Hemoglobin concentration, total hemoglobin mass and plasma volume in patients: implications for anemia

Otto, James M.; Plumb, James O. M.; Clissold, Eleri; Kumar, Shriya B.; Wakeham, Denis J.; Schmidt, Walter; Grocott, Michael P.W.; Richards, Toby; Montgomery, Hugh

doi:10.3324/haematol.2017.169680

Cited by 70 publications

(89 citation statements)

References 43 publications

(45 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…; Otto et al. ). The adaptive response to this hemoconcentration involves the loss of erythrocytes that can reach clinical anemia levels (Trudel et al.…”

Section: Introductionmentioning

confidence: 97%

Hemolysis during and after 21 days of head-down-tilt bed rest

2017

View full text Add to dashboard Cite

Hemoconcentration is observed in bed rest studies, descent from altitude, and exposure to microgravity. Hemoconcentration triggers erythrocyte losses to subsequently normalize erythrocyte concentration. The mechanisms of erythrocyte loss may involve enhanced hemolysis, but has never been measured directly in bed rest studies. Steady‐state hemolysis was evaluated by measuring two heme degradation products, endogenous carbon monoxide concentration [CO] and urobilinogen in feces, in 10 healthy men, before, during, and after two campaigns of 21 days of 6° head‐down‐tilt (HDT) bed rest. The subjects were hemoconcentrated at 10 and 21 days of bed rest: mean concentrations of hemoglobin (15.0 ± 0.2 g/L and 14.6 ± 0.1 g/L, respectively) and erythrocytes (5.18 ± 0.06E6/μL and 5.02 ± 0.06E6/μL, respectively) were increased compared to baseline (all Ps < 0.05). In contrast, mean hemoglobin mass (743 ± 19 g) and number of erythrocytes (2.56 ± 0.07E13) were decreased at 21 days of bed rest (both Ps < 0.05). Indicators of hemolysis mean [CO] (1660 ± 49 ppb and 1624 ± 48 ppb, respectively) and fecal urobilinogen concentration (180 ± 23 mg/day and 199 ± 22 mg/day, respectively) were unchanged at 10 and 21 days of bed rest compared to baseline (both Ps > 0.05). A significant decrease in [CO] (−505 ppb) was measured at day 28 after bed rest. HDT bed rest caused hemoconcentration in parallel with lower hemoglobin mass. Circulating indicators of hemolysis remained unchanged throughout bed rest supporting that enhanced hemolysis did not contribute significantly to erythrocyte loss during the hemoconcentration of bed rest. At day 28 after bed rest, decreased hemolysis accompanied the recovery of erythrocytes, a novel finding.

show abstract

“…; Otto et al. ). The adaptive response to this hemoconcentration involves the loss of erythrocytes that can reach clinical anemia levels (Trudel et al.…”

Section: Introductionmentioning

confidence: 97%

Hemolysis during and after 21 days of head-down-tilt bed rest

2017

View full text Add to dashboard Cite

show abstract

“…Teniendo en cuenta, que la medición de Hb se usa como un marcador indirecto del estado de hierro, la situación en la altura se complica debido a que para definir anemia se debería tener una deficiencia global de hemoglobina (baja eritropoyesis) y no una expansión del volumen plasmático (hemodilución) (31) , como ocurre en la gestación. Todos estos hallazgos sugieren que la Hb no es un buen marcador del estado de hierro en el organismo.…”

Section: Gonzales Gf Et Alunclassified

Necesidades de investigación para el diagnóstico de anemia en poblaciones de altura

Gonzáles

Fano

2017

Rev Peru Med Exp Salud Publica

View full text Add to dashboard Cite

RESUMENTanto la deficiencia como la sobrecarga de hierro son situaciones que ponen en riesgo la salud y la vida de las personas, por lo que es importante mantener su homeostasis. Como la hemoglobina contiene 70% del hierro del organismo, la OMS recomienda su medición para determinar la prevalencia de anemia por deficiencia de hierro (ID), a pesar que ellos mismos reconocen que la anemia no es específica de ID. Como la hemoglobina aumenta con la altitud de residencia, la OMS recomienda corregir el punto de corte para definir anemia en la altura. Una objeción a esta corrección es que el aumento de la hemoglobina en la altura no es universal ni aumenta de manera lineal. Además, las poblaciones de mayor antigüedad generacional tienen menos hemoglobina que las más recientes. En infantes, niños, gestantes y adultos, la prevalencia de anemia usando hemoglobina corregida es 3-5 veces mayor que usando marcadores del estatus de hierro. Los programas estatales buscan combatir la anemia mediante la suplementación de hierro; no obstante, resultan ineficaces, especialmente en las poblaciones de altura. Entonces, ¿hay deficiencia de hierro en la altura? Los niveles de hepcidina sérica, hormona que regula la disponibilidad de hierro, son similares a los de nivel del mar indicando que en la altura no hay deficiencia de hierro. Un problema adicional al corregir la hemoglobina por la altura, es que las prevalencias de eritrocitosis disminuyen. En conclusión, la corrección del punto de corte de la hemoglobina en la altura para determinar deficiencia de hierro es inadecuada. Palabras clave: Anemia, Deficiencia de hierro, Factor de corrección, Ferritinas (fuente: DeCS BIREME). DIAGNOSIS OF ANEMIA IN POPULATIONS AT HIGH ALTITUDES ABSTRACTIron deficiency and overload are risk factors for numerous poor health outcomes, and thus the maintenance of iron homeostasis is vital. Considering that hemoglobin contains 70% of the total iron in the body, the World Health Organization (WHO) recommends the measurement of iron levels to calculate the rate of iron deficiency anemia (IDA), although WHO recognizes that IDA is not the only cause of anemia. As hemoglobin increases with altitude, WHO recommends correcting the cut-off point to define anemia at high altitudes. An objection to this correction is that the increase in hemoglobin at high altitudes is not universal and is not linear. In addition, individuals in older age groups have lower hemoglobin levels than those in younger age groups. In infants, children, pregnant women, and adults, the prevalence of anemia using corrected hemoglobin is 3-5 times higher than that using markers of iron status. State programs seek to control anemia by means of iron supplementation. However, these programs are ineffective, particularly for high-altitude populations. Therefore, the occurrence of iron deficiency at high altitudes is controversial. The serum levels of the hormone hepcidin, which regulates iron availability, are similar in individuals at high altitudes to those of individuals at sea level, indicat...

show abstract

“…The main differences compared with previous CO‐rebreathing methods are a reduced rebreathing time of 2 min in a custom‐made spirometer, fewer acquired blood samples and the possibility of using capillary blood (Schmidt & Prommer, ). The oCOR method is well tolerated by young trained athletes and by older subjects and patients (Ahlgrim, Schumacher, Wrobel, Waller, & Pottgiesser, ; Otto et al., ; Wachsmuth et al., ).…”

Section: Introductionmentioning

confidence: 99%

Modification of the CO‐rebreathing method to determine haemoglobin mass and blood volume in patients suffering from chronic mountain sickness

Wachsmuth

Soria

Jiménez

et al. 2019

Experimental Physiology

Self Cite

View full text Add to dashboard Cite

New Findings What is the central question of this study?Is it necessary to modify the CO‐rebreathing method to acquire reliable measurements of haemoglobin mass in patients with chronic mountain sickness? What is the main finding and its importance?The CO‐rebreathing method must be modified because of the prolonged CO‐mixing time in patients with chronic mountain sickness. After adaptation of the blood sampling method, reliable and valid results were attained. With this modification, it is possible to quantify the extent of polycythaemia and to distinguish between a haemoconcentration and an exclusive enhancement of erythrocyte volume. Abstract Patients suffering from chronic mountain sickness (CMS) exhibit extremely high haemoglobin concentrations. Their haemoglobin mass (Hbmass), however, has rarely been investigated. The CO‐rebreathing protocol for Hbmass determination in those patients might need to be modified because of restricted peripheral perfusion. The aim of this study was to evaluate the CO uptake and carboxyhaemoglobin‐mixing time in the blood of CMS patients and to adapt the CO‐rebreathing method for this group. Twenty‐five male CMS patients living at elevations between 3600 and 4100 m above sea level were compared with ethnically matched healthy control subjects from identical elevations (n = 11) and near sea level (n = 9) and with a Caucasian group from sea level (n = 6). CO rebreathing was performed for 2 min, and blood samples were taken for the subsequent 30 min. After the method was modified, its reliability was evaluated in test–retest experiments (n = 28), and validity was investigated by measuring the Hbmass before and after the phlebotomy of 500 ml (n = 4). CO uptake was not affected by CMS. The carboxyhaemoglobin mixing was completed after 8 min in the Caucasian group but after 14 min in the groups living at altitude. When blood was sampled 14–20 min after inhalation, the typical error of the method was 1.6% (confidence limits 1.2–2.5%). After phlebotomy, Hbmass decreased from 1779 ± 123 to 1650 ± 129 g, and no difference was found between the measured and calculated Hbmass (1666 ± 122 g). When the time of blood sampling was adapted to accommodate a prolonged carboxyhaemoglobin‐mixing time, the CO‐rebreathing method became a reliable and valid tool to determine Hbmass in CMS patients.

show abstract

Hemoglobin concentration, total hemoglobin mass and plasma volume in patients: implications for anemia

Cited by 70 publications

References 43 publications

Hemolysis during and after 21 days of head-down-tilt bed rest

Hemolysis during and after 21 days of head-down-tilt bed rest

Necesidades de investigación para el diagnóstico de anemia en poblaciones de altura

Modification of the CO‐rebreathing method to determine haemoglobin mass and blood volume in patients suffering from chronic mountain sickness

Contact Info

Product

Resources

About