Clinical Hemorheology and Microcirculation - Volume 8, issue 5
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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.
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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: We were deeply saddened to announce, on the occasion of this issue dedicated to our late friend and colleague George William Scott Blair, also the news of the death of our friend and colleague Takehiko Azuma. He was an Editor of CLINICAL HEMORHEOLOGY since 1981, when this Companion Journal of BIORHEOLOGY began its publication. We express our deeply felt sympathies to Mrs. Rita Scott Blair and Mrs. Etsuko Azuma and their families. In our condolences we are joined by the Publishers and the members of the Editorial Board of CLINICAL HEMORHEOLOGY.
Abstract: These pages are dedicated to the memory of our colleague and dear friend George William Scott Blair, Co-Founder of BIORHEOLOGY and its Co-Editor-in-Chief from November 1959 to December 1978. The photograph of George W. Scott Blair was taken in 1972 during the Banquet of the First International Congress of Biorheology, held together with the Sixth International Congress on Rheology, at Lyon, France.
Abstract: In four patients with extreme fetal growth retardation before 28 wks amenorrhea an attempt was made to improve maternal placental perfusion by isovolemic hemodilutio. Despite the substantial reduction in maternal whole blood viscosity, the predicted intra-uterine fetal death occurred in all 4 patients. No substantial changes were found in the fetal non stress cardiotocogram during or after the hemodilution procedure. Very small and largely infarcted placentae were present. It is concluded, that the decrease in maternal whole blood viscosity was not effecti ve in modi fying the ultimate fatal outcome.
Abstract: A laser diffraction system for the measurement of R BC deformation (i.e., Elongation Index, EI) has been evaluated and the results compared to data obtained via direct observation with a cone-plate Rheoscope; this laser system is designed to be used with a Contraves LS-30 viscometer and is based on the ektacytometric principle. When compared with the Rheoscope, EI values from the laser system are in close agreement (r = 0.965, 7 normal donors) over a shear stress range of 6.2 to 245.8 dynes/cm2 . Both methods demonstrated decreasing RBC deformability consequent to increasing periods of heat treatment at 48 ∘…C, with the paired data being fitted by a Y = X relationship. In addition, the laser system clearly demonstrated the expected inverse relation between cell age (i.e., density and cell deformation. The laser system was also used to measure light transmission-shear rate relations and thus to determine the minimum shear rate necessary to induce complete RBC disaggregation (γ ˙ Tmin ); paired studies indicated excellent agreement between this method and results obtained with a Myrenne Aggregometer (r = 0.989, 7 normal donors). In overview, this laser diffraction system offers a useful, relatively low cost method for the measurement of RBC deformability and of RBC aggregation parameters; whole blood and plasma viscosity measurements are also possible via the associated Contraves viscometer.
Abstract: This paper deals with the study of comparison of haemorheological parameters between normal controls (NC) and cases of chronic infections (INFC) including tuberculosis. The haemorheological parameters studied include haematocrit, whole blood viscosity, plasma viscosity, erythrocyte deformability, erythrocyte sedimentation rate and red cell aggregation. Of all the haemorheological parameters the values of haematocrit, red cell aggregation and red cell rigidity index (Tk) are significantly altered.
Keywords: Chronic infections, red cell aggregation, hacmatocrit, plasma viscosity
Abstract: We studied blood and plasma viscosity, hematocrit, erythrocyte aggregation index and plasma protein fractions in 26 healthy subjects. We found a significant positive linear correlation between hematocrit and blood viscosity at each of the considered shear rates (low shear range), and a significant negative linear correlation between hematocrit and erythrocyte aggregation index. Furthermore, we found a significant linear correlation between a multiparameter index and erythrocyte aggregation index so that fibrinogen and a-2-globulins seemed to have an enhancing effect on rouleaux forming whereas albumin and hematocrit seemed to play an opposing role. Physiopathological and clinical aspects of these findings were discussed.
Abstract: The oxygen-carrying resuscitative fluids called blood substitutes, have been synthesized from a hydroxyethyl starch (HES) modified to a polymeric trialdehyde and hemoglobins (Hgb) which are stabilized with either glyoxalic acid or 1,2-cyclohexanedione. The molecular weights of the starting HES polymers were 450,000, 264,000 and 59,000. The modified HES compounds averaged about 35% aldehyde. After synthesis, the new polymers shifted the P50 from 14.9 mmHg for a 6% Hgb solution to about 35 mmHg. From the preliminary studies in this laboratory, it appears feasible to produce a suitable substance in a freeze-dried form. In vivo experiments included exchange-transfusion in rats…following the hemoglobin retention kinetics in the plasma and the excretion in the urine. The results indicate that these blood substitutes are hemodiluents, can provide adequate oncotic pressure as well as the necessary oxygen transport for animal survival. Using these new polymers, final hematocrits below 15% were much easier to obtain with a vastly improved survival rate. Electrophoretic mobility patterns of the plasma during the transfusion-exchange indicate a step-wise breakdown of the polymer. In some cases, the substitute remained in the plasma up to 72 hours.
Abstract: The impaired deformability of sickle cells is a consequence of increased cytoplasmic viscosity secondary to cell dehydration and polymerization of haemoglobin S. Cetiedil citrate and oxpentifylline are potential anti-sickling agents that preserve intracellular cations and improve the deformability of sickle cells when they are dehydrated by ionophore-induced loss of intracellular K+ and water. When sickle cells from 19 patients were dehydrated by hyperosmolar stress, without inducing loss of cell cations, neither drug prevented the consequential reduction in cell filterability through 5 µm diameter pores. These drugs will not, therefore, prevent loss of water from erythrocytes in a hypertonic environment…such as the renal medulla or ischaemic tissue. Preservation of erythrocyte K+ content would, however, maintain a higher reserve of cell cations and water to withstand hyperosmolar stress.
Abstract: Cetiedil citrate is an iminoester and vasodilator that has a rheological effect in vascular disease and sickle-cell anaemia. When norma 1 human erythrocytes were dehydrated in vi tro us i ng the Ca2+ ionophore A23187, or the Na+ /K+ ionophore nystatin, the drug was shown to have a dual effect - decreasing K+ loss via the Gardos channel and increasing passive Na+ and K+ flux along their concentration gradients. Erythrocyte filterability through 5 µm diameter pores altered in association with change in the cation, and therefore water, content of the ionophore-treated erythrocytes. There was no…evidence that the drug increased ATP concentration or, when tested by osmotic fragility and laser diffractometry, that it expanded the membrane surface area of erythrocytes. Thus the rheological action of cetiedil citrate on human erythrocytes is mediated by an effect on cell hydration.
Keywords: Rheology, erythrocyte deformability, ion transport
Abstract: Haemorheological parameters are determined in six different allergic skin diseases. Only Plasma Viscosity was found to be significantly altered in both pooled sample and diseases Classified into 6 groups.
Abstract: ESR was greatly influenced by Hct, which caused ESR to lose its original meaning and accuracy. In order to avoid the interference, an equation relating ESR to Hct was derived as ESR = − K ( ln H + ( 1 − H ) ) , here K was defined as the coefficient for the equation which could be easily calculated for every tested subject from ESR and Hct. The increase of K implied losing charge on surface of RBC biophysically and associated with the contents of fibrinogen, IgG and IgA. The method using K to test patients…instead of origenal ESR showed the good superriority such as exclusion of interference from Hct and increase of accuracy in clinical investigation. The abnormality of some patients with ischemic stroke or acute myocardial infarction could be detected by K, but they were shown in normal range by ESR.
Abstract: Elderly subjects ingested 2g or 1g of Cod Liver Oil for 6 weeks. Platelet aggregation, Blood filterability and fatty acid composition of both plasma and red cell membrane phospholipids were investigated before and after Cod Liver Oil intake. Platelet aggregation induced by low concentration of collagen, epinephrin and ADP was significantly reduced after 2g or 1g of Cod Liver Oil. Blood filterability was enhanced as well as EPA and DBA content in red cell membrane after 2g of CLO intake. There is no modification in the fatty acid composition of both plasma or red cell phospholipids after 1g of…CLO. Further to their antiaggregatory effect, dietary EPA and DBA may regulate hemorheological parameters. Therefore daily intake of these n-3 fatty acids may protect against atherosclerosis and thrombosis.
Abstract: The aggregation state of sickle cells was studied as a function of oxygen partial pressure, with ultrasound backscattering. The ultrasonic backscattering coefficient χ , which depends on the size of the aggregates, is highly correlated with erythrocyte sedimentation rate. Sickle cells (SS) in their plasma present a χ variation versus pO2 similar to the variation of the sickling curve. These results suggest that sickling prevent aggregation of sickle cells.
Keywords: Aggregation, Ultrasound, Red Blood Cell, Sickle cell anemia
Abstract: The effect of sialic acid of erythrocytes on the cellular aggregation and deformability was quantitatively examined. Desialylated red blood cells were obtained after incubation with neuraminidase at different concentrations. The electrophoretic mobility was controlled. Erythrocyte aggregation was measured via ultrasound backscattering on erythrocytes resuspended In autoloqous plasma. Red blood cell deformability was studied on dilute suspensions In phosphate buffer by the Initial flow rate filtration method and the cell transit time analysis. For desialylated red blood cells In suspension. Aggregation is increased due to the reduction of the electrostatic repulsive force among erythrocytes. An increase of the cellular transit time…is found. A reason which could explain this phenomenon is the role of the cell membrane-pore wall sieves Interactions.
Abstract: We have examined the influence of Ca2+ -ions and 2,3-diphosphoglycerate (2,3-DPG) on the solubility of deoxygenated human hemoglobin A. We could demonstrate that Ca2+ - normally present with 0.2 µmol in the erythrocyte - reduces solubility by 13 % already in a concentration of 50 µmol. This decrease in solubility by Ca2+ could be compensated by 2,3-DPG in physiological ranges from 15–20 µmol/g hemoglobin, and there is no synergistic behaviour of these two substances. A model is presented that accounts for the intraerythrocytic Ca2+ /organic phosphate equilibrium as a determining factor of deoxyhemoglobin leading to an altered deformability…of erythrocytes.
Keywords: Calcium ions, 2,3-diphosphoglycerate, deoxygenated human hemoglobin
Abstract: The effects of diabetes mellitus and myocardial infarction on the erythrocyte sedimentation profiles under gravitational field are determined by the transmission of He-Ne laser light through the blood sample contained in a glass chamber, and are compared with that of normal sample. It has been observed that the sedimentation profiles at various points in the blood column depend on the clinical status of blood. In myocardial infarction the erythrocytes tend to settle faster than that of diabetes mellitus at all time intervals, which in turn sediment faster than that of normal blood. The aggregation index, (as obtained by the ratio…of the transmittod intensity for normal to that of diseased blood) is higher in myocardial infarction compared to that of diabetes mellitus at all time intervals.
Abstract: Blood rheology measurements (whole blood viscosity, plasma viscosity, erythrocyte viscosity, hematocrit and fibrinogen) were made in 130 obese subjects (89 adults and 41 children), 23 hyperlipidemic subjects and 88 controls. Obesity was characterized by an increase in blood and plasma viscosity and plasma fibrinogen. Erythrocyte viscosity was normal in obese adults and elevated in obese children. Blood hyperviscosity in adult obese subjects was more evident in the presence of hypertension. Nevertheless, adult obese subjects without associated disease showed a higher blood viscosity than control subjects. Blood viscosity in obese children was not found to have any correlation with…hypertension, cholesterol and triglycerides but correlated significantly with percentage overweight. Increased blood, plasma and erythrocyte viscosity but a normal plasma fibrinogen were found in hyperlipidemia.
Abstract: A controlled physical training was programmed for 15 peripheral obliterative arterial disease (POAD) patients with a daily exercise for 6 days every week, for 3 consecutive weeks without drugs treatment. Several haemorheological, haemodynamic and metabolic parameters were registered before and after the treadmill exercise, before and after the training period. The mean starting pain free walking distance was 283.7±50.4 m. At this moment, after the exercise, a Significant increase of whole blood viscosity and fibrinogen concentration, and a decrease of whole blood filterability were shown. At the same time a significant increase of venous β -thromboglobulin, thromboxane A2 adenosine…and lactate were registered while the euglobulin lysis time was reduced as well as blood pH and venous PO2 . After three weeks of training the pain free distance increased to 447.0±53.4 m. At this moment three measurements of the above mentioned functions are made: the first at the beginning of the exercise, the second one at the time corresponding to the pain free distance registered before training, and the last at the new pain free distance. The registered data showed that at the first and at the second point the value of each variable was better than that registered before the training, while that registered at the last time was not significantly different from the corresponding initial evaluation. The leg blood flow was unchanged. In conclusion the training-dependent improvement of the pain free distance was not associated to an increase of blood flow but rather to a complex mechanism involving both rheological and metabolic changes.
Abstract: Four normal women and two heterozygous β -thalassemic women were examined throughout one or more menstrual cycles for variations in several rheological parameters and red cell metabolism during the menstrual, follicular and luteal phases. Cyclic variations were found in the physical and chemical properties of the red cells (including mean corpuscular hemoglobin concentration, intracellular contents of 2,3-diphosphoglycerate and adenosine triphosphate, and erythrocyte deformability). These physiological changes during the menstrual cycle are exaggerated in heterozygous B-thalassemic women.
Keywords: Blood Rheology, Heterozygous Thalassemia, Menstrual Cycle, Red Cell Aggregation, Red Cell Deformability, Red Cell Metabolism
Abstract: In a series 43 patients suffering from cerebral or peripheral diseases were investigated over a period of 3 days after a single hypervolemic hemodilution with 500ml low molecular weight dextran (Rheomacrodex® ) applied within 3 hours. Changes in hematocrit, visco-elasticity of whole blood and plasma viscosity were studied. 18 to 36 hours after onset of infusion a significant increase in plasma viscosity (p ⩽ 0.001 ) and elasticity (p ⩽ 0.01 ) could be observed. Furthermore, there was a tendency towards higher hematocrit and whole blood viscosity levels. However, after 60 hours a second lower…numerical peak for hematocrit and viscosity of whole blood could be seen, which was yet above starting values.
Abstract: The present study evaluates the whole blood filterability index (WB-FI) and the washed red blood cell filterability index (WRBC-FI) in 21 chronic cerebrovascular insufficiency (CCVI) patients and in 36 control subjects. Althoug no significant differences were found in the mean values of the two groups, approximately 30% of the patients had a decreased WB-FI. Of the 7 CCVI patients who showed reduced WB-FI, this decrease could be attributed to erythrocyte deficiency in only two of the cases. Of the 21 CCVI patients, pentoxifylline (POX) was administered to 9, dipyridamole (DIP) to 6 and POX+DIP to another 6. The changes…in WB-FI were evaluated 7, 15 and 45 days after treatment was begun. POX and DIP administered separately favoured WB-FI at 15 and 7 days respectively, but when administered together, WB-FI only increased slightly on the 45th day.
Abstract: Piracetam (2-oxo-1-pyrrolidine acetamide) has been reported to have a beneficial rheological effect on sickle cells although its mode of action has remained unclear. When the Ca2+ -ionophore A23187 was used to induce loss of K+ and water from sickle cells from 20 patients, the consequential loss of erythrocyte filterability through pores of 5 µm diameter was partially corrected by piracetam at concentrations of 0.1-100 mmol/l (p < 0.002 - < 0.02). No beneficial effect of piracetam was found when sickle cells were dehydrated using the K+ ionophore valinomycin. Piracetam therefore prevents cation (K+ ) loss, via the Gardos…channel, from Ca2+ -loaded erythrocytes and may thereby inhibit the dehydration of sickle cells.