| Low-shear red blood cell oxygen transport effectiveness is adversely affected by transfusion and further worsened by deoxygenation in sickle cell disease patients on chronic transfusion therapy. | |
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MedLine Citation:
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PMID: 22882132 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Simple chronic transfusion therapy (CTT) is a mainstay for stroke prophylaxis in sickle cell anemia, but its effects on hemodynamics are poorly characterized. Transfusion improves oxygen-carrying capacity, reducing demands for high cardiac output. While transfusion decreases factors associated with vasoocclusion, including percent hemoglobin (Hb)S, reticulocyte count, and circulating cell-free Hb, it increases blood viscosity, which reduces microvascular flow. The hematocrit-to-viscosity ratio (HVR) is an index of red blood cell oxygen transport effectiveness that varies with shear stress and balances the benefits of improved oxygen capacity to viscosity-mediated impairment of microvascular flow. We hypothesized that transfusion would improve HVR at high shear despite increased blood viscosity, but would decrease HVR at low shear. STUDY DESIGN AND METHODS: To test this hypothesis, we examined oxygenated and deoxygenated blood samples from 15 sickle cell patients on CTT immediately before transfusion and again 12 to 120 hours after transfusion. RESULTS: Comparable changes in Hb, hematocrit (Hct), reticulocyte count, and HbS with transfusion were observed in all subjects. Viscosity, Hct, and high-shear HVR increased with transfusion while low-shear HVR decreased significantly. CONCLUSION: Decreased low-shear HVR suggests impaired oxygen transport to low-flow regions and may explain why some complications of sickle cell anemia are ameliorated by CTT and others may be made worse. |
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Authors:
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Jon Detterich; Tamas Alexy; Miklos Rabai; Rosalinda Wenby; Ani Dongelyan; Thomas Coates; John Wood; Herbert Meiselman |
Publication Detail:
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Type: Clinical Trial; Journal Article; Research Support, N.I.H., Extramural Date: 2012-08-06 |
Journal Detail:
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Title: Transfusion Volume: 53 ISSN: 1537-2995 ISO Abbreviation: Transfusion Publication Date: 2013 Feb |
Date Detail:
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Created Date: 2013-02-06 Completed Date: 2013-03-28 Revised Date: 2013-04-16 |
Medline Journal Info:
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Nlm Unique ID: 0417360 Medline TA: Transfusion Country: United States |
Other Details:
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Languages: eng Pagination: 297-305 Citation Subset: IM |
Copyright Information:
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© 2012 American Association of Blood Banks. |
Affiliation:
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Division of Cardiology, Children's Hospital Los Angeles, California 90027, USA. jdetterich@chla.usc.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Anemia, Sickle Cell / blood*, metabolism, therapy* Biological Transport Blood Viscosity / physiology Child Cross-Sectional Studies Efficiency / physiology Erythrocyte Transfusion / adverse effects* Erythrocytes / metabolism* Female Hemoglobin, Sickle / metabolism Humans Male Oxygen / metabolism* Oxygen Consumption / physiology Shear Strength Time Factors Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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1 U54 HL090511-01/HL/NHLBI NIH HHS; 5RC1 HL099412-01/HL/NHLBI NIH HHS; RC1 HL099412/HL/NHLBI NIH HHS; RR00043-43/RR/NCRR NIH HHS; UL1 TR000130/TR/NCATS NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Hemoglobin, Sickle; 7782-44-7/Oxygen |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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