Clinical Hemorheology and Microcirculation - Volume 14, issue 1
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Clinical Hemorheology and Microcirculation, a peer-reviewed international scientific journal, serves as an aid to understanding the flow properties of blood and the relationship to normal and abnormal physiology. The rapidly expanding science of hemorheology concerns blood, its components and the blood vessels with which blood interacts. It includes perihemorheology, i.e., the rheology of fluid and structures in the perivascular and interstitial spaces as well as the lymphatic system. The clinical aspects include pathogenesis, symptomatology and diagnostic methods, and the fields of prophylaxis and therapy in all branches of medicine and surgery, pharmacology and drug research.
The endeavour of the Editors-in-Chief and publishers of
Clinical Hemorheology and Microcirculation is to bring together contributions from those working in various fields related to blood flow all over the world. The editors of
Clinical Hemorheology and Microcirculation are from those countries in Europe, Asia, Australia and America where appreciable work in clinical hemorheology and microcirculation is being carried out. Each editor takes responsibility to decide on the acceptance of a manuscript. He is required to have the manuscript appraised by two referees and may be one of them himself. The executive editorial office, to which the manuscripts have been submitted, is responsible for rapid handling of the reviewing process.
Clinical Hemorheology and Microcirculation accepts original papers, brief communications, mini-reports and letters to the Editors-in-Chief. Review articles, providing general views and new insights into related subjects, are regularly invited by the Editors-in-Chief. Proceedings of international and national conferences on clinical hemorheology (in original form or as abstracts) complete the range of editorial features.
The following professionals and institutions will benefit most from subscribing to
Clinical Hemorheology and Microcirculation: medical practitioners in all fields including hematology, cardiology, geriatrics, angiology, surgery, obstetrics and gynecology, ophthalmology, otology, and neurology. Pharmacologists, clinical laboratories, blood transfusion centres, manufacturing firms producing diagnostic instruments, and the pharmaceutical industry will also benefit.
Important new topics will increasingly claim more pages of
Clinical Hemorheology and Microcirculation: the role of hemorheological and microcirculatory disturbances for epidemiology and prognosis, in particular regarding cardiovascular disorders, as well as its significance in the field of geriatrics. Authors and readers are invited to contact the editors for specific information or to make suggestions.
Abstract: Background: Pharmacokinetic properties of hydroxyethyl starch (HES) depend on its molecular structure. However, various medium molecular weight HES preparations with different molar substitution (MS) are used in haemodilution (HD) with identical dosage recommendations. Objective: HES 200/0.5 and HES 200/0.62 respectively were compared with respect to their quantitative and qualitative parameters when used in hypervolemic haemodilution. Materials and Methods: 20 patients who suffered from acute middle cerebral artery infarction were randomly assigned to hypervolemic haemodilution with either HES 200/0.5 or HES 200/0.62. Using infusion pumps, a dosage of 500ml HES/24h was administered over a period of five days. Blood…samples were drawn daily and analyzed with respect to molecular weight fractions, erythrocyte aggregation and plasma Viscosity. Clinical examinations using Mathew Scale were performed on days 1, 3 and 5. Results: 120 hours following initial HD, significantly lower HES plasma levels (p < 0.01) and plasma viscosity (p < 0.05) were measured in the HES 200/0.5 group. Erythrocyte aggregation was also found to be less pronounced in this group, however, not to a statistically significant extent. Conclusion: “Steady state” infusion with HES 200/0.62 was followed by a higher accumulation of molecules compared to HES 200/0.5 leading to higher plasma viscosity and erythrocyte aggregation. Lower MS might thus have a more favourable influence on microcirculation. These findings, however, did not reflect statistically significant differences in clinical parameters in any HD group.
Abstract: The atherosclerotic process, along with the thrombotic events induce changes in blood and wall cells during the cerebro-vascular disease. Both the plaque, as a growing hindrance and a place for a chronic inflammation, and the underlying risk factors are acting upon the cells. A third actor is hypoxaemia occuring first as acute and transient episodes before a permanent setting behind the plaque. These changes disturb the flow and favour the wall cell adhesion. The platelets are shear induced activated. The red cells express a high aggregation related to elevated fibrinogen and specific disturbances linked to risk factors, acting also on…deformability and adherence. Granulocytes are primed and exhibit a higher adhesion potency. Endothelial cells, in areas of microcirculation related to artery stenosis, are very susceptible to hypoxaemia which induces a fall in NO, a depletion of nucleotides, prothrombotic and adhesive properties and a decrease expression of thrombomodulin. This latter glycoproein appears as an interesting marker providing split fragments linked to O2-generation during the reperfusion injury. Finally the cells are also involved in cell-to-cell interactions. These changes greatly influence the vascular disease and should be specifically treated.
Keywords: cell changes, C.V.A. red cells, endothelium
Abstract: The impact of heparin-induced extracorporeal low density lipoprotein (LDL) precipitation (HELP), a method that safely and effectively reduces plasma lipoproteins and fibrinogen and improves the haemorheologic pattern and blood flow properties, on regional cerebral blood flow (rCBF) was investigated in 10 patients with chronic cerebral infarctions. rCBF was measured by the 133 Xenon clearence method. Patients underwent a single HELP procedure after the first measurement of rCBF, and the second measurement was done one hour after the HELP session. 10 other patients with similar clinical symptoms and findings in CAT scan which were not subjected to HELP firmed as controls.…The HELP treatment produced an immediate and statistically significant reduction of all parameters relevant to haemorheology, such as plasma fibrinogen, whole blood viscosity at both, high and low shear rate, plasma viscosity, and red cell transit time. Total cholesterol, LDL, and triglycerides were reduced, too. The treated group showed significantly improved rCBF relative to the untreated controls to between 8.5 and 18.8 %. These results indicate that HELP has a potent impact in situation where a quick and drastic fluidification of the blood is required, thereby obtaining an improvement of rCBF.
Abstract: The effect of heparin-induced extracorporeal LDL precipitation (HELP), which is a relatively new method for safe and immediate reduction of parameters relevant to haemorheology, such as plasma fibrinogen or the lipoproteins, was investigated in 26 patients with cerebrovascular disease (CVD). 12 of them suffered from acute thrombembolic stroke, 14 had cerebral multiinfarct dementia. All the patients underwent 2 HELP applications within 8 days. The impact of HELP on CVD was studied by changes of laboratory data and by evaluation of clinical symptoms before and after treatment. Each HELP session caused an immediate, safe and significant reduction of important rheological parameters…such as fibrinogen (p < 0.001), whole blood viscosity at high and low shear rate, plasma viscosity and red cell transit time (p < 0.01 each). Even total cholesterol and low density lipoprotein (p < 0.0001 each), lipoprotein (a) (p < 0.003) and the triglycerides (p < 0.0001) had been reduced. The results in laboratory measurement were followed in both groups by a statistically significant improved neurologic recovery, represented in the values of the Mathew Scale, the Mini Mental State Examination and the Activities-of-Daily-Living-Test. These results can indicate the importance and influence of haemorheology on clinical symptoms in CVD.
Keywords: fibrinogen, HELP, blood viscosity, ADL, Mathew Scale, Mini Mental State Examination
Abstract: By means of heparin-induced extracorporeal LDL precipitation (HELP) selective, immediate and safe elimination of substances relevant to haemorheology such as fibrinogen, total cholesterol, low-density lipoprotein (LDL) , and triglycerides has become possible. The reduction of these parameters leads to a quick and statistically significant amelioration of the haemorheologic pattern, which has so far not been obtained by any haemorheologically active substance in comparable time or to a comparable degree. As this procedure was proved to be successful in cases of cardiac and cerebrovascular disease as well as in peripheral arterial disease where the haemorheologic state and clinical symptoms were improved…after HELP series, this treatment was also used in five patiens with ocular microcirculatory diseases (two branch retinal vein occlusions, one central retinal vein occlusion, one central artery occlusion, and one nonarteritic anterior ischaemic optic neuropathy. HELP was applied 6 times in each case. Fibrinogen (p < 0.0001), total cholesterol, LDL, and triglycerides (p < 0.001 each) were significantly reduced, even whole blood and plasma viscosity (p < 0.002 each) and red cell transit time (p < 0.003) had been ameliorated. At the end of the treatment session the patients showed an increase of their visual acuity by three or more lines as well as an improvement of the visual field. This very first results in oculary application of HELP could open an new discussion about the hypothesis that improved haemorheologic property of blood is an important factor in clinical recovery as well as basic ophtalmological function.
Abstract: Recombinant human erythropoietin (rhEPO; 180 or 1800 IU per kg) was daily administered to 6 weeks old rats for 1 to 2 weeks.  The increase of blood viscosity in rhEPO-administered rats in a saturation manner entirely depends on the hematocrit (the plasma viscosity and the plasma protein composition were not altered by rhEPO-administration).  No change in red cell deformability was observed upon rhEPO administration.  The velocity of rouleaux formation in autologous plasma decreased in rhEPO-administered rats.  A considerable polycythemia with reticulocytosis was induced in dose- and duration-dependent manners but in a saturation manner: cell volume increased…and intracellular hemoglobin concentration inversely decreased. The density distribution of red cells shifted towards low specific gravity and became heterogenous.  No drastic alterations in contents of 2, 3-diphosphoglycerate and ATP were detected. In conclusion, the increase of blood viscosity upon daily administration of rhEPO was hematocrit-dependent, regardless of the appearance of red cells with large volume and low internal viscosity.
Keywords: Erythropoietin (recombinant human), red cell deformability, red cell aggregation, viscosity, organic phosphates
Abstract: Blood cell and vascular cell dysfunctions have been observed in diabetes mellitus. Platelet hyperaggregability, monocyte dysfunctions, erythrocyte aggregability and adherence begin to be understood at the molecular level. The smooth muscle cell proliferation and the increase in vascular permeability could be related to cell-cell interactions or mediated via released factors such as cytokines or free radicals. A common but not exclusive explanation of these abnormalities could be non enzymatic glycosylation of lipids, proteins and cellular components.
Abstract: The successful management of marked biochemical and hemorheological abnormalities in preterm neonates, especially in babies with perinatal asphyxia, requires a thorough understanding of the causes and consequences of such changes. We divided 41 preterm newborns (< 37 weeks of gestational age) into two groups–with and without perinatal asphyxia–to study biochemical, hematological and hemorheological variables (plasma viscosity and internal erythrocyte viscosity measured with a Harkness type capillary viscosimeter, osmolality, anion gap, osmol gap) in blood samples from the umbilical artery and vein. The results were analyzed with comparison of the t-test, correlation and regression studies. The most noteworthy findings were: 1.)…similar values in biochemical, hematological and hemorheological variables in both vessels and in both groups, and 2.) evidence of a similar relation between plasma protein concentration and plasma viscosity in umbilical artery and vein in preterm neonates with acute fetal distress.
Abstract: We investigated the effect of intravenous 2mM Troxerutine and 10mM α-Tocopherol (Vitamin E) and their combination on erythrocyte aggregation and deformability, blood viscosity and leukocyte adhesivity in rats made mildly diabetic (fasting glycemia: 10mM vs 6mM in controls; HbA1 c: 6.5% vs 3% in controls) by a low dose of streptozotocin (35mg/kg) injected via the saphenous vein. In diabetic rats, as compared to controls, erythrocyte aggregation and blood viscosity were dramatically increased (disaggregation shear stress: 5.2 ± 0.4 dynes/cm2 vs 3.7 ± 0.3 dynes/cm2 in controls), whereas erythrocyte deformability and mesenteric blood flow were sharply decreased. Moreover, leukocyte…adhesivity was significantly increased. In diabetic rats, the combination of Troxerutine and Tocopherol improved all the above cited parameters. These data show that mild diabetes in rats results in many hemorheological disorders that can be largely corrected by Troxerutine and α-Tocopherol.
Keywords: Blood flow, Red Blood Cell aggregation, White Blood Cell adhesivity, Troxerutine, Diabetes, Vitamin E
Abstract: 202 human fetuses underwent percutaneous fetal blood sampling under ultrasound guidance for investigation of fetal structural abnormalities, red cell alloimmunization, or fetal infection. 75 were subsequently found not to be affected by the condition for which they were being investigated, or to have any other discernable abnormality. The blood samples from these 75 ‘normal fetuses’ were used to derive gestational reference ranges for fetal whole blood viscosity (over a range of shear rates), plasma viscosity, total plasma proteins and fibrinogen. The results show that fetal haematocrit is the major determinant of fetal whole blood viscosity, that fetal plasma proteins…and hence plasma viscosity are at very low levels compared to the adult and that all fetal haemorheological parameters rise significantly with gestation.
Abstract: Trained sportsmen have low values of blood viscosity (ηb). In this study we tested the functional consequences of this reduction of ηb in 34 sportsmen submitted to a 25 min progressively increasing submaximal work load. A low resting ηb (measured at high shear rate with the MT90 viscometer) was associated to a lower increase in blood lactate during exercise (correlation of ηb with: maximal lactate value: r=0.357 p < 0.05; area under the curve: r=0.490 p < 0.01). Subjects with ηb > 2.4 mPa.s (with this method) had higher lactate increase (p < 0.01) and a deeper decrease in blood…bicarbonate (p < 0.001). RBC rigidity (‘Tk’ index) is increased proportionaly to lactate when lactate increases above 4 mmol.l−1 . Another group of 21 professional footballers was studied during a maximal triangular work load until VO2 max. In this group there was a correlation between maximal lactate response during the test and RBC aggregation (r=0.705 p < 0.005). These results suggest that low whole blood viscosity at rest either (a) prevents from excessive lactate increase in this kind of exercise protocol; (b) or is a marker of trained persons characterized by metabolic/circulatory adaptations protecting against exercise-induced hyperlactatemia. In these experimental conditions lower RBC aggregation (within the normal range) seems to be also associated with fitness and lower lactate increase.
Abstract: Red blood cell (RBC) aggregation was determined in elderly subjects (mean age over 80 years) by using two ultrasonic (interferometry and backscattering) methods and compared with RBC aggregation measured in young healthy volunteers (mean age below 30 years). The two time parameters (tm and Δt) given by the interferometry method and the backscattering coefficient χ given by the backscattering method have been shown to be connected to the erythrocyte sedimentation rate and to the RBC aggregate size respectively. The results show that elderly subjects display hemorheological parameters significantly altered compared to those of young healthy volunteers. Long term treatment of…elderly patients (3 months) with a RBC anti-aggregant (dihydroergo cryptine) demonstrates an improvement of hemorheological parameters (Δt: + 10 %; χ coefficient: −29 %), in spite of a moderate increase of fibrinogenemia, and corroborates the favourable effects of the compound previously found in animals.