The value of determining erythroblasts in adult patients after heart surgery
Abstract
Background. Timely diagnosis of complications after heart surgery remains relevant and in demand today. Clinical-instrumental and laboratory investigation methods are used to diagnose complications in cardiac patients. Laboratory research methods are standardized, reliably and accurately indicate the development of the pathological process in contrast to the clinical and instrumental methods, which depend on the level of qualification of the doctor.
There is evidence in the literature about the prognostic value of determining erythroblasts in peripheral blood in resuscitation patients after an operation on the abdominal cavity.
The aim is to study the frequency of detection of peripheral blood erythroblasts in patients after heart surgery and to evaluate the value of this indicator in cardiac surgery.
Material and methods. A case history of 5633 adult patients who underwent coronary bypass surgery or prosthetic heart valves from 2011 to 2016 in the Federal Center for Cardiovascular Surgery (Astrakhan) were subjected to a retrospective analysis.
Results. A retrospective analysis of the results of determining the number of erythroblasts in peripheral blood during the postoperative period allowed us to divide the patients into 2 groups: the 1st group of erythroblast negative patients (n=5399) with a noncomplicated postoperative period. Erythroblasts in peripheral blood before surgery and after surgery were not detected; the 2nd group of patients, erythroblast positive patients (n=234), in whom, after heart surgery, erythroblasts in the range from 10 to 140 erythroblasts per 100 leukocytes were found in peripheral blood.
The patients of the second group postoperative period proceeded with the development of complications and they can be divided into three subgroups 2A, 2В and 2С.
2A subgroup of patients (n=162, men – 108, women – 54) with complicated postoperative period (with an increased flow of discharge through the drainage), with a favorable outcome. The ap- pearance of erythroblasts in peripheral blood in patients 2A subgroup due to blood loss. Against the background of an increased flow of discharge from the drains in the peripheral blood, there was a decrease in the amount of hemoglobin on average to 79.85±3.81 g/L and erythrocytes 2,86±0,46×1012/L erythroblasts were found in the range from 3 to 10 per 100 leukocytes (on average 4.71±1.56 erythroblasts per 100 leukocytes).
2В subgroup of patients with complicated postoperative period (development of acute heart failure, infectious inflammatory process, renal-hepatic failure), with a favorable outcome.
2С subgroup of patients with a complicated postoperative period (with the development of acute heart failure, an infectious inflammatory process, renal-hepatic failure) and an unfavorable outcome (death).
Mean value of erythroblasts in patients of subgroup 2А 4.71±1.56, erythrocytes 2.86±0.46 (on the background of blood loss) and 3.51±0.03 (after hemоtransfusion) and hemoglobin 75.85±3.81 (on the background of blood loss) and 100.52±0.64 (after hemоtransfusion). The range of oscillation of erythroblasts in the blood 10–25.
Mean value of erythroblasts in patients 2В subgroup 40.36±3.91, erythrocytes 3.5±0.03 and hemoglo- bin 103.45±1, 36. The range of erythroblast oscillations in the blood is 25–100.
Mean value of erythroblasts in patients 2С subgroup 76.43±7.29, erythrocytes 3.43±0.07 and hemo- globin 100.78±1,98. The range of oscillations of erythroblasts in the blood is 32–140.
Patients in subgroup 2A after transfusion therapy showed a significant increase in the number of erythrocytes to 3.51±0.03×1012/L, while there was an increase in the number of erythrocytes, there was a lack of erythroblasts in the blood.
While at the same values of erythrocytes in patients with 2В and 2С subgroups, erythroblasts were determined in the peripheral blood.
To assess the severity of the patients in the intensive care unit, the following laboratory parameters were determined: transaminases (alanine transaminase, aspartate transaminase), creatinine, urea, total bilirubin, lactate and leukocytes, C-reactive protein and procalcitonin.
The correlation analysis revealed the following: a positive pronounced and a positive moderate correlation between the studied parameters, except leukocytes.
The correlation between the number of erythroblasts and the number of leukocytes was weakly positive. In most cases, the number of leukocytes in the peripheral blood of patients was within the reference intervals.
Conclusion. Analysis of the frequency of detection of erythroblasts in peripheral blood in cardiac surgical patients led to the following conclusions:
1. If the postoperative period is favorable, erythroblasts are not detected in peripheral blood
2. With the development of complications in the postoper- ative period, erythroblasts are detected in peripheral blood in cardiac patients.
3. Erythroblasts are an indicator of erythropoiesis and systemic inflammatory response.
4. Erythroblasts are an independent indicator of the severity of the patient’s condition.
Study design: the level of evidence IIa.
Keywords:erythroblasts, cardiac surgery patients, blood
Conflict of interests. The authors declare no conflict of interests.
For citation: Petrova O.V., Shabanova G.R., Nikulina D.M., Tarasov D.G. The value of determining erythroblasts in adult patients after heart surgery. Clin Experiment Surg. Petrovsky J. 2020; 8 (1): 56–66. doi: 10.33029/2308-1198-2020-8-1-56-66 (in Russian)
Received 18.07.2019. Accepted 05.02.2020.
References
1. Beloborodova N.V., Tumanyan M.R., Chernevskaya E.A., Popov D.A., et al. Modern biomarker of an infection in cardiac practice. Detskie bolezni serdtsa i so- sudov [Heart and Vessels Diseases in Children]. 2009; (1): 48–56. (in Russian)
2. Kchibekov Je.A., Nikulina D.M., Zurnadzh’yanc V.A. The complex program of forecasting of complications of sharp inflammatory diseases of organs of a belly cavity. Astrakhanskiy meditsinskiy zhurnal [Astrakhan Medical Journal]. 2011; 6 (2): 182–4. (in Russian)
3. Petrova O.V., Tarasov D.G., Nikulina D.M., Urtaeva Z.A., Motreva A.P., Murygina O.I., et al. Value of the procalcitonin in cardiosurgery practice. Clin Experiment Surg. Petrovsky J. 2018; 6 (1): 51–61. (in Russian)
4. Petrova O.V., Tarasov D.G., Nikulina D.M., Birukova L.A., Martyanova Yu.B., Panova E.V., et al. D-dimer and fibrin-monomer as markers of efficiency of the new oral anticoagulants. Clin Experiment Surg. Petrovsky J. 2018; 6 (3): 64–9. (in Russian)
5. Petrova O.V., Shashin S.A., Tarasov D.G. Markers of systemic inflammatory response in patients operated for complications of infectious endocarditis. Klinicheskaya meditsina [Clinical Medicine]. 2015; 93 (7): 26–30. (in Russian)
6. Petrova O.V., Shashin S.A., Tarasov D.G. The significance of immature granulocytes in diagnostic of infectious inflammatory processes in cardiosurgery patients. Klinicheskaya laboratornaya diagnostika [Clinical Laboratory Diagnostics]. 2014; 59 (5): 25–40. (in Russian)
7. Savenkov M.S., Petrova O.V., Bisalieva R.A., Ni- kulina D.M. Complex laboratory assessment of expressiveness of inflammatory changes at obstructive cholecystitis. Volgogradskiy nauchno-meditsinskiy zhurnal [Volgograd Scientific and Medical Magazine]. 2006; (2): 51. (in Russian)
8. Barati M., Alinejad F., Bahar M.A. Comparison of WBC, ESR, CRP and PCT serum levels in septic and non-septic burn cases. Burns. 2008; 34 (4): 770–4.
9. Bone R.C., Balk R.A., Cerra F.B. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. THE ACCP/SCCM consensus conference committee. Chest. 1992; 101: 1644–55.
10. Chalupa P., Beran O., Herwald H., Kaspiikova N., et al. Evaluation of potential biomarkers for the discrimination of bacterial and viral infections. Infection. 2011; 39 (5): 411–7.
11. DellingerR.P.,CarletJ.M.,MasurH.Survivingsepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004; 32: 858–73.
12. Dellinger R.P., Levy M.M., Carlet J.M. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock. Crit Care Med. 2008; 36: 296–327.
13. Dellinger R.P., Levy M.M., Rhodes A. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. Crit Care Med. 2013; 41 (2): 580–637.
14. Dou Y.H., Du J.K., Liu H.L., Shong X.D. The role of procalcitonin in the identification of invasive fungal infection-a systemic review and meta-analysis. Diagn Microbiol Infect Dis. 2013; 76 (4): 464–9.
15. Levy M.M., Fink M.P., Marshall J.C. 2001 SCCM/ ESICM/ACCP/ ATS/SIS international sepsis definitions conference. Crit Care Med. 2003; 31 (4): 1250–6.
16. Limper M., de Kruif M.D., Duits A.J., Brandjes D.P.M., et al. The diagnostic role of Procalcitonin and other biomarkers in discriminating infectious from non-infectious fever. J Infect. 2010; 60 (6): 409–16.
17. Osei-Bimpong A., Meek J.H., Lewis S.M. ESR or CRP? A comparison of their clinical utility. Hematology. 2007; 12 (4): 353–7.
18. Reinhart K., Bauer M., Riedemann N.C., Hartog C.S. New approaches to sepsis: molecular diagnostics and biomarkers. J Clin Microbiol. 2012; 25 (4): 609–34.
19. Riedel S., Melendez J.H., An A.T., Rosenbaum J.E., et al. Procalcitonin as a marker for the detection of bacteremia and sepsis in the emergency department. Am J Clin Pathol. 2011; 135 (2): 182–9.
20. Sakr Y., Sponholz C., Tuche F., Brunkhorst F., et al. The role of procalcitonin in febrile neutropenic patients: review of the literature. Infection. 2008; 36 (5): 396–407.
21. Tsalik E.L., Jaggers L.B., Glickman S.W., et al. Discriminative value of inflammatory biomarkers for suspected sepsis. J Emerg Med. 2012; 43 (1): 97–106.
22. Tschaikowsky K., Hedwig-Geissing M., Braun G.G., Radespiel-Troeger M. Predictive value of procalcitonin, interleukin-6, and C-reactive protein for survival in post-operative patients with severe sepsis. J Crit Care. 2011; 26 (1): 54–64.
23. Uzzan B., Cohen R., Nicolas P., Cucherat M., et al. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med. 2006; 34 (7): 1996–2003.
24. Wacker C., Prkno A., Brunkhorst F.M., Schlattmann P. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis. 2013; 13 (5): 426–35.