MECHANISM OF OEDEMA IN CHRONIC SEVERE ANAeMIA

Abstract

Cardiovascular adjustments that develop in chronic anaemia have been studied by many investigators. Studies of renal circulation in anmmia, however, are few (Bradley and Bradley, 1947;Whitaker, 1956). A characteristic reversible renal functional abnormality has been described in chronic anxmia. It has been suggested that cedema, which occurs in a large number of cases of anemia on some basis other than decreased plasma osmotic pressure or increased venous pressure, may be secondary to renal retention of salt and water, possibly attributable to glomerulotubular imbalance (Bradley and Bradley, 1947) or abnormal tubular reabsorption (Whitaker, 1956).Abnormalities of renal function in chronic anemia in patients with cedema have, however, not been reported. The present investigation of circulatory abnormalities, particularly of renal circulation, was undertaken to determine the etiological factor of cedema in patients with chronic severe anemia. SUBJECTS AND METHODSForty-five patients, 36 men and 9 women, admitted to the hospital for treatment of chronic anemia of not less than three months' duration and with hematocrit values of less than 30 per cent were selected for this study. Their ages ranged between 14 to 50 years with an average of 30 years. (Edema was present in 25 patients, 17 men and 8 women, in 8 of whom congestive heart failure was considered to be present. Dyspnoea, cedema of feet, and hepatic enlargement, which are usual manifestations of congestive heart failure, also occur in uncomplicated chronic aneemia. Heart failure was, therefore, considered to be present after careful consideration of these factors, and of elevated venous pressure, clinical and radiological evidence of pulmonary congestion, and rapid regression in size of the enlarged tender liver with improvement of the anwmia. The duration of symptoms of anmmia varied between four months and three years with an average of 15 months. The duration of anemia was presumably much longer, and was due to hookworm infestation in 21 cases, chronic dysentery in 13, bleeding hkmorrhoids in 4, and chronic malaria in 2 cases, and was of undetermined etiology in 5 cases. The hxematocrit values ranged between 8 and 28 per cent with an average of 14-4 per cent: they were up to 10 per cent in 18, between 11 and 19 per cent in 16, and 20 and 28 per cent in 11 cases. Care was taken to exclude patients with hypertension or any renal or cardiovascular disorder apart from anemia, which might interfere with the circulatory abnormalities. The laboratory data were obtained on admission in each patient, but could be obtained after treatment in only 14 patients as it was found difficult to persuade patients for follow-up study after they were cured. The data were also obtained in 20 others to serve as normal controls.

Regional Circulatory Adjustments to Moderate and Severe Chronic Anemia in Conscious Dogs at Rest and during Exercise

“…There are several possible explanations of the apparent discrepancy between our findings and those reported by others (1)(2)(3)(4)(5)(6)(7)(8)(9). The technique which was used in most of these studies (1-5, 7, 8), i.e., para-aminohippurate (PAH) clearance, is insensitive to renal arterial inflow which is shunted around the peritubular capillary network.…”

“…Although some studies have noted no change or a slight increase in renal blood flow during anemia (30)(31)(32)(33), it is generally held that the renal bed responds to anemia with marked vasoconstriction to provide additional blood flow for the heart and brain (1)(2)(3)(4)(5)(6)(7)(8)(9). This response of diversion of renal flow has teleological attractiveness since there is normally a wide arteriovenous O 2 difference across this bed, which could thus tolerate a reduction in arterial oxygen content without necessarily impairing oxygen delivery.…”

Effect of Intra- and Postoperative Fluid and Blood Volume on Postoperative Pulmonary Edema in Patients With Intraoperative Massive Bleeding: Multi-Center Cohort Study Using Time Varying Analysis

“…Anemia and pulmonary edema are interrelated. [20][21][22] Existing severe anemia can often be associated with salt and water retention, [23][24][25] and hormonal and metabolic changes due to low hemoglobin levels can also cause direct myocardial toxicity, myocardial hypertrophy, and increase salt and water retention. [20,26] Heart failure can lead to anemia through a variety of mechanisms such as iron de ciency, in ammation, low erythropoietin level, medication, hemodilution, and medullar dysfunction .…”

Sudden intraoperative pulmonary congestion in a patient with severe anemia transfused 3 days prior to surgery

“…A possible cause might be that her intravenous volume had been at the critical state of congestion because of transfusion and water retention. [ 2 ] A subsequent change of sympathetic tone by mildly increased catecholamine could have led to pulmonary vasoconstriction. This postcapillary vasoconstriction may have affected vascular permeability and led to a consequent capillary fluid leakage.…”