Exchange Transfusion with Dextran 40 in Polycythaemia Secondary to Hypoxic Lung Disease

Phlebotomy improves Pulmonary Gas Exchange in Chronic Mountain Polycythemia

“…How ever, patients with COPD showed no im provement in spirometry [6,10,11,14,20] and variable improvement in blood gases [6,10,11,14,20,22,27], The changes we have observed in spirometry and blood gas es after phlebotomy in CMP patients are comparable to those obtained in PV pa tients [18], (2) Small sample size of the population studied. Of five published stud- ies, one showed improvement [20] and four showed [1,11,14,22] the tendency to in crease P a02 and decreased PaC 02 with phlebotomy without statistically significant difference before versus after phlebotomy. However, when we pooled data from 45 pa tients in these reports, we observed an im provement in blood gases (Pa02 2.7 ± 0.81 mm Hg, p < 0.002; PaC02-1.8 ± 0.87 mm Hg, p < 0.05).…”

“…In the published reports [1,11,14,20,22] the increases in PaO, did not correlate with the decreases in PaCO,. Therefore, we considered it unlikely that phlebotomy had increased alveolar ventilation.…”

“…On the other hand, there is not unanimous agreement between investigators upon the effects of bleeding on cardiopul monary function. Some reports show signifi cant changes in blood gases [18,20] and lung volumes [1,9] while others fail to de monstrate such changes [6,10,11,14,20,22,27]. However, all reports document im provement in the subjective feeling of well-being as well as the symptomatic relief experienced by COPD, CCHD and PV pa tients after phlebotomy [1, 6, 9-11, 14, 18, 20, 22, 27], Thus, blood-letting of a polycy themic patient is not an easy consideration except when thrombosis and bleeding are associated with polycythemia [25] or when symptomatic ischemic heart disease is asso ciated with erythrocytosis [2].…”

Clinical features of polycythaemic patients with chronic obstructive non-specific lung disease

“…The justification for doing this is based on evidence which suggests that the development of polycythaemia can produce a poor prognosis in this condition (Mitchell, Webb, and Filley, 1964) due to the development of pulmonary hypertension and high blood viscosity producing heart failure and further hypoxia (Harvey et al, 1951;Renzetti, McClement, and Litt, 1966;Segel and Bishop, 1966;Dintenfass and Read, 1968;Agarwal, Paltoo, and Palmer, 1970). Furthermore, encouraging results have been obtained by those who have reduced the level of polycythaemia by, for example, using continuous oxygen (Chamberlain and Millard, 1963), venesection (Massaro and Katz, 1965;Rakita, Gillespie, and Sancetta, 1965), haemolytic drugs combined with marrow suppressants (Pengelly, 1966 and1969), and, more recently, exchange transfusion with Dextran 40 (Harrison, Gregory, Clark, and Scott, 1971). However, the efficacies of these measures need further assessment, as all these observations were made on relatively few patients without matched controls.…”

Early Effects of Oxygen Administration and Prognosis in Chronic Obstuctive Pulmonary Disease and Cor Pulmonale1–3

“…However, a number of patients show no improvement with oxygen therapy. Identification of these patients would spare the expense, inconvenience, and hazards (8,9) of long-term oxygen therapy, and it also might turn the attention of the physician to potentially more effective measures, such as the control of heart failure and infection (10), vasodilators (11), dextran infusion in patients with polycythemia (12), and a rehabilitation program (13). The importance of predicting a good response to oxygen therapy has been widely acknowledged (13,14).…”