Characteristics of the Course of Anemia as a Consequence of Combat Injuries in Military Servicemen Participating in High-Intensity Combat Actions.

Abstract

Introduction: During the full-scale war in Ukraine, the number of military personnel suffering from combat injuries with the development of anemia significantly increased. The work aimed to generalize and study the clinical and hematological characteristics of anemia in service members who received gunshot and blast injuries during combat operations.

Materials and methods: We examined 264 servicemen within 6 months (main group). They took part in hostilities and received gunshot and shrapnel wounds accompanied by blood loss. The control group consisted of 87 practically healthy service members. Complete blood test was performed on an automatic hematology analyser ABX Micros ES 60 of the company Horiba ABX. We determined the level of ferritin using the enzyme immunoassay method ELISA, the concentration of serum iron using the photometric method, and C-reactive protein (CRP) using the immunoturbidimetric latex method (quantitatively). The studies' results were processed using variational statistics. For each group of patients, the arithmetic mean (M), the standard deviation (Ϭ), and the error of the arithmetic mean (m) were calculated. We used the statistical processing package STATISTICA 10 (Statsoft Inc.).

Results: Isolated injuries accounted for 50.89%, injuries to two or more anatomical areas-49.11%, injuries to limbs and large joints-30.6%, chest-14.66%, abdominal cavity-21.9%, and polytrauma-32.84%. All patients had blood loss, but its degree was not countable. The number of erythrocyte mass transfusions ranged from 2 to 7 (3.5 ± 0.7 on average). A total of 39.42% of victims were delivered in a severe condition, and 60.58% in a moderate condition. We divided the patients into the groups: 1st group (n = 60) where the blood was tested after in 1 month after injury, 2nd (n = 42)-2 months, 3rd (n = 37), 4th (n = 31), 5th (n = 26), and 6th (n = 24) in 3, 4, 5, and 6 months. We observed an initial increase in the number of leukocytes and platelets, and a decrease in the levels of erythrocytes, hemoglobin, MCV, and MCH, an increase in the absolute number of granulocytes and monocytes, and a decrease in the number of lymphocytes. In all, 7.9% of patients were diagnosed with severe anemia, 44.7% with moderate, and 40.4% with mild. The ferritin level exceeded the control group's results almost three times, while the iron content in the blood serum was significantly reduced. The hemoglobin level did not normalize within six months in most service members with anemia (because of severity or complications of the injuries and multiple surgeries). The CRP was elevated for 6 months after injury. Correlation analysis confirmed a positive relationship between the level of hemoglobin, the number of leukocytes, and the level of CRP.

Conclusions: We view combat anemia as more than a hematology issue. It needs prompt, coordinated care from various fields. Interventions may include blood transfusions, surgery, and correcting iron levels. We can decrease the concentration of pro-inflammatory cytokines through anti-inflammatory therapy. Additionally, possible adrenergic modulation can promote erythropoiesis.