Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-23T01:38:46.405Z Has data issue: false hasContentIssue false
  • English
  • Français

Circulating blood volumes in pulmonary hypertension associated with erythrocytosis – the effects of therapeutic hemodilution

Published online by Cambridge University Press:  24 May 2005

Rilvani C. Gonçalves ,
Carlos Alberto Buschpigell  and
Antonio Augusto Lopes
Rilvani C. Gonçalves
Affiliation:
Department of Pediatric Cardiology and Adult Congenital Heart Disease, Heart Institute, São Paulo, Brazil
Carlos Alberto Buschpigell
Affiliation:
Department of Nuclear Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
Antonio Augusto Lopes
Affiliation:
Department of Pediatric Cardiology and Adult Congenital Heart Disease, Heart Institute, São Paulo, Brazil
Get access Rights & Permissions [Opens in a new window]

Abstract

In the Eisenmenger syndrome, indirect estimation of blood volumes may provide quite inaccurate information when seeking to define therapeutic strategies. With this in mind, we analyzed directly the red cell mass, plasma volume, and total blood volume in patients with pulmonary hypertension associated with congenital cardiac defects and erythrocytosis, comparing the results with the respective estimated volumes, and examining the changes induced by therapeutic hemodilution.

Thus, we studied 17 patients with the Eisenmenger syndrome, aged from 15 to 53 years, in the basal condition, studying 12 of them both before and after hemodilution. We also investigated five individuals with minimal cardiac lesions, aged from 14 to 42 years, as controls. Red cell mass and plasma volumes were measured using [51 chromium]-sodium chromate and [131iodine]-albumin respectively. Hemodilution was planned so as to exchange 10% of the total blood volume, using 40,000 molecular weight dextran simultaneously to replace the removed volume. The mean values of the red cell mass, plasma volume and total blood volume as assessed by radionuclide techniques were 32%, 31% and 32% higher than the respective volumes as estimated using empirical mathematical formulas (p < 0.002). The measured total blood volume was also 19% higher in the patients compared with controls. Following a period of 5 days after hemodilution, we noted a 13% reduction in red cell mass (p = 0.046), and 10% reduction in total blood volume (p = 0.02), albeit with no changes in the plasma volume.

We conclude that direct measurement of blood volumes is useful for proper management of these patients, and provides results that are considerably different from those obtained by empirical estimations.

Keywords

Plasma volumered cell masscongenital heart disease
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 6 , December 2003 , pp. 544 - 550
Copyright
© 2003 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Wood P. The Eisenmenger's syndrome or pulmonary hypertension with reversed central shunt. Br Med J 1958; 2: 701–709.Google Scholar
Heath D, Edwards JE. The pathology of hypertensive pulmonary vascular disease. A description of six grades of structural changes in the pulmonary arteries with special reference to congenital cardiac septal defects. Circulation 1958; 18: 533–547.Google Scholar
Moraes D, Lozcolzo J. Pulmonary hypertension: newer concepts in diagnosis and management. Clin Cardiol 1997; 20: 676–682.Google Scholar
Janssens SP, Thompson BT, Spence CR, Hales CA. Polycythemia and vascular remodeling in chronic hypoxic pulmonary hypertension in guinea pigs. J Appl Physiol 1991; 71: 2218–2223.Google Scholar
Vongpatanasin W, Brickner ME, Hillis LD, Lange LA. The Eisenmenger syndrome in adults. Ann Intern Med 1998; 128: 745–755.Google Scholar
Yu YA, Shimoda LA, Iyer NV, et al. Impaired physiological responses to chronic hypoxia in mice partially deficient for hypoxia-inducible factor 1α. J Clin Invest 1999; 103: 691–696.Google Scholar
Loer AS, Peters J. Effects of hemoconcentration and hemodilution on acute hypoxia-induced pulmonary hypertension and changes in vascular compliance of isolated rabbit lung. Intensive Care Med 2000; 26: 1124–1130.Google Scholar
Borst MB, Leschke M, König U, Worth H. Repetitive hemodilution in chronic obstructive pulmonary disease and pulmonary hypertension: effects on pulmonary hemodynamics, gas exchange, and exercise capacity. Respiration 1999; 66: 225–232.Google Scholar
Agarwal JB, Raymond P, Palmer WH. Relative viscosity of blood at varying hematocrits in pulmonary circulation. J Appl Physiol 1970; 29: 866–871.Google Scholar
Messmer K. Hemodilution (Symposium on a physiologic approach to critical care). Surg Clin of North Am 1975; 55: 659–677.Google Scholar
Oldershaw PJ, St John Sutton MG. Hemodynamic effects of hematocrit reduction in patients with polycythaemia secondary to cyanotic congenital heart disease. Br Heart J 1980; 44: 584–588.Google Scholar
Perloff JK. Systemic complications of cyanosis in adults with congenital heart disease: hematologic derangements, renal function and urate metabolism. Cardiol Clin 1993; 11: 689–699.Google Scholar
Vérel D. Blood volume changes in cyanotic heart disease and polycythemia rubra vera. Circulation 1961; 23: 749–753.Google Scholar
Rosenthal A, Nathan DG, Marty AT, Button LN, Miettinen OS, Nadas AS. Acute hemodynamic effects of red cell volume reduction in polycythemia of cyanotic heart disease. Circulation 1970; 42: 297–308.Google Scholar
Rosenthal A, Button LN, Nathan DG, Miettinen OS, Nadas AS. Blood volume changes in cyanotic congenital heart disease. Am J Cardiol 1971; 27: 162–167.Google Scholar
Rosove MH, Perloff JK, Hocking WG, Child JS, Canobbio MM, Skorton DJ. Chronic hypoxaemia and descompensated erythrocytosis in cyanotic congenital heart disease. Lancet 1986; 2: 313–315.Google Scholar
Brooks H, Kirk ES, Vokanas PS, Urschel CW, Sonnenblick EH. Performance of the right ventricle under stress: regulation to right coronary flow. J Clin Invest 1971; 50: 2176–2183.Google Scholar
Vlhakes GJ, Turley K, Hoffman JIE. The pathophysiology of failure in acute right ventricular hypertension: hemodynamic and biochemical correlations. Circulation 1981; 63: 87–95.Google Scholar
Forrester AL. Hemodynamics of the right ventricle in normal and disease states. Cardiol Clin 1992; 10: 59–67.Google Scholar
Schulman DS, Matthay RA. The right ventricle in pulmonary disease. Cardiol Clin 1992; 10: 111–135.Google Scholar
Adjunctive Medical Knowledge. Recommended methods for measurement of red cell and plasma volume. International Committee for Standardization in Haematology (ICSH). J Nucl Med 1980; 21: 793–800.
Caramuru LH, Soares RPS, Maeda NY, Lopes AA. Hypoxia and altered platelet behaviour influence von Willebrand factor multimeric composition in secondary pulmonary hypertension. Clin Appl Thromb Hemost 2003; 9: 251–258.Google Scholar
Saha A, Balakrishnan KG, Jaiswal PK, et al. Prognosis for patients with Eisenmenger syndrome of various aethiology. Int J Cardiol 1994; 45: 199–207.Google Scholar
Richard JP, Bairelle P, Conil JM, Antonini A. Hémodiluition normovolémique intentionnélle: calcul de la masse de sang a soustraire. Cah Anesth 1985; 33: 343–344.Google Scholar
Brecher ME, Rosenfeld M. Mathematical and computer modeling of acute normovolemic hemodilution. Transfusion 1994; 34: 176–179.Google Scholar
Weiskopf RB. Mathematical analysis of isovolemic hemodilution indicates that it can decrease the need for allogeneic blood transfusion. Transfusion 1995; 35: 37–41.Google Scholar
Baker RJ, Kozoll DP, Meyer K. The use of surface area as a basis for establishing normal blood volume. Surg Gynec Obst 1957; 104: 183–189.Google Scholar
Nadler SB, Hidalgo JU, Bloch T. Prediction of blood volume in normal human adults. Surgery 1962; 51: 224–232.Google Scholar
Price PC. The hematopoietic system. In: Harbert JC, Eckelmon WC, Newmann RD (eds). Nuclear Medicine: Diagnosis and Therapy. Thieme Med. Publ, New York, 1996, pp 759–798.
Pearson TC, Guthrie DL, Simpson J, et al. Interpretation of measured red cell mass and plasma volume in adults – expert panel on radionuclides of the International Council for Standardization in Haematology. Br J Haematol 1995; 89: 748–756.Google Scholar
Chaplin H, Mollison DL, Vetter H. The body/venous hematocrit ratios – its constancy over a wide hematocrit range. J Clin Invest 1953; 32: 1309–1316.Google Scholar
Dacie JV, Lewis SM. Practical haematology, 6th edn. Churchill Livingstone, London, 1984, pp 281–287.
Cosgriff PS, Blunkett M, Monish O. Estimating plasma volume from red cell volume. Nucl Med Comm 1999; 20: 1165–1167.Google Scholar
Wedemeyer AL, Lewis JH. Improvement in hemostasis following phlebotomy in cyanotic patients with heart disease. J Pediatr 1973; 83: 46–50.Google Scholar
Lopes AAB, Maeda NY, Ebaid M, Chamone DAF, Pileggi F. Effect of intentional hemodilution on platelet survival in secondary pulmonary hypertension. Chest 1989; 95: 1207–1210.Google Scholar