Evaluation of circulating haematopoietic progenitor cells in patients with Trauma Haemorrhagic shock and its correlation with outcomes.
BACKGROUND
Haemorrhagic shock accounts up to 50% of early trauma deaths. Hematopoietic failure has been observed in experimental animals and human following shock and injury. One of the facets of bone marrow failure is multiple organ dysfunction syndrome and is commonly seen in patients recovering from severe trauma and hemorrhagic shock. Bone Marrow (BM) dysfunction is associated with mobilization of hematopoietic progenitor cells (HPCs) into peripheral blood. Present study explored the association of peripheral blood hematopoietic progenitor cells (HPCs) with mortality in trauma haemorrhagic shock patients (T/HS).


METHODS
Prospective cohort studies of patients presenting within 8 hrs of injury with T/HS to the Department of Emergency Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences were recruited. Peripheral blood samples were collected in each patient for measurement of peripheral blood HPCs. Peripheral blood progenitor cell (PBPC) quantification was performed by measuring HPCs counts using the haematology analyzer (Sysmex XE-2100). Clinical and laboratory data were prospectively collected after consent. Ethical approval was taken and data was analysed by Stata 11.2.


RESULTS
39 patients with trauma hemorrhagic shock and 30 normal healthy controls were recruited. HPCs were significantly higher (P < 0.001) in the T/HS as compared to control. Among study group, 14 patients died within 24 h. at the hospital admission, and found HPCs concentrations were highly significant (<0.001) in non-survivors (n = 14) when compared with survivors (n = 25) among T/HS patients.


CONCLUSIONS
Our studies suggest the peripheral blood HPCs may be early prognostic marker for mortality among patients who presented with trauma hemorrhagic shock on admission. But the exact molecular mechanism and signalling pathway involved in the change of the behaviour of bone marrow microenvironment is still unclear.
Department of Emergency Medicine, Jai Prakash Narayan Apex Trauma Centre, New Delhi, India.
Manoj
M
Kumar
Department of Emergency Medicine, Jai Prakash Narayan Apex Trauma Centre, New Delhi, India.
Sanjeev
S
Bhoi
Department of Lab Medicine, Jai Prakash Narayan Apex Trauma Centre, New Delhi, India.
Arulselvi
A
Subramanian
Department of Bio Statistics, All India Institutes of Medical Sciences, New Delhi, India.
Vineet Kumar
VK
Kamal
Department of Stem Cell Facility, All India Institutes of Medical Sciences, New Delhi, India.
Sujata
S
Mohanty
Department of Biochemistry, All India Institutes of Medical Sciences, New Delhi, India.
D N
DN
Rao
Department of Emergency Medicine, University of Florida, Florida, USA.
Sagar
S
Galwankar
Hematopoietic progenitor cells; outcome; trauma hemorrhagic shock