A patient may develop bone marrow failure following severe trauma with shock. This may be secondary to release of cytokines.
Changes in the bone marrow may appear within 12 hours of the trauma and can last a week or more.
Signs of bone marrow dysfunction following trauma:
(1) persistent anemia with low reticulocytosis
(2) continuing need for blood transfusion
(3) immature red and white blood cells in the peripheral blood
(4) elevated blood erythropoietin
(5) impaired function of white blood cells
The changes cannot be explained by iron or nutritional deficiency or drug-induced marrow suppression.
Both progenitor and stem cells from the bone marrow show reduced proliferative activity following trauma, with impaired growth in tissue culture. Erythroid precursors are poorly responsive to erythropoietin.
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