Analysis of Red Cell Mass and Plasma Volume in Patients With Polycythemia

2005 ◽  
Vol 129 (1) ◽  
pp. 89-91 ◽  
Author(s):  
Mordechai Lorberboym ◽  
Naomi Rahimi-Levene ◽  
Helena Lipszyc ◽  
Chun K. Kim
Keyword(s):  
Body Weight ◽  
Plasma Volume ◽  
Cell Mass ◽  
Mean Value ◽  
Whole Body ◽  
Red Cell ◽  
Volume Data ◽  
Red Cell Mass ◽  
The Mean ◽  
Iodine 125

Abstract Context.—Polycythemia describes an increased proportion of red blood cells in the peripheral blood. In absolute polycythemia, there is increased red cell mass (RCM) with normal plasma volume, in contrast with apparent polycythemia, in which there is increased or normal RCM and decreased plasma volume. In order to deliver the appropriate treatment it is necessary to differentiate between the two. Objective.—A retrospective analysis of RCM and plasma volume data are presented, with special attention to different methods of RCM interpretation. Design.—The measurements of RCM and plasma volume in 64 patients were compared with the venous and whole-body packed cell volume, and the incidence of absolute and apparent polycythemia was determined for increasing hematocrit levels. Measurements of RCM and plasma volume were performed using chromium 51–labeled red cells and iodine 125–labeled albumin, respectively. The measured RCM of each patient was expressed as a percentage of the mean expected RCM and was also defined as being within or outside the range of 2 SD of the mean. The results were also expressed in the traditional manner of mL/kg body weight. Results.—Twenty-one patients (13 women and 8 men) had absolute polycythemia. None of them had an increased plasma volume beyond 2 SD of the mean. When expressed according to the criteria of mL/kg body weight, 17 of the 21 patients had abnormally increased RCM, but 4 patients (19%) had a normal RCM value. Twenty-eight patients had apparent polycythemia. The remaining 15 patients had normal RCM and plasma volume. Conclusions.—The measurement of RCM and plasma volume is a simple and necessary procedure in the evaluation of polycythemia. In obese patients, the expression of RCM in mL/kg body weight lacks precision, considering that adipose tissue is hypovascular. The results of RCM are best described as being within or beyond 2 SD of the mean value.

Should Whole-Body Red Cell Mass Be Measured or Calculated?

2000 ◽  
Vol 26 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Ingrid Balga ◽  
Max Solenthaler ◽  
Miha Furlan
Keyword(s):  
Cell Mass ◽  
Whole Body ◽  
Red Cell ◽  
Red Cell Mass

Erythropoietin production in exhypoxic polycythemic mice

1989 ◽  
Vol 256 (4) ◽  
pp. C925-C929 ◽  
Author(s):  
I. Seferynska ◽  
J. Brookins ◽  
J. C. Rice ◽  
J. W. Fisher
Keyword(s):  
Body Weight ◽  
Ambient Pressure ◽  
Cell Mass ◽  
Rapid Decline ◽  
Red Cell ◽  
Erythropoietin Production ◽  
Hypobaric Chamber ◽  
Red Cell Mass ◽  
Posthypoxic Period ◽  
Serum Erythropoietin

Our present study was undertaken to determine the serum erythropoietin concentration (radioimmunoassay), hematocrit, red cell mass, and body weight of mice exposed to hypoxia in a hypobaric chamber (0.42 atm, 22 h/day) for 14 days and during the 10 posthypoxic days at ambient pressure to clarify the correlation of the red cell mass and erythropoietin production during hypoxia. The mean serum erythropoietin titer was 326.23 +/- 77.04 mU/ml after 2 days, reached the highest level after 3 days (452.2 +/- 114.5 mU/ml), then gradually declined to a level of 36.5 +/- 11.4 mU/ml after 14 days of hypoxia, and was undetectable during the 10-day posthypoxic period. The hematocrit values were significantly increased from 41.09 +/- 0.50% at day 0 to 51.65 +/- 1.08% after 3 days and to 72.20 +/- 1.53% after 14 days of hypoxia. The red cell mass (calculated from initial body weight) increased from 3.24 +/- 0.1 ml/100 g at day 0 to 7.32 +/- 0.46 ml/100 g after 14 days of hypoxia and declined to 6.66 +/- 0.53 ml/100 g at the end of the 10-day posthypoxic period. The mice lost weight while they were in the hypobaric chamber and showed a significant increase in body weight during the 10-day posthypoxic period. These studies support the concept that chronic intermittent hypoxia causes an early increase, followed by a rapid decline, in erythropoietin production, which is correlated with the gradual increase in red cell mass.

Polycythemia in rats following restricted food intake

1964 ◽  
Vol 206 (4) ◽  
pp. 762-764 ◽  
Author(s):  
Herbert Wohl ◽  
Clarence Merskey
Keyword(s):  
Body Weight ◽  
Food Intake ◽  
Cell Mass ◽  
Diet Group ◽  
Control Group ◽  
Red Cell ◽  
Restricted Diet ◽  
Red Cell Mass ◽  
Normal Chow ◽  
Unit Body Weight

Rats were divided into two groups such that mean weight and hemoglobin and hematocrit levels were not significantly different. One group (controls) was then fed a normal chow ad libitum. The other group was fed 6 g daily (30% of normal intake) for 2 weeks. The hemoglobin levels of rats fed the restricted diet rose 1.4–3.5 g/100 ml and hematocrit level rose 2–6%. At the end of 2 weeks total red cell mass (Cr51) was 5.5–6.0 ml in the underfed groups compared with 6.8 ml in the control group. Body weight fell proportionally more than did red cell mass, elevating the calculated red cell mass per unit body weight. Serum osmolality and K+ were not significantly different from control values, and there was a slightly higher serum Na+ and Cl– in the restricted diet group. It is concluded that restriction of food intake produced a relative polycythemia. At the end of 2 weeks of restriction an isosmotic reduction in plasma volume was present.

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

2003 ◽  
Vol 13 (6) ◽  
pp. 544-550 ◽  
Author(s):  
Rilvani C. Gonçalves ◽  
Carlos Alberto Buschpigell ◽  
Antonio Augusto Lopes
Keyword(s):  
Pulmonary Hypertension ◽  
Blood Volume ◽  
Plasma Volume ◽  
Cell Mass ◽  
Red Cell ◽  
Total Blood Volume ◽  
Eisenmenger Syndrome ◽  
Total Blood ◽  
Red Cell Mass ◽  
Blood Volumes

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.

Blood distribution during cardiac arrest induced by hypothermia

1961 ◽  
Vol 16 (3) ◽  
pp. 538-540
Author(s):  
Paul W. Willard ◽  
Steven M. Horvath
Keyword(s):  
Cardiac Arrest ◽  
Body Temperature ◽  
Blood Volume ◽  
Cell Mass ◽  
The Body ◽  
Whole Body ◽  
Red Cell ◽  
Red Cell Mass ◽  
Blood Redistribution ◽  
Blood Volumes

Blood volumes with simultaneous blood- and red cell-distribution measurements were determined by the Cr51 technique in four groups of rats. In splenectomized and nonsplenectomized animals, blood volume of the whole body, lung, spleen, liver, kidney, heart, diaphragm, and gastrocnemius muscle was measured in both the control rats (body temperature 37 C) and in rats with hypothermically induced cardiac arrest (body temperature 8–9 C). Splenectomy caused alterations in some visceral blood volumes without concurrent changes in red cell mass. With cardiac arrest increased quantities of blood and red cell mass were observed in the lung, liver, and gastrocnemius in both splenectomized and nonsplenectomized groups. In the nonsplenectomized animals an increase of over 100 % in spleen blood volume was observed. When the two hypothermic groups were compared, differences existed only in blood volume of the lung, heart, and kidney. Hypothermia induced a pattern of blood redistribution toward visceral areas of the body. Submitted on October 14, 1960

Red Cell Mass Measurement in Polycythemia: Evaluation of Performance and Added Value.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1525-1525
Author(s):  
Shireen Sirhan ◽  
Ayalew Tefferi
Keyword(s):  
Bone Marrow ◽  
Plasma Volume ◽  
Test Performance ◽  
Mass Measurement ◽  
Cell Mass ◽  
Added Value ◽  
Study Cohort ◽  
Red Cell ◽  
Disease Category ◽  
Red Cell Mass

Abstract Background : Current diagnosis of polycythemia vera (PV) is based on a set of clinical and laboratory criteria that were adopted more by consensus rather than because of support from systematic evidence. Accordingly, one major criterion for the diagnosis of PV requires the demonstration of increased red cell mass (RCM) as measured by radionuclide dilution methods. In order to adjust for the influence of obesity on RCM expressed in mL/kg, an expert radionuclide panel of the International Committee for Standardization in Haematology (ICHS) has recommended that the results be expressed in reference to body surface area and specific formulae for the prediction of normal values as well as guidelines for the interpretation of measured values have been proposed (J Nuclear Med1980;21:793, BJH1995;89:748). Nevertheless, there is limited data on either the performance or added value of RCM measurement, following these revised recommendations, for the diagnosis of PV in current clinical practice. Methods : The current study looks at a single institution experience with RCM measurement over the last 10 years involving patients in whom the test was performed to consider the diagnosis of PV. The study excluded patients that were previously treated with either phlebotomy or cytoreduction. Designation of diagnostic categories was based on both a retrospective and prospective analysis of clinical data, bone marrow histology, and other laboratory parameters including leukocyte count, platelet count, serum erythropoietin (EPO) level, serum B12 level, and leukocyte alkaline phospatase (LAP) score. A diagnosis of secondary polycythemia (SP) required the presence of a condition known to be associated with SP. Apparent polycythemia (AP) was represented by patients in whom the diagnosis of either PV or SP could not be made and the stability of hematocrit values was documented by serial measurements. Measurement and interpretation of RCM values were according to the aforementioned published criteria and separate analyses were performed for males and females. Results : i) Evaluation of test performance : The study cohort consisted of 105 patients (60 males; median age 62 years, range 16–89) including 25 with PV, 35 with SP, 38 with AP, and 7 with essential thrombocythemia (ET). Table 1 outlines the percentage of patients, in each disease category, whose measured values exceeded the 98–99% limits of the reference range (i.e. ±25% of the normal predicted mean for an individual patient). Table 1 Diagnosis % with increased RCM (m2) % with normal RCM (m2) % with decreased plasma volume % with increased plasma volume PV (n=25) 80 20 0 20 ET (n=7) 57.1 42.9 0 29 SP (n=35) 20 80 2.9 5.7 AP (n=38) 21.6 78.4 5.4 5.4 The results reveal that RCM measurement was neither adequately sensitive nor specific in distinguishing PV from the other disease categories. In addition, based on the aforementioned ICHS criteria, chronically contracted plasma volume appears to be an infrequent phenomenon in AP. ii) Evaluation of added value for the diagnosis of PV : Among the 19 PV patients with elevated RCM, serum EPO was measured in 17 and the results showed decreased levels in 16 (94%). Bone marrow biopsy was available for review in 9 patients and the results were consistent with PV in all instances (100%). LAP score was performed in 12 patients and 11 had LAP scores above 130 (92%). In none (0%) of the 19 patients was RCM measurement found to be vital for the diagnosis of PV. Conclusion : In the current retropsective study, RCM measurement was found to be neither diagnostically accurate nor essential for the diagnosis of PV.

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