The impact of a hypercatecholamine state on erythropoiesis following severe traumatic injury

Abstract Introduction: Hemorrhagic shock-induced bone marrow (BM) dysfunction following severe trauma renders patients susceptible to infection and persistent anemia. The relationship between the early hypercatecholamine state that accompanies severe injury and its effect on erythropoietic dysfunction has not been studied. The aim of this study was to investigate the impact of a hyper-adrenergic stimulus on erythropoiesis both in normal and trauma BM. Methods: BM aspirates were obtained from severely injured patients and healthy volunteers. BM mononuclear cells were isolated and erythropoiesis was assessed by the growth of BFU-E and CFU-E colonies in the presence of norepinephrine (NE), isoproterenol (ISO) and epinephrine (EPI) at increasing concentrations. Data presented as mean %; ∗p Results: Under physiologic conditions (10 − 7M), NE produces an increase in normal BM BFU-E growth and with increasing concentrations, less proliferation is seen. At equimolar concentrations, NE has less effect on trauma BM and at stress levels (10 − 5M) is actually inhibitory (see Table1). ∗BFU-E (% of normal control)SampleNormal BMTrauma BMControl10053NE 10 −7 M324∗232∗∗NE 10 −6 M276∗154∗∗NE 10 −5 M189∗23∗∗∗p Conclusions: Adrenergic stimulation has a proliferative effect on normal erythropoiesis. Trauma BM is less responsive to catecholamine and there is a profound suppression of BFU-E growth at stress levels of catecholamine. In conclusion, the erythropoietic dysfunction seen following trauma may be partially mediated by a hypercatecholamine state that may benefit from the use of early beta blockade.