Burn patients experience erythropoietin resistant anemia in which early commitment and late maturation of erythroblasts are defective. We previously showed that propranolol (Prop) treatment restores erythroid committed progenitors, but terminal maturation remains impaired. Hemoglobinization and maturation occurs during terminal erythropoiesis and these processes are aided by an erythroblast intrinsic functional protein called alpha hemoglobin stabilizing protein (AHSP). We evaluated the role of AHSP in PBMC (peripheral blood mono nuclear cell) derived erythroblasts and the implications of Prop in burn patients. Blood samples were collected at three time points from seventeen patients receiving standard burn care (SBC) or Prop. Five healthy volunteers provided control plasma (CP). PBMCs were placed in biphasic cultures with 5% autologous plasma (BP) or CP. Erythroblasts were harvested during mid and late maturation stages; the percentage of AHSP + erythroblasts, AHSP expression, and relative distribution of reticulocytes and polychromatophilic erythroblasts (PolyE) were determined by cytometry. During the second time point (7-10 days post burn), Prop cohort required 35% less transfusions. At mid maturation, PBMCs from Prop treated patients cultured in BP had 33% more AHSP + erythroblasts and 40% more AHSP expression compared to SBC. Furthermore, at late maturation, Prop had 50% more reticulocytes and 30% less PolyEs in CP versus BP compared to SBC (11% and 6% respectively). AHSP is positively associated with late stage maturation of PBMC derived erythroblasts in the presence of CP. Albeit transiently, this is more pronounced in Prop than SBC. Early administration of propranolol in burn patients supports erythropoiesis via the chaperone AHSP.
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References

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