Effects of phlebotomy on a patient with secondary polycythemia and angina pectoris

Piccirillo, Gianfranco; Fimognari, Filippo Luca; Lama-Valdivia, Jaime; Marigliano, Vincenzo

doi:10.1016/0167-5273(94)90023-x

Cited by 6 publications

(7 citation statements)

References 4 publications

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“…Hyperviscosity angina-cardiac ischemia resulting from poor coronary perfusion caused by hyperviscous blood-has been described in polycythemia and connective tissue disorders. 14,15 To our knowledge, however, hyperviscosity angina The Plot Thickens | Fleming et al has not been reported in patients with multiple myeloma. Treatment of hyperviscosity with end-organ damage typically consists of plasmapheresis, but this patient was started on urgent chemotherapy, and his symptoms improved.…”

Section: Discussionmentioning

confidence: 88%

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Fleming

Sena

Manesh

et al. 2017

Journal of Hospital Medicine

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The approach to clinical conundrums by an expert clinician is revealed through the presentation of an actual patient's case in an approach typical of a morning report. Similarly to patient care, sequential pieces of information are provided to the clinician, who is unfamiliar with the case. The focus is on the thought processes of both the clinical team caring for the patient and the discussant. This icon represents the patient's case. Each paragraph that follows represents the discussant's thoughts.

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Section: Discussionmentioning

confidence: 88%

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Fleming

Sena

Manesh

et al. 2017

Journal of Hospital Medicine

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“…Decrease in incidence and severity of angina pectoris[10] and improvement in exercise tolerance has been observed after phlebotomy. [11] Data tends to support the hypothesis that the afterload on the left ventricle is reduced resulting in improved myocardial contractility and left ventricular function.…”

Section: Discussionmentioning

confidence: 99%

Phlebotomy for rapid weaning and extubation in COPD patient with secondary polycythemia and respiratory failure

2010

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The increased incidence of ventilator-associated complications in patients with chronic obstructive pulmonary disease (COPD) necessitates rapid weaning and extubation. The presence of secondary polycythemia in this subgroup increases the incidence of stroke and myocardial infarction due to hyperviscosity and tissue hypoxia. We present a 58-year-old male patient of COPD with secondary polycythemia (hematocrit 64%) who had possible hyperviscosity-related complications leading to cardiac arrest after a minor surgical procedure. The patient developed ventilator dependence after recovery. Phlebotomy was done to remove 10% of total blood volume. Symptomatic improvement was dramatic. Improvement in weaning indices like rapid shallow breathing index and PaO2/PAO2 was observed facilitating rapid weaning and early extubation. Monitored, acute phlebotomy is safe and cost-effective. It decreases blood volume and viscosity, increases cardiac output and improves exercise tolerance in patients.

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“…Those patients reported a general feeling of improvement in wellbeing after phlebotomy. Additional reports of the efficacy of therapeutic phlebotomy in angina pectoris were published in 1970 [Parker et al 1970] and 1994 [Piccirillo et al 1994]. Most recently, a prospective, randomized trial of therapeutic phlebotomy in metabolic syndrome resulted in significant decreases in serum glucose and blood pressure [Houschyar et al 2012].…”

Section: Therapeutic Implicationsmentioning

confidence: 99%

The systemic vascular resistance response: a cardiovascular response modulating blood viscosity with implications for primary hypertension and certain anemias

Sloop

Weidman

Cyr³

2015

Therapeutic Advances in Cardiovascular Disease

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Without an active regulatory feedback loop, increased blood viscosity could lead to a vicious cycle of ischemia, increased erythropoiesis, further increases of blood viscosity, decreased tissue perfusion with worsened ischemia, further increases in red cell mass, etc. We suggest that an increase in blood viscosity is detected by mechanoreceptors in the left ventricle which upregulate expression of cardiac natriuretic peptides and soluble erythropoietin receptor. This response normalizes systemic vascular resistance and blood viscosity at the cost of producing 'anemia of chronic disease or inflammation' or 'hemolytic anemia' both of which are better described as states of compensated hyperviscosity. Besides its role in disease, this response is also active in the physiologic adaptation to chronic exercise. Malfunction of this response may cause primary hypertension.

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Effects of phlebotomy on a patient with secondary polycythemia and angina pectoris

Cited by 6 publications

References 4 publications

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Phlebotomy for rapid weaning and extubation in COPD patient with secondary polycythemia and respiratory failure

The systemic vascular resistance response: a cardiovascular response modulating blood viscosity with implications for primary hypertension and certain anemias

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