Plasmapheresis Edema. I. The Relation of Reduction of Serum Proteins to Edema and the Pathological Anatomy Accompanying Plasmapheresis 1

Darrow, Daniel C.; Hopper, Edward; Cary, M. Katharine

doi:10.1172/jci100443

Cited by 18 publications

(3 citation statements)

References 7 publications

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“…1 B. If the plasma osmotic pressure is reduced to 20 mm Hg, filtration occurs along almost the entire length of the capillary, and excessive fluid accumulation should occur in the interstitial space. This finding is contrary to clinical experience, however; edema does not occur until the plasma protein concentration has fallen to almost half its normal value (4)(5)(6). A similar disturbance of equilibrium would result if venous and arterial capillary pressures were elevated, as in heart failure or venous obstruction ( Fig.…”

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confidence: 76%

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Dynamics of Transcapillary Fluid Exchange

Wiederhielm

1968

The Journal of General Physiology

120

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Fluid balance at the capillary level has been simulated with an analogue computer program, based on experimental data on regional differences in capillary permeability, surface areas, and hydrostatic pressures. The program takes into account fluid and protein fluxes into and out of the interstitial space. Solutions are obtained for tissue hydrostatic pressure, tissue fluid osmotic pressure, interstitial space volume, and lymph flow. Simulation of a variety of physiological experiments and clinical disease states has yielded reasonable agreement between experimental data and data obtained by computer analysis. Dilution of the interstitial plasma protein pool with a consequent reduction of its oncotic pressure appears to be a major factor, which prevents edema unless plasma oncotic pressures are reduced by 10-15 mm Hg or, alternatively, venous pressures are elevated by a similar amount. The computer analysis in all instances yields positive values for tissue pressure, in agreement with experimental data obtained by needle puncture. The negative tissue pressures observed in subcutaneous capsules can be reproduced in the computer program, if the interface between the capsule and the surrounding interstitial space is assumed to have the properties of a semipermeable membrane.Partition of body fluids between the circulation, on the one hand, and the interstitial and intracellular spaces, on the other, is normally maintained within narrow limits. The mechanism maintaining this precise partition is still not well understood, but a balance of capillary hydrostatic and colloid osmotic pressures is generally acknowledged to play an important role, as originally pointed out by Starling (1). Current views on capillary water balance are summarized in Fig. 1, which is based on experimental data of Starling (1) and Landis (2). The graphs illustrate the relationship between hydrostatic pressures along the length of a capillary and the colloid osmotic pressure of plasma proteins.The oncotic pressure of plasma (7r,,) averages 25 mm Hg (3), corresponding to a plasma protein concentration of 7%. The hdyrostatic capillary pressures are averages based on extensive series of pressure recordings in skin capillaries of man by Landis (2). In arterial capillaries ( Fig. 1 A, left), the pressures averaged 32 mm Hg (Pa). The hydrostatic pressures in the 29 The Journal of General Physiology TRANSCAPILLARY EXCHANGES venous capillaries (Fig. 1 A, right) averaged 15 mm Hg (Pv). The transcapillary flux of fluid is governed by the difference in the hydrostatic and colloid osmotic pressure of the plasma; thus fluid is filtered from the capillary into the tissues in the arterial end of the capillary, and it is reabsorbed from the tissues into the capillary at the venous end. The hydrostatic pressures in the arterial and venous ends of the capillary bracket the colloid osmotic pressure, and the amount of fluid filtered at the arterial end is similar to the volume reabsorbed at the venous end. 20-In. This equilibrium of filtration and reabso...

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confidence: 76%

“…Tissue pressure: PT = K 4 AV (6) where K 4 represents the compliance of the interstitial space. At a given volume of the interstitial space, which might be considered a reference volume (Vo), tissue pressure is zero.…”

Section: Computer Analysis Of Capillary Water Balancementioning

confidence: 99%

Dynamics of Transcapillary Fluid Exchange

Wiederhielm

1968

The Journal of General Physiology

120

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“…Experimental edema in animals has resulted from two methods which have in common the lowering of serum protein, that is, plasmapheresis in dogs (6,7,8,9,10,11), and low protein diets in rats (12) and in the dog (8). The experiments to be discussed in this paper were performed by utilizing both methods of experimental approach.…”

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The Relation Between Plasma Protein Content, Plasma Specific Gravity and Edema in Dogs Maintained on a Protein Inadequate Diet and in Dogs Rendered Edematous by Plasmapheresis

Weech

Snelling²,

Goettsch³

1933

J. Clin. Invest.

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Clinical edema of several types and its relation to low serum proteins have been adequately discussed in recent publications (1,2,3,4,5). Experimental edema in animals has resulted from two methods which have in common the lowering of serum protein, that is, plasmapheresis in dogs (6,7,8,9,10,11), and low protein diets in rats (12) and in the dog (8). The experiments to be discussed in this paper were performed by utilizing both methods of experimental approach. Dogs were maintained on a diet deficient in protein. Edema was produced sometimes acutely by plasmapheresis, sometimes more slowly as the result of dietary deficiency alone, and in several instances after recovery from the edema of plasmapheresis the edema of protein starvation was allowed to supervene in the same animal. Nine dogs have been followed over periods varying from 59 to 107 days and averaging 84 days. It has seemed worthwhile at this time to present together the results of both methods of study and to compare the events attending the onset of edema in both groups of animals and the relationships found for plasma protein concentrations and plasma specific gravity. METHODSThe animals were kept in metabolism cages throughout the periods of observation, the daily urine collections being measured and aliquots saved for analysis. The importance of washing the cages to insure complete urine collection was not appreciated at first. Later observations indicated an average loss of 1.9 per cent through neglect of this precaution and accordingly records of total urine have been increased by this amount. Stools were not saved regularly but only over short periods often enough to determine approximately the necessary balance corrections. Since the substances studied (sodium, chloride and nitrogen) are excreted chiefly in the urine, these corrections were not large. The diets were offered in weighed amounts and corrected for refusals National Research Council Fellow. 193

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Concentration of Serum Protein in Different Types of Edema

Hand¹

1934

Arch Intern Med

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Plasmapheresis Edema. I. The Relation of Reduction of Serum Proteins to Edema and the Pathological Anatomy Accompanying Plasmapheresis 1

Cited by 18 publications

References 7 publications

Dynamics of Transcapillary Fluid Exchange

Dynamics of Transcapillary Fluid Exchange

The Relation Between Plasma Protein Content, Plasma Specific Gravity and Edema in Dogs Maintained on a Protein Inadequate Diet and in Dogs Rendered Edematous by Plasmapheresis

Concentration of Serum Protein in Different Types of Edema

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