Blood Volume and Hematocrit Value in Macroglobulinemia and Myeloma

Kopp, William L.; MacKinney, Archie A.; Wasson, Gertrude W.

doi:10.1001/archinte.1969.00300140040009

Cited by 23 publications

(3 citation statements)

References 4 publications

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“…This may be partly a result of plasma hypervolemia as indicated by the linear relationship found between increasing plasma volume and increasing plasma viscosity. A number of other investigators (30)(31)(32)(33)(34)(35) have also reported plasma hypervolemia in paraproteinemia. Therefore the reduced hematocrit in these patients can be considered, at least in part, as a dilutional anemia.…”

Section: Methodsmentioning

confidence: 93%

Paraproteinemia: blood hyperviscosity and clinical manifestations.

McGrath¹,

Penny²

1976

J. Clin. Invest.

104

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A B S T R A C T Many of the clinical features of paraproteinemia result from impairment of blood flow through the vascular tree because of blood hyperviscosity. Studies were carried out in 65 patients with serum paraproteins (31 with IgG, 25 with IgM, and 9 with IgA) to examine the relationship between the blood viscosity and the frequency of selected clinical features. The blood and plasma viscosities were measured at low rates of shear. Blood hyperviscosity was present in 91% of the patients and plasma hyperviscosity in 75% of the patients. In each of the three immunoglobulin classes both the blood and plasma viscosities increased logarithmically with the paraprotein concentration being greatest in the case of IgM. In addition, the relationship between the hematocrit and the logarithm of blood viscosity tended to be linear at any given protein concentration. In patients with very high levels of paraprotein the blood viscosity was modified by low hematocrits; the latter was below 30 in 70% of patients in whom the concentration of paraprotein was above 4 g/100 ml. The prevalence of clinical complications involving the retinal circulation, the peripheral vascular system, and the central nervous system increased markedly with increasing blood viscosity, measured at 0.18 s-1. One or more of these regions was affected in greater than 80% of patients with blood viscosity above 60 centipoise and in less than 23% ofpatients with blood viscosity below 40 centipoise. These observations illustrate the complex relationship between blood viscosity, concentration of paraprotein, immunoDr. M. A.

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Section: Methodsmentioning

confidence: 93%

Paraproteinemia: blood hyperviscosity and clinical manifestations.

McGrath¹,

Penny²

1976

J. Clin. Invest.

104

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“…Several factors have been implicated in the pathogene sis of MM-associated anemia [5,16], Among them are bone marrow (BM) infiltration by plasma cells, chemo therapy-induced BM suppression, renal failure, shortened RBC survival [17], dilutional effect of hypervolemia [18] and increased plasma viscosity [19], ACD appears to be more significant, typically occurring in cancer [6,20]. ACD is characterized by decreased RBC survival and defective iron reutilization due to cytokines, like tumor necrosis factor and IL-1, which are produced by tumor and normal host cells and suppress erythropoiesis [6,17,22], In MM, IL-6 is also important [ 16,22], Ariad et al [23] suggested that the anemia is caused not by low serum Epo levels, but by inadequate response to Epo at the level of the target cell.…”

Section: Discussionmentioning

confidence: 99%

Recombinant Human Erythropoietin in the Treatment of Multiple Myeloma-Associated Anemia

Mittelman¹,

Zeidman²,

Fradin³

et al. 1997

Acta Haematol

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Multiple myeloma (MM) is commonly associated with anemia. Several causes have been implicated but inadequate erythropoietin (Epo) production appears to be important. This single-institute open-label, non-comparative clinical trial was undertaken in order to evaluate serum Epo levels in patients with MM and to study the efficacy and toxicity of recombinant human Epo (rHuEpo) in the treatment of MM-associated anemia. MM patients with a baseline hemoglobin (Hb) level of < 11 g/dl received rHuEpo 150 U/kg 3 times/week subcutaneously, with a possible dose increase to 300 U/kg if no response was observed after 4 weeks. The study was designed for 12 weeks, although some responders continued rHuEpo. The study endpoints were determined by an increase in Hb and a decrease in blood transfusion requirements (BTR). Seventeen patients were enrolled in the study. The median serum Epo level was 150 mU/ml (range 11-232). Four patients did not complete the study for reasons unrelated to rHuEpo, but to their underlying MM. Twelve patients (70.6%) responded with an increase in their Hb levels. One patient (5.9%) responded partially. The median Hb level rose from 9.4 g/dl (range 7.3-10.7) at study commencement to 12.5 g/dl (range 9.0-15.2). Six of the 11 patients who were transfusion dependent enjoyed a complete abolition of BTR. The response was also interpreted as an improved quality of life: 3 patients reported a decrease of 1 level in their WHO performance status (PS) score; in 8 patients, the PS declined by 2 grades and 1 patient enjoyed PS reduction by 4 scores. Six patients continue to receive rHuEpo up to 18 months, with a good response and a smaller maintenance dose. Four patients reported flu-like symptoms, 2 suffered from a local irritation and 1 experienced a transient controlled elevation of blood pressure. Summmary: (1) Pretreatment endogenous serum Epo levels were relatively low in all patients studied with MM-associated anemia; (2) rHuEpo was well tolerated in these patients; (3) rHuEpo was highly effective in the treatment of anemia in MM, and (4) the response to rHuEpo is characterized by an increase in Hb levels, a reduction in BTR and an improvement in the WHO PS score.

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“…Pryor (1967a) drew attention to raised serum globulin levels in patients with tropical splenomegal y and raised plasma volumes. However: more recently Kopp, MacKinney and Wasson (1969) have failed to show a correlation be-tween an abnormal globulin concentration and the plasma volume in patients with macroglobulinaernia or myelomatosis, Another factor in cirrhosis causing an increase in plasma volume might be secondary hyperaldosteronism (Coppage, Island, Cooper and Uddle, 1962). Retention of sodium and water causes an increase in the extracellular volume, as found in some of the cirrhotic patients but in patients with blood diseases extracellular volume was normal and three patients with enlarged plasma volumes had normal sodium balance studies.…”

Section: Discussionmentioning

confidence: 99%

Studies on the Haemodilution Anaemia of Splenomegaly

Blendis

Ramboer

Williams

1970

Eur J Clin Investigation

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The occurrence and causes of a haemodilution anaemia have been studied in two groups of patients, one with diseases of the blood or reticulo‐endothelial system, the other with cirrhosis. In the blood dyscrasia group 37 of 46 patients were anaemic but only 3 had a reduced red cell mass. In the remainder the plasma volume was increased to a greater extent than the red cell mass which was slightly elevated or within the normal range. A significant correlation was found between a decrease in haemoglobin concentration and an increase in plasma volume. Both the increase in plasma volume and the changes in red cell mass were related to enlargement of the spleen. Measurements carried out at splenectomy showed that an excess of red cells was held within the enlarged spleen whereas up to 30 per cent only of the excess plasma could be found there. A correlation between the plasma volume and spleen blood flow was found but both are related to spleen size and the most likely explanation for the increased plasma volume was a primary increase in vascular capacity. The different effect of posture on the plasma volume in patients before and after splenectomy would also support this hypothesis. In contrast, 20 of the 50 cirrhotic patients were anaemic and seven of these had a reduced red cell mass. In the other 13 patients the plasma volume was increased to a greater extent than the red cell mass but even in those with a haemodilution anaemia, the haemoglobin concentration was not inversely related to the plasma volume. In seven patients the increase in plasma volume was less than that of the red cell mass and four patients were polycythaemic. There was no correlation between the changes in red cell mass and plasma volume or between either of these and the enlargement of the spleen. The presence of portal hypertension appeared to be an important factor but the increase in plasma volume was not related to the extent of the portosystemic venous collaterals.

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Blood Volume and Hematocrit Value in Macroglobulinemia and Myeloma

Cited by 23 publications

References 4 publications

Paraproteinemia: blood hyperviscosity and clinical manifestations.

Paraproteinemia: blood hyperviscosity and clinical manifestations.

Recombinant Human Erythropoietin in the Treatment of Multiple Myeloma-Associated Anemia

Studies on the Haemodilution Anaemia of Splenomegaly

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