Improvement in hemostasis following phlebotomy in cyanotic patients with heart disease

Wedemeyer, Anne L.; Lewis, Jessica H.

doi:10.1016/s0022-3476(73)80311-7

Cited by 31 publications

(7 citation statements)

References 10 publications

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“…In keeping with this, in patients with hematocrit values over 0.60, preoperative phlebotomy improved the coagulation abnormalities, and blood loss at surgery was reported to be lower than in untreated patients. 32 Several mouse lines transgenic for different fragments of the gene encoding erythropoietin 33,34 or transgenic for a mutant human erythropoietin receptor identified in a patient with erythrocytosis 35 have been generated in the past. None of these publications commented on the presence or absence of thrombosis or investigated the coagulation system.…”

Section: Discussionmentioning

confidence: 99%

Hemostasis and coagulation at a hematocrit level of 0.85: functional consequences of erythrocytosis

Shibata¹,

Hasegawa²,

Siemens³

et al. 2003

Blood

100

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We have generated a transgenic mouse line that reaches a hematocrit concentration of 0.85 due to constitutive overexpression of human erythropoietin in an oxygen-independent manner. Unexpectedly, this excessive erythrocytosis did not lead to thrombembolic complications in all investigated organs at any age. Thus, we investigated the mechanisms preventing thrombembolism in this mouse model. Blood analysis revealed an age-dependent elevation of reticulocyte numbers and a marked thrombocytopenia that matched the reduced megakaryocyte numbers in the bone marrow. However, platelet counts were not different from wild-type controls, when calculations were based on the distribution (eg, plasma) volume, thereby explaining why thrombopoietin levels did not increase in transgenic mice. Nevertheless, bleeding time was significantly increased in transgenic animals. A longitudinal investigation using computerized thromboelastography revealed that thrombus formation was reduced with increasing age from 1 to 8 months in transgenic animals. We observed that increasing erythrocyte concentrations inhibited profoundly and reversibly thrombus formation and prolonged the time of clot development, most likely due to mechanical interference of red blood cells with clot-forming platelets. Transgenic animals showed increased nitric oxide levels in the blood that could inhibit vasoconstriction and platelet activation. Finally, we observed that plasmatic coagulation activity in transgenic animals was significantly decreased. Taken together, our findings suggest that prevention of thrombembolic disease in these erythrocytotic transgenic mice was due to functional consequences inherent to increased erythrocyte concentrations and a reduction of plasmatic coagulation activity, the cause of which remains to be elucidated. (Blood. 2003;101:4416-4422)

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Section: Discussionmentioning

confidence: 99%

Hemostasis and coagulation at a hematocrit level of 0.85: functional consequences of erythrocytosis

Shibata¹,

Hasegawa²,

Siemens³

et al. 2003

Blood

100

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“…These factors would seem to be theoretically advantageous in preventing stroke produced by the raised viscosity from the erythrocytosis. Indeed, it has been shown and is recommended that these patients should undergo a venesection 24 h before elective non‐cardiac surgery to improve the clotting function (Wedemeyer & Lewis, 1973).…”

Section: Cyanotic Congenital Heart Diseasementioning

confidence: 99%

Guidelines for the diagnosis, investigation and management of polycythaemia/erythrocytosis

et al. 2005

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“…Patients with congenital cyanotic heart disease have numerous haematological and haemostatic abnormalities [3, 4, 5, 6, 7, 8]and probably a mildly increased risk of cerebral infarction [9, 10]. We report a case with congenital cyanotic heart disease, haematological and haemostatic abnormalities, a transient ischaemic attack and numerous microembolic signals on repeated transcranial Doppler recordings.…”

Section: Introductionmentioning

confidence: 99%

Abundance of Microembolic Signals Detected by Transcranial Doppler Ultrasound in a Patient with Eisenmenger’s Syndrome

et al. 1999

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Background: Clinically silent circulating microemboli can be detected by transcranial Doppler sonography. Case Description: We report the case of a 45-year-old man with congenital cyanotic heart disease, elevated haematocrit, low platelet count and decreased protein C and protein S activity. Before and following several haemodilutions, we performed 5 1-hour transcranial Doppler recordings from one or both middle cerebral arteries (MCAs) on different days. The number of microembolic signals per hour varied from 54 to 134. During the bilateral recording, the microemboli occurred on both sides (55 in the right and 45 in the left MCA, respectively). There was no relation to red blood cell count, platelet count, the spontaneously lowered prothrombin time or the spontaneously prolonged activated partial thromboplastin time. Conclusions: The origin of the large number of microembolic signals found in this patient remains unclear, but may be presumed in the intra-abdominal or crural venous system.

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Improvement in hemostasis following phlebotomy in cyanotic patients with heart disease

Cited by 31 publications

References 10 publications

Hemostasis and coagulation at a hematocrit level of 0.85: functional consequences of erythrocytosis

Hemostasis and coagulation at a hematocrit level of 0.85: functional consequences of erythrocytosis

Guidelines for the diagnosis, investigation and management of polycythaemia/erythrocytosis

Abundance of Microembolic Signals Detected by Transcranial Doppler Ultrasound in a Patient with Eisenmenger’s Syndrome

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