Clinical Hemorheology and Microcirculation - Volume 6, issue 3
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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: In this lecture the attention is focused on some data that may contribute to clarifying the relationship between Hemorheology, Fibrinolysis and Thrombosis. The natural link between these events is fibrinogen. Changes in fibrinogen concentration are therefore first discussed, as capable of contributing to hemorheologic changes in thrombotic and pre thrombotic states. Reduction of fibrinolytic activity has been described in many conditions associated with thrombosis, but it is doubtful whether persistent depression of the fibrinolytic “potential” should be considered a cause of increased fibrinogen levels. Association between high fibrinogen and depressed fibrinolysis is however a frequent event. The role of hyperfibrinogenaemia…as a risk factor for arterial thrombosis is established, while depression of the fibrinolytic potential is better correlated with venous thrombosis. The effect of fibrinogen derivatives, both plasmin and thrombin-derived, is finally discussed and some personal preliminary data are presented.
Abstract: The diagnostic and prognostic relevance of hemorheologic data in vascular diseases is critically analysed. Pathologic values of the flow properties of blood do not allow to draw conclusions in an individual patient. So far patients with severe ischemic diseases but without any rheological disorders can be found. Some exceptions from this rule exist.
Keywords: Flow properties of blood, diagnosis, prognosis, vascular diseases
Abstract: The aim of this paper is the study of the secondary hyperviscosity syndrome of ischemizing vascular diseases which becomes important during exercise. An experimental model was set up for the study of arterial and venous hemorheological parameters during an isotonic exercise in a lower limb of patients suffering from peripheral obliterative arterial disease with intermittent claudication. The exercise was performed on a pedal ergometer with a dynamic brake of our design, until the onset of claudication. Before and after exercise, arterial, femoral venous, and brachial venous blood was withdrawn. The whole blood viscosity at various shear rates, and whole blood…and washed red cell filterability were controlled. These hemorheological parameters were correlated to the variations of other parameters indicative of oxigen transfer and local acid-base equilibrium, of lactid acid production, of leucocyte and platelet activation and of fibrinolysis, always in arterial, femoral venous, and brachial venous blood. The results confirm that there is a worsening of the local blood fluidity in patients after exercise which is simultaneous and proportional to lactic acidosis and to venous pO2 fall. The reduction of whole blood filterability is more evident than that of washed red cells. The activation of platelets (beta-thromboglobulin increase) and of fibrinolysis (euglobulin-lysis-time shortening) in femoral venous blood was also pointed out. The insignificant variation of lactoferrin and of the number of leucocytes suggests a scarce involvement of granulocytes in this experimental model.
Abstract: The fluidity of blood in patients with coronary heart disease (CHD) is impaired. Earlier studies revealed an increased plasma viscosity, intensified red cell aggregation (RCA) and a reduced red cell filtrability (RCF) in CHD patients in comparison to healthy subjects. To clarify the causes of these changes the influences of physical activity, extent of coronary artery stenoses and rheological effect of the common therapy with nitrates and/or betablockers was been studied. In 105 patients with proven CHD (89 male, 16 female) and in 114 control subjects (69 male, 45 female) matched for age and risk factors blood viscosity, several of…its determinants (haematocrit, plasma fibrinogen, serum protein concentration, plasma viscosity), RCA and RCF have been measured. Following stress testing patients with CHD exhibited a more pronounced increase in fibrinogen, RCA and a significantly reduced RCF, despite their lower working capacity. In patients with stable CHD the degree of coronary stenoses is hardly related to altered blood fluidity but correlates significantly with the number of stenosed coronary arteries. A daily dose of 120 mg Isosorbitdinitrate was effective in a small group of 7 patients to improve their impaired RCF. In another small placebo controlled study in patients under nitrates an additional positive effect of 150 mg Metoprolol per day on RCF could be observed. To investigate the direct influence of myocardial ischaemia blood samples have been taken from the coronary sinus during right heart cathetrisation in 6 CHD patients and 4 control subjects. Whereas in the normal circulation arterial and venous blood behave rheologically identical, this does not seem to apply to coronary circulation. The fluidity of coronary venous blood turned out to be lower than that of the arterial control both in CHD and control patients.
Abstract: Red cell filterability (RCF in 8% buffer suspensions with albumin), haematocrit (Ht), haemoglobin (Hb), plasma viscosity (PV), fibrinogen (Fb) and erythrocyte sedimentation rate (ESR) were studied rn 15 patients (4 male, 11 female) of age range 15–58 years with idiopathic Raynaud’s syndrome and compared with 14 healthy controls (7 male, 7 female) of age range 19–67 years. Patients were in acute phase of vascular disease. RCF and PV were measured at 25°C and 37°C. There was no significant difference between patients and controls in the Hb, Ht, RCF and Fb. Plasma viscosity was significantly increased in the patients at 37°C…(p < 0.01) and even more at 25°C (p < 0.005). A significant increase (p < 0.01) in ESR was also detected in the patients. These findings suggest that abnormalities in plasma composition and physical properties may contribute to impairement of blood flow in the microcirculation.
Abstract: During a 5 weeks’ journey in the Far East healthy volunteers were exposed to radically different environments. In order to examine their influences on hemorheological and other variables, venous blood samples were taken repeatedly before and after the journey. Results yield significant changes in blood rheology, blood count, electrophoresis and plasma iron. It is therefore suggested that the bodily reactions to environmental changes affect such parameters. This should be taken into account when designing and interpretating clinical studies.
Abstract: Iron deficiency predisposes children with cyanotic forms of congenital cardiac disease to cerebrovascular accidents. We studied the contribution of blood viscosity (η) to the cerebrovascular symptoms of an iron deficient adolescent girl with a complete form of transposition of the great vessels. At clinical presentation, blood η was elevated and greater than expected for the hematocrit (HCT) level. An isovolemic, isohematocrit exchange transfusion with iron sufficient blood decreased blood η, rendered η appropriate for HCT level, and stopped cerebrovascular symptoms within hours. Hemoglobin (HB), HCT, chromium 51 red cell mass, pulse, blood pressure and blood gases were unaffected by treatment.…Cerebrovascular symptoms returned while blood iron deficiency persisted as blood η again increased beyond that expected for HCT; the anomalous η and symptoms were reversed by isovolemic plasma hemodilution. A comparable magnitude of blood η was well tolerated after blood iron sufficiency was attained and η was appropriate for HCT. The anomalous flow behavior of iron deficient blood was temporally associated with the central nervous system manifestations of polycythemic cyanotic heart disease in our patient.
Keywords: blood viscosity, iron deficiency, cyanotic heart disease
Abstract: Rheological behaviour in 150 normotensive pregnant subjects has been studied. All patients had uncomplicated pregnancies and consisted of 66 primagravidae and 84 multigravidae subjects. Whole blood and plasma viscosities were measured on a Carri-Med controlled Stress Rheometer and, with the exception of plasma fibrinogen quantitation, all other parameters were calculated from the results of these two basic techniques. These included red cell rigidity and “oxygen delivery” quotient. The latter is a relative calculation based on the fact that oxygen delivery to the tissues is directly proportional to the haemoglobin concentration and blood fluidity. Given that viscosity is inversely proportional to…fluidity then the haemoglobin/whole blood viscosity quotient indicates the oxygen delivery relative to the control group. Whole blood viscosity produces a decline (not statistically significant by the least squares method which was used throughout this study) reaching a minimum at 26 to 28 weeks of gestation then an increase to its original value by delivery (r=0.74, p=<0.0l). Plasma viscosity shows an increase from 32 weeks (r=0.74, P=<0.05). The mean haematocrit produces similar results to those of whole blood viscosity while the red cell rigidity peaks at 26 weeks then peaks again at a value outside the reference range at delivery. Similarly relative oxygen delivery to the tissues steadily decreases throughout pregnancy and reaches a minimum at 28 weeks (r=0.64, p=<0.001). An immediate increase to a value at 32 weeks then occurs followed by a further decrease to delivery at which point only some 55% relative oxygen delivery occurs. Clearly, further haematological investigation is indicated at the 26th to 28th week of gestation in view of these physiological changes.