When there is a big inflammatory response in the body, even if it's not happening in one area of the body, it can affect another area of the body. So we see this all the time. And one area that gets affected is the bone marrow. So for example, if you get sepsis from pneumonia in the lungs, you will have a significant leukocytosis in production of leukocytes from the

bone marrow. So most people that work in hospitals know that because they see a CBC and they see

a high white blood cell count. But what they may not realize is that other things are happening

in the bone marrow. So urethroid precursors, the precursors to

red blood cells, have decreased responsiveness to urethropoatin. So inflammation impairs the response of

urethrocyte precursors to urethropotin. In fact, it's even a little bit more interesting than that because there are

subgroups of patients with systemic inflammation that have decreased levels, meaning they're making

less serum urethropotin as well. So that can be a double whammy. Not only are you not making

enough urethropotin, but in the bone marrow, your red blood

cell precursors are not as responsive to urethropotin. So it's always interesting. You know,

humans have 206 bones when they are adults. And I always say that us German shepherd owners, and boy, do I love German shepherds, but

we think they love us for our personalities, but I think they are just waiting.

I think they know more than 200 bones exist in our bodies.

Getting back to urethrocytes, our red blood cells, not only are we not making them as well in high

inflammatory states, but when there is a lot of inflammation, our urethrocytes survive for less time.

In fact, they can survive 25% less days, so only 90 days instead of our usual 120 days when there is a lot of inflammation.

One of many reasons for this is macrophage activation, and so this is often termed a consumptive

anemia of inflammation in which there's hemophagocytosis.

But this gets me back to what I was saying

in the part one series about anemia of inflammation

that you may understand certain lab levels better

if you understand the disease process.

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