Hematologic abnormalities within the first week after acute isolated traumatic cervical spinal cord injury: a case-control cohort study.
METHODS
Case-control cohort study.


OBJECTIVE
To evaluate 1) the hematologic abnormalities within the first week following isolated acute cervical spine trauma or spinal cord injury (SCI); and 2) the influence of age, sex, and severity of SCI on these hematologic abnormalities.


BACKGROUND
Given that autonomic nervous system has a critical role in the regulation of the hematopoietic system, we sought to evaluate the potential association between hematologic abnormalities within the first week posttrauma and the severity of SCI.


METHODS
All consecutive individuals with isolated acute cervical spine trauma admitted to our institution from 1998 to 2000 were reviewed. Exclusion criteria included preexisting medical comorbidities and polytrauma. The study population was divided into a SCI group and a control group (individuals with spine trauma without neurologic impairment). The SCI group was subdivided into patients with motor complete SCI (American Spinal Injury Association [ASIA] Grades A/B) and individuals with motor incomplete SCI (ASIA Grades C/D).


RESULTS
There were 21 SCI individuals (15 male, 6 female; ages 17-83 years; mean, 57 years) and 11 controls (6 male, 5 female; ages 18-75 years; mean, 41 years). When controlled for age, SCI individuals showed a significantly higher frequency of reduced hemoglobin concentration (RHC), leukocytosis, lymphopenia, and thrombocytopenia than controls within the first week posttrauma. Blood hemoglobin concentration, lymphocyte, and platelet counts in the SCI group were significant lower than the controls. The SCI group showed a significant higher leukocyte count than the controls. The degree of RHC and lymphopenia was significantly correlated with the severity of SCI.


CONCLUSIONS
Our results indicate that patients with isolated cervical SCI have significantly greater frequency of RHC, leukocytosis, lymphopenia, and thrombocytopenia than controls during the first week posttrauma. The degree of RHC and lymphopenia was significantly associated with the severity of SCI. While the mechanisms underlying these clinically important hematologic consequences of SCI remain undetermined, evidence from the literature suggests that acute autonomic denervation of the hematopoietic system could play a key role.
Furlan
Julio C
JC
Department of Surgery, Division of Neurosurgery, University of Toronto, Ontario, Canada.
Krassioukov
Andrei V
AV
Fehlings
Michael G
MG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000097:blood; D016022:Case-Control Studies; D002574:Cervical Vertebrae; D015331:Cohort Studies; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007958:Leukocyte Count; D007964:Leukocytosis / Q000209:etiology*; D018655:Lymphocyte Count; D008231:Lymphopenia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D010976:Platelet Count; D012720:Severity of Illness Index; D012737:Sex Factors; D013119:Spinal Cord Injuries / Q000097:blood* / Q000503:physiopathology; D013921:Thrombocytopenia / Q000209:etiology*; D013997:Time Factors
D006454:Hemoglobins