## 4 Discussion  
The results of our study in children suffering from abdominal sepsis with first- and second- stage shock show the changes of ultrastructure of erythrocytes, granulocytes, and lymphocytes. The specific changes of erythrocytes included: irregular shape of the echinocytes (burr cells), diminished volume of cells, condensation (pyknosis), low density of electrons and signs of rupture of cytoplasm. The specific changes of granulocytes ultrastructure encompassed significant degranulation with accompanying disorganization of intracellular membranes and sometimes even with decomposition of cytoplasm. Lymphocytes of the children examined were characterized by uneven distribution of chromatine and lack of nuclear membranes in the cells. Apart from the aforementioned changes, the Golgi apparatus was larger and there was a high number of young mitochondria, lysosomes, ribosomes and vesicles. Under normal physiological conditions, the mature erythrocyte has a characteristic biconcave disc shape, approximately 6-8 um in diameter and 2 um thick [30]. Sepsis alters morphology of erythrocytes and affects aggregation of RBC. Presence of echinocytes (RBC)with numerous spikes protruding from the surface) was found in the study by [PERSON] et al. [31], aggregates of RBC and improper RBC in a patient with sepsis in the study by [PERSON] al. [32]. Sepsis can cause an increase or decrease in WBCs and triggers the release of cytokines, which results in the release of immature leukocytes from bone marrow. The structural changes of granulocytes and lymphocytes are rarely described in literature; thus, our results can serve as the basis for further knowledge. With generalized peritonitis, emergency surgery is often performed to identify and treat acute pathogenesis, and to minimize bacterial load through abundant irrigation and drainage of the peritoneum [33]. A patient with generalized peritonitis often requires intensive supervision with appropriate antibiotic therapy. Generalized peritonitis can lead to septic rhinitis, which entails many adverse changes in the patient's body. According to our study, blood cells undergo substantial ultrastructural changes, causing gas exchange disruption, changes in reactivity and decompensation of organs and systems functioning with first- or second-stage abdominal septic shock. It has been shown that the appearance of different forms of erythrocytes is linked to reduced deformity of red blood cells, which means that their adaptability is limited and caused, for example, by polycythemia [34] or metabolic syndrome [35]. Although it is known that echinocytes may regain their discocyte forms in normal conditions, the changes are irreversible in the above-mentioned echinocytes [36]. Such forms of erythrocytes demonstrate limited abilities to alter, thus affecting intercellular contacts, triggering intravascular aggregation, which contributes to sludging, gas exchange disorders, and hypoxia. Erythrocytes do not contain the nuclei and mitochondria necessary for apoptosis, which is the programmed death of cells. However, the erythrocytes undergo a number of changes both in normal and pathological conditions distinct from apoptosis. In view of those specific mechanisms for erythrocyte apoptosis, the term 'eryptosis' has been introduced to describe the programmed or suicidal death of erythrocytes [37; 38]. Our findings serve to demonstrate the destructive (recrotic rather than apoptotic) changes in erythrocytes caused by toxemia with distinctive disorders in both extracellular and intracellular homeostasis [38]. The ultrastructural changes in granulocytes testify to their hyperactivation. According to the authors [29], this neutrophic state leads to the exhaustion of membrane synthetic resources, membrane destruction and ineffective expenditure of bactericidal factors on substrates not subject to destruction. Although eosinophils undergo analogous changes, they are less distinct, compared to neutrophils.