Hematologic Changes in Sepsis and Their Therapeutic Implications

Richert E. Goyette; Nigel S. Key; E. Wesley Ely

doi:10.1055/s-2004-860979

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2004; 25(6): 645-659
DOI: 10.1055/s-2004-860979

Hematologic Changes in Sepsis and Their Therapeutic Implications

Richert E. Goyette¹ , Nigel S. Key² , E. Wesley Ely³

¹Consultant, hematology and oncology, private practice, Knoxville, Tennessee
²Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota Medical School, Minneapolis, Minnesota
³Department of Medicine, Division of Allergy/Pulmonary/Critical Care Medicine and Center for Health Services Research and the VA Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC), all at the Vanderbilt University School of Medicine, Nashville, Tennessee

Abstract

ABSTRACT

The blood and bone marrow constitute the hematologic organ system. Unlike other organ systems, hematologic organs are distributed in space and provide for a variety of seemingly unrelated functions. The hematologic system has both cellular and fluid-phase elements. Cellular elements include erythrocytes, leukocytes, and platelets; fluid phase elements include coagulation factors, natural antithrombotics, and proteins of the fibrinolytic system. The most common abnormalities of the hematologic system in patients with sepsis are anemia, leukocytosis, thrombocytopenia, and activation of the hemostatic system. Dysfunction of the hematologic organ system is an early manifestation of severe sepsis and is seen in virtually all patients with this disease. In concert with alterations in the endothelium, hematologic changes reflect both the body's reaction to an infectious insult as well as attempts to restore homeostasis. Dysfunction of the hematologic organ system can contribute to multiple organ dysfunctions and death. Recognizing these sepsis-associated changes and understanding the underlying pathophysiology are key to improving outcomes in patients with this deadly disease.

KEYWORDS

Coagulation - erythrocytes - hematology - inflammation - leukocytes - platelets - sepsis

Full Text

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E. Wesley ElyM.D. M.P.H.

Center for Health Services Research

#6109 MCE, Vanderbilt University Medical Center

Nashville, TN 37232-8300

Email: wes.ely@vanderbilt.edu