Document Detail


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.
MedLine Citation:
PMID:  22882132     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Jon Detterich; Tamas Alexy; Miklos Rabai; Rosalinda Wenby; Ani Dongelyan; Thomas Coates; John Wood; Herbert Meiselman
Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, N.I.H., Extramural     Date:  2012-08-06
Journal Detail:
Title:  Transfusion     Volume:  53     ISSN:  1537-2995     ISO Abbreviation:  Transfusion     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-06     Completed Date:  2013-03-28     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  0417360     Medline TA:  Transfusion     Country:  United States    
Other Details:
Languages:  eng     Pagination:  297-305     Citation Subset:  IM    
Copyright Information:
© 2012 American Association of Blood Banks.
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MeSH Terms
Descriptor/Qualifier:
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:
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; U54 HL090511/HL/NHLBI NIH HHS; UL1 TR000130/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Hemoglobin, Sickle; S88TT14065/Oxygen
Comments/Corrections

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