: autoimmune hemolytic anemia induced by systemic lupus erythematosus and myelodysplastic syndrome.

Keywords

References

  1. Gando S, Hayakawa M. Pathophysiology of trauma-induced coagulopathy and management of critical bleeding requiring massive transfusion. Semin Thromb Hemost 2016;42:155-65. https://doi.org/10.1055/s-0035-1564831
  2. Cap A, Hunt B. Acute traumatic coagulopathy. Curr Opin Crit Care 2014;20:638-45. https://doi.org/10.1097/MCC.0000000000000158
  3. Gando S, Wada H, Thachil J; Scientific and Standardization Committee on DIC of the International Society on Thrombosis and Haemostasis (ISTH). Differentiating disseminated intravascular coagulation (DIC) with the fibrinolytic phenotype from coagulopathy of trauma and acute coagulopathy of trauma-shock (COT/ACOTS). J Thromb Haemost 2013;11:826-35. https://doi.org/10.1111/jth.12190
  4. Yoo G, Kim J, Uh Y, Yoon KR, Park SD, Yoon KJ. Scoring system for detecting spurious hemolysis in anticoagulated blood specimens. Ann Lab Med 2015;35:341-7. https://doi.org/10.3343/alm.2015.35.3.341
  5. Lippi G, Favaloro EJ, Franchini M. Haemolysis index for the screening of intravascular haemolysis: a novel diagnostic opportunity? Blood Transfus 2018;16:433-7.
  6. Gehrs BC, Friedberg RC. Autoimmune hemolytic anemia. Am J Hematol 2002;69:258-71. https://doi.org/10.1002/ajh.10062
  7. Della Porta MG, Tuechler H, Malcovati L, Schanz J, Sanz G, Garcia-Manero G, et al. Validation of WHO classification-based Prognostic Scoring System (WPSS) for myelodysplastic syndromes and comparison with the revised International Prognostic Scoring System (IPSS-R). A study of the International Working Group for Prognosis in Myelodysplasia (IWG-PM). Leukemia 2015;29:1502-13. https://doi.org/10.1038/leu.2015.55
  8. Corbett JM, Ho KM, Honeybul S. Prognostic significance of abnormal hematological parameters in severe traumatic brain injury requiring decompressive craniectomy. J Neurosurg 2019;132:545-51. https://doi.org/10.3171/2018.10.jns182293
  9. Kumar M, Bhoi S, Subramanian A, Kamal VK, Mohanty S, Rao DN, et al. Evaluation of circulating haematopoietic progenitor cells in patients with trauma haemorrhagic shock and its correlation with outcomes. Int J Crit Illn Inj Sci 2016;6:56-60. https://doi.org/10.4103/2229-5151.183016
  10. The Lancet Haematology. The global burden of haematological diseases. Lancet Haematol 2018;5:e1. https://doi.org/10.1016/s2352-3026(17)30233-8
  11. Fanouriakis A, Kostopoulou M, Alunno A, Aringer M, Bajema I, Boletis JN, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis 2019;78:736-45. https://doi.org/10.1136/annrheumdis-2019-215089
  12. Weinzierl EP, Arber DA. The differential diagnosis and bone marrow evaluation of new-onset pancytopenia. Am J Clin Pathol 2013;139:9-29. https://doi.org/10.1309/AJCP50AEEYGREWUZ
  13. Priya PP, A R S. Role of absolute reticulocyte count in evaluation of pancytopenia-a hospital based study. J Clin Diagn Res 2014;8:FC01-3.
  14. Otterman ML, Nijboer JM, van der Horst IC, van Meurs M, ten Duis HJ, Nijsten MW. Reticulocyte counts and their relation to hemoglobin levels in trauma patients. J Trauma 2009;67:121-4.