Alterations in haematological and clotting profile of post-menopausal women in Benin City, Nigeria

Background: The cessation of ovarian functions at menopause and the accompanying decline in the production of ovarian steroid hormones creates a unique set of health concerns for women. Reductions in sex steroid levels, particularly oestrogen, have been associated with various diseases and conditions, including bleeding disorders, coronary heart disease (CHD), osteoporosis, cognitive dysfunction, urinary incontinence, hot flushes, and mood changes, among others. Objective: To determine changes in haemorheological and clotting profile in post-menopausal women. Methods: Two hundred participants comprising one hundred and fifty post-menopausal women and fifty healthy pre-menopausal control subjects were studied. The investigations carried out include whole blood viscosity, plasma viscosity, fibrinogen concentration, Prothrombin time (PT), Activated partial thromboplastin time with kaolin (APTTK) levels and complete blood count using standard methods. Results: The mean age (p=0.01), platelet count (p= 0.013), neutrophil (p= 0.03), neutrophil to lymphocyte ratio (p= 0.045) and platelet to lymphocyte ratio (p=0.044) in postmenopausal women were significantly higher while lymphocyte count (p= 0.004) was significantly lower in postmenopausal compared to premenopausal women. Similarly, plasma oestradiol (p= 0.001), plasma viscosity (p= 0.03), relative blood viscosity (p= 0.03), whole blood viscosity (p= 0.03) and PTTK(p= 0.04) were significantly lower among postmenopausal women compared to premenopausal control subjects. Conclusion: Relative plasma viscosity correlated positively with age. There were significantly lower levels of haemorheological and clotting profile in post-menopausal women. These changes may be due to age or a decline in circulating oestrogen levels.

Síndrome de hiperviscosidade em paciente com mieloma múltiplo / Hyperviscosity syndrome in multiple myeloma patients

O mieloma múltiplo é uma neoplasia progressiva e incurável de células B, caracterizado pela proliferação desregulada e clonal de plasmócitos na medula óssea. A síndrome de hiperviscosidade é uma das complicações relacionadas às gamopatias monoclonais, sendo considerada emergência oncológica. O objetivo deste estudo foi descrever o quadro clínico de um paciente diagnosticado com mieloma múltiplo que apresentou síndrome de hiperviscosidade, avaliando a prevalência de sinais e sintomas, bem como características fisiopatológicas dessa entidade clínica. Foi revisado o prontuário de um paciente internado na enfermaria da Clínica Médica do Hospital Regional do Cariri (CE) no período de junho a julho de 2018. Além disso, foi realizada revisão de literatura em base de dados (PubMed®) direcionada ao tema proposto. O diagnóstico de mieloma múltiplo foi comprovado por mielograma, sendo prontamente iniciada a corticoterapia e avaliada a resposta clínica após essa terapêutica. Apesar de incomum e menos frequentemente relacionada ao mieloma múltiplo, a síndrome de hiperviscosidade está relacionada a uma grande taxa de mortalidade quando apresenta diagnóstico tardio. A terapia de primeira linha indicada para a síndrome de hiperviscosidade foi a plasmaferese, no entanto, as condições clínicas (instabilidade hemodinâmica) impossibilitaram sua realização. O desfecho deste caso foi o óbito do paciente. Concluiu-se que o diagnóstico precoce e a intervenção terapêutica estão diretamente relacionados à ocorrência de menor incidência de complicações relacionadas ao mieloma múltiplo e à síndrome de hiperviscosidade.

Multiple myeloma is a progressive and incurable B-cell neoplasm characterized by unregulated and clonal proliferation of plasmocytes in the bone marrow. Hyperviscosity syndrome is one of the complications related to monoclonal gammopathies and is considered an oncological emergency. The aim of this study was to describe the clinical condition of a patient diagnosed with multiple myeloma who presented hyperviscosity syndrome, evaluating the prevalence of symptoms and signs, as well as the pathophysiological characteristics of this clinical entity. The medical records of a patient admitted to the Internal Medicine ward of the Hospital Regional do Cariri (CE) from June to July of 2018 were reviewed. In addition, we conducted a literature review in a database (PubMed®) directed to the theme proposed. The diagnosis of multiple myeloma was confirmed by myelogram, and corticosteroid therapy was promptly initiated and the clinical response was evaluated after this therapy. Although uncommon and less frequently related to multiple myeoloma, hyperviscosity syndrome is related to a high mortality rate when diagnosed late. The first line therapy indicated to hyperviscosity syndrome was plasmapheresis; however, the clinical conditions (hemodynamic instability) precluded its performance. The outcome of this case was the patient's death. Thus, it was concluded that early diagnosis and therapeutic intervention are directly related to the occurrence of lower incidence of complications related to multiple myeloma and hyperviscosity syndrome.

Blood-cooling and hemostasis effects of Rehmanniae Radix before and after carbonizing / 中国中药杂志

To compare the blood-cooling and hemostasis effects of Rehmanniae Radix before and after carbonizing on rats with blood heat and hemorrhage syndrome. The blood heat and hemorrhage syndrome rat model was established. Indexes including rectal temperature,whole blood viscosity,plasma viscosity,thrombin time(TT),activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen content(FIB),red blood cell(RBC),hemoglobin(Hb),hematocrit(HCT),blood platelet count(PLT),mean platelet volume(MPV),serum IL-1,serum IL-6 and lung histopathology were detected to investigate the blood-cooling and hemostasis effects of Rehmanniae Radix and its carbonized products. Compared with the blank control group,the rectal temperature was significantly increased with rise of the high,middle and low whole blood viscosities and plasma viscosity(P<0.05); both the high and low whole blood restore viscosity and the high and low whole blood relative viscosity were increased significantly(P< 0.05); TT,APTT and PT were notably prolonged with the increase in FIB content(P<0.05); RBC,Hb and HCT increased significantly(P< 0.05); concentrations of serum IL-1 and IL-6 were also increased(P< 0.05) in model group. Additionally,obvious hemorrhages in lung and stomach were observed in rats of the model group. Rehmanniae Radix and its carbonized products can significantly reduce rectal temperature,high middle and low whole blood viscosities and plasma viscosity(P<0.05). TT and APTT were shortened,with lower expression of FIB in group of Rehmannia Radix and its carbonized products. Hemorrhages of lung and stomach were improved by Rehmannia Radix and its carbonized products. The results indicated that Rehmannia Radix before and after carbonizing had the hemostasis and blood-cooling effects by promoting coagulation,improving blood rheology and inhibiting expressions of IL-1 and IL-6.

Study on absorbed components of Aconitum kusnezoffii under Yunnan Baiyao compatibility in effect of activating blood circulation and removing blood stasis / 中国中药杂志

Rat model of blood stasis syndrome was prepared by subcutaneous injecting of epinephrine hydrochlorid,then the model rats were administrated by Yunnan Baiyao for 15 days. Blood rheology,coagulation function and histopathology were chosen as indicators to evaluate the successful replication of blood stasis syndrome model and the treatment effect of Yunnan Baiyao. UPLC-Q-TOF-MS was used to rapidly analyze the serum samples of blood stasis syndrome rat after 15 days Yunnan Baiyao treatment,Progenesis QI software was employed to identify the alkaloids components. The results showed that Yunnan Baiyao reduced the plasma viscosity and whole blood viscosity of rats with blood stasis syndrome,prolonged thrombin and prothrombin time,reduced fibrinogen content,and effectively improved pathological state such as inflammatory cell infiltration,blood stasis,congestion and edema of various organs in rats with blood stasis syndrome. Seven alkaloids components from Aconitum kusnezoffii,including karacolidine,senbusine B,isotalatizidine,karakoline,denudatine,talatisamine and chasmanine were found in the rat serum after Yunnan Baiyao treatment. Based on the effectiveness of Yunnan Baiyao in the treatment of blood stasis syndrome induced by epinephrine hydrochloride in rats,alkaloids components from the root of A. kusnezoffii absorbed into blood after Yunnan Baiyao treatment were clarified rapidly and accurately with the help of UPLC-Q-TOF-MS. Karacolidine,senbusine B,isotalatizidine,karakoline,denudatine,talatisamine and chasmanine are the pharmacodynamic material basis of the root of A. kusnezoffii for activating blood circulation and removing blood stasis.

Leukostasis by hyperleukocytic childhood acute leukemia: pathophysiology, clinical presentation, and emergency care

Hyperleukocytosis (HL), defined by a peripheral white blood cell (WBC) count exceeding 100,000/mm³, is occasionally observed in childhood acute leukemia. The increased viscosity in the micro-circulation by HL and the interaction between the leukemic blasts and endometrium of blood vessels sometimes result in leukostasis. Leukostasis can incur life-threatening manifestations, such as respiratory distress, brain infarction and hemorrhage, and renal failure, needing an emergency care. Although early stage of leukostasis is difficult to detect due to nonspecific manifestations, an emergency care is mandatory because leukostasis can proceed to a fatal course. Initial management includes an aggressive fluid therapy that can reduce WBC count, and prevent other metabolic complications implicated by HL. Packed red blood cells should be judiciously transfused because it increases blood viscosity. Conversely, transfusion of platelet concentrates or fresh frozen plasma, which does not affect blood viscosity, is recommended for prevention of hemorrhage. To reduce tumor burden, leukapheresis or exchange transfusion is commonly performed. However, the efficacy is still controversial, and technical problems are present. Leukapheresis or exchange transfusion is recommended if WBC count is 200,000–300,000/mm³ or more, especially in acute myelocytic leukemia, or manifestations of leukostasis are present. In addition, early chemotherapy is the definite treatment of leukostasis.

Patient-Specific Computational Fluid Dynamics in Ruptured Posterior Communicating Aneurysms Using Measured Non-Newtonian Viscosity : A Preliminary Study

OBJECTIVE: The objective of this study was to analyze patient-specific blood flow in ruptured aneurysms using obtained non-Newtonian viscosity and to observe associated hemodynamic features and morphological effects.METHODS: Five patients with acute subarachnoid hemorrhage caused by ruptured posterior communicating artery aneurysms were included in the study. Patients’ blood samples were measured immediately after enrollment. Computational fluid dynamics (CFD) was conducted to evaluate viscosity distributions and wall shear stress (WSS) distributions using a patient-specific geometric model and shear-thinning viscosity properties.RESULTS: Substantial viscosity change was found at the dome of the aneurysms studied when applying non-Newtonian blood viscosity measured at peak-systole and end-diastole. The maximal WSS of the non-Newtonian model on an aneurysm at peaksystole was approximately 16% lower compared to Newtonian fluid, and most of the hemodynamic features of Newtonian flow at the aneurysms were higher, except for minimal WSS value. However, the differences between the Newtonian and non-Newtonian flow were not statistically significant. Rupture point of an aneurysm showed low WSS regardless of Newtonian or non-Newtonian CFD analyses.CONCLUSION: By using measured non-Newtonian viscosity and geometry on patient-specific CFD analysis, morphologic differences in hemodynamic features, such as changes in whole blood viscosity and WSS, were observed. Therefore, measured non-Newtonian viscosity might be possibly useful to obtain patient-specific hemodynamic and morphologic result.

Patient-Specific Computational Fluid Dynamics in Ruptured Posterior Communicating Aneurysms Using Measured Non-Newtonian Viscosity : A Preliminary Study

OBJECTIVE: The objective of this study was to analyze patient-specific blood flow in ruptured aneurysms using obtained non-Newtonian viscosity and to observe associated hemodynamic features and morphological effects. METHODS: Five patients with acute subarachnoid hemorrhage caused by ruptured posterior communicating artery aneurysms were included in the study. Patients’ blood samples were measured immediately after enrollment. Computational fluid dynamics (CFD) was conducted to evaluate viscosity distributions and wall shear stress (WSS) distributions using a patient-specific geometric model and shear-thinning viscosity properties. RESULTS: Substantial viscosity change was found at the dome of the aneurysms studied when applying non-Newtonian blood viscosity measured at peak-systole and end-diastole. The maximal WSS of the non-Newtonian model on an aneurysm at peaksystole was approximately 16% lower compared to Newtonian fluid, and most of the hemodynamic features of Newtonian flow at the aneurysms were higher, except for minimal WSS value. However, the differences between the Newtonian and non-Newtonian flow were not statistically significant. Rupture point of an aneurysm showed low WSS regardless of Newtonian or non-Newtonian CFD analyses. CONCLUSION: By using measured non-Newtonian viscosity and geometry on patient-specific CFD analysis, morphologic differences in hemodynamic features, such as changes in whole blood viscosity and WSS, were observed. Therefore, measured non-Newtonian viscosity might be possibly useful to obtain patient-specific hemodynamic and morphologic result.

Ginkgo Leaf Extract and Dipyridamole Injection as Adjuvant Treatment for Angina Pectoris: A Meta-Analysis of 41 Randomized Controlled Trials / 中国结合医学杂志

OBJECTIVE@#To provide information about the effectiveness and safety of Ginkgo Leaf Extract and Dipyridamole Injection (GD) as one adjuvant therapy for treating angina pectoris (AP) and to evaluate the relevant randomized controlled trials (RCTs) with meta-analysis.@*METHODS@#RCTs concerning AP treated by GD were searched in China Biology Medicine Disc (SinoMed), PubMed, the China National Knowledge Infrastructure Database (CNKI), the Chinese Scientifific Journals Database (VIP), Wanfang Database, Embase, and the Cochrane Library, from inception to February, 2017. The Cochrane Risk Assessment Tool was adopted to assess the methodological quality of the RCTs. The Review Manager 5.3 software was utilized to conduct the meta-analysis.@*RESULTS@#A total of 41 RCTs involving 4,462 patients were included in the meta-analysis. The results indicated that the combined use of GD and Western medicine (WM) against AP was associated with a higher total effective rate [risk ratio (RR)=1.25, 95% confifidence interval (CI): 1.21-1.29, P<0.01], total effective rate of electrocardiogram (RR=1.29, 95% CI: 1.21-1.36, P<0.01). Additional, GD combined with WM could decrease the level of plasma viscosity [mean difference (MD)=-0.56, 95% CI:-0,81 to-0.30, P<0.01], fifibrinogen [MD=-1.02, 95% CI:-1.50 to-0.54, P<0.01], whole blood low shear viscosity [MD=-2.27, 95% CI:-3.04 to-1.49, P<0.01], and whole blood high shear viscosity (MD=-0.90, 95% CI: 1.37 to-0.44, P<0.01).@*CONCLUSIONS@#Comparing with receiving WM only, the combine use of GD and WM was associated with a better curative effect for patients with AP. Nevertheless, limited by the methodological quality of included RCTs more large-sample, multi-center RCTs were needed to confifirm our fifindings and provide further evidence for the clinical utility of GD.

Does Blood Flow Change according to Mood? Blood Rheology in Bipolar Disorder

OBJECTIVE: Bipolar disorder (BD) is associated with increased rates of cardiovascular diseases. There is growing evidence that blood viscosity may have a common role, correlated with well-known major risk factors that promote cardiovascular disease. In this study we aimed to investigate the whole blood viscosity (WBV) in different stages of BD. METHODS: A total of 121 bipolar patients and 41 age-gender matched healthy controls were included. Forty-four of bipolar patients were in manic, 35 were depressed and 42 were in euthymic state. WBV was calculated from hematocrit and total plasma protein according to Simone’s formula at low and high shear rates (LSR and HSR). RESULTS: WBV at HSR of manic group was 16.91±1.01, depressive group was 17.23±0.80, euthymic group was 17.63±0.95, and control group was 17.52±0.71 (p=0.001). WBV at LSR of manic depressive, euthymic and control group were 53.10±20.58, 60.30±17.02, 68.91±20.33, and 62.01±19.28, respectively (p=0.001). Both WBV at HSR and LSR of manic group was significantly lower than that of the euthymic and control groups (p=0.001 and 0.010 respectively for HSR, p=0.001 and 0.011 respectively for LSR). WBV was significantly positively correlated with lipid profile except high density lipoprotein (HDL). CONCLUSION: Our results demonstrate a decrement in blood viscosity in manic episode compared with euthymics and controls. Positive correlation of blood viscosity with lipid parameters (except HDL), and negative correlation with number of previous manic episodes suggest that manic episode has favorable effect on cardiovascular risk regarding to blood viscosity.

Effect of Blood Donation on the Donor's Hemorheological Properties / 대한수혈학회지

The circulatory system is closely related to the inter-relationship between the anatomy of the heart and blood vessels, and the fluid dynamic properties of blood. The physical properties of blood, which affect blood flow, are called hemorheologic factors. Hemorheologic factors, such as blood viscosity and erythrocyte aggregation, are influenced mainly by hematocrit. A higher hematocrit level results in an increase in blood viscosity, erythrocyte aggregation, which impedes the circulation itself, and tissue oxygenation. An excess of serum ferritin causes injury to vascular endothelial cells and erythrocytes via oxygen free radicals. In addition, an excess of blood can aggravatee the adverse effects of the hemorheologic parameters and induce atherogenesis, microcirculatory disturbances, and major cardiovascular events. A preventive and therapeutic approach with a phlebotomy or blood donation has been stimulated by the knowledge that blood loss, such as regular donations, is associated with significant decreases in key hemorheologic variables, including blood viscosity, erythrocyte aggregation, hematocrit, and fibrinogen. Major cardiovascular events have been improved in regular blood donors by improving blood flow and microcirculation by decreasing the level of oxidative stress, improving the hemorheologic parameters, and reducing the serum ferritin level. Confirmation of the positive preventive and therapeutic effects of blood donations on cardiovascular disease by a well-designed and well-controlled Cohort study may be good news to patients with cardiovascular disease or at risk of these diseases, as well as patients who require a transfusion.

Analytical Performance and Reference Interval of a Microfluidic Viscometer, Viscore-300 for the Measurement of Whole Blood Viscosity

BACKGROUND: Whole blood viscosity (WBV) refers to the internal resistance that occurs when blood flows through blood vessels. WBV is known to be related to many diseases including cardiovascular and neurovascular diseases. We have investigated the analytical performance and established reference intervals for a newly developed microfluidic viscometer, Viscore-300 (NanoBiz, Korea), used for the measurement of WBV. METHODS: We performed a precision test of 240 measurements over 20 days using three control materials. For evaluation of repeatability, a total of 60 WBV measurements were made in 3 whole blood samples 20 times a day. A total of 100 whole blood samples were used to evaluate the accuracy of the Viscore-300 in comparison to a rotating viscometer, DV3T (Brookfield, USA), in accordance with the the Clinical and Laboratory Standards Institute's guidelines. To establish the reference intervals, 122 healthy individuals were enrolled in this study. RESULTS: The precision and repeatability results showed that the CV was less than 5% for three samples and two shear rates. In the accuracy test, the mean differences between two viscometers were 0.09 cP (0.9%) and −0.07 cP (−1.4%) at shear rates of 10 s−1 and 300 s−1, respectively. The reference intervals of WBV for men were 6.88–13.52 cP at 10 s−1 and 4.32–6.43 cP at 300 s−1; those of women were 5.74–13.29 cP at 10 s−1 and 3.60–6.12 cP at 300 s−1. CONCLUSIONS: Viscore-300 showed excellent precision and accuracy and it might be a good instrument for reporting WBV quickly and accurately.

Factores bioquímicos y nutricionales asociados a la viscosidad sanguínea en adultos de la sierra urbana (Imbabura), Ecuador / Biochemical and nutritional factors associated with blood viscosity in adults living in a mountain chain, (Imbabura), Ecuador

La asociación de la viscosidad sanguínea (VS) con la hipertensión y la diabetes mellitus 2, indica que debe ser considerada sobre todo en poblaciones que viven en la sierra donde el hematocrito y la hemoglobina son más elevados. Se evaluó la asociación de la VS con factores de riesgo cardiovascular y de síndrome metabólico (SM) en una población de 237 adultos (20-60 años) de la sierra urbana ecuatoriana. Se calculó el índice de masa corporal (IMC), porcentaje de grasa y agua corporal, se midieron la circunferencia de la cintura (CC) y la presión arterial. Se realizaron determinaciones de parámetros bioquímicos, hematológicos y de VS (mediante fórmula validada). El 14,76% de la población presentó hiperviscosidad (HV). El 42,8% de las personas con HV presentó SM contra 33% en el grupo con normoviscosidad (NV). El ácido úrico (AU) se observó más elevado en los grupos HV y NV con SM. Se encontró una correlación lineal simple de las concentraciones de glucosa (GLU) y de triglicéridos (TRI) con la VS en el grupo HV sin SM. El análisis de regresión lineal múltiple indicó que la GLU, el AU y la presión sistólica son variables que influyen independientemente con el incremento de la VS en el grupo HV sin SM. Las variables GLU y % de agua influyen en el incremento de la VS en el grupo NV sin SM. El incremento de las concentraciones de glucosa y de ácido úrico son los dos factores que mayormente influyen en la VS en esta población.

The association of blood viscosity (BV) with hypertension and diabetes mellitus type 2 indicates that it should be considered, especially in populations living in mountain chains where the hemoglobin and hematocrit values are higher. In fact, this work analyzed the association of BV with nutritional and biochemical risk factors in the development of cardio metabolic diseases in healthy adults (20-60 years old; 46.39% female and 53.61% male) living in the urban Ecuadorian sierra. The body mass index (BMI) was calculated. The body fat percentage, body water percentage, waist circumference (WC) and blood pressure were measured. Determinations of biochemical and hematological parameters were performed using established methodologies and a validated formula was used to determine the BV. Hyperviscosity (HV) was present in 14.76% of the population: 10.46% men, 4.3% women. In this group, 42.8% showed metabolic syndrome (MS) against 33% in the normoviscosity group (NV). Uric acid (UA) was observed statistically higher in HV and NV with MS groups. A simple positive linear correlation was found between glucose (GLU) and triglycerides (TRI) concentrations and BV in HV without MS group. The multiple linear regression analysis indicated that GLU, UA and systolic pressure influence to increase BV in the HV without MS group. Glucose concentration and percentage of water, independently influence the BV in the NV without MS group. The increase in GLU and UA concentrations are the most influencing factors on BV in this population.

Rheological variations among Nigerians with different hemoglobin genotypes

A total of one hundred and Forty-five (145) subjects comprising of 50 homozygous Hemoglobin A subjects (HbAA); 50 heterozygous hemoglobin AS (HbAS) subjects and 45 homozygous hemoglobin S (HbSS) subjects were recruited for this study with a view to ascertain variations in the Hemorheological values possibly associated with the inherited hemoglobin genotype. Some Hemorheological determinants such as whole blood viscosity (WBV) and plasma viscosity (PV) and Plasma Fibrinogen Concentration (PFC) were measured with standard methods. We recorded a relatively unchanged whole blood viscosities in subjects with various hemoglobin genotypes (AA; AS and SS; P0.05; respectively). Also; there were no significant differences in PV values of HbAA and HbAS while there were significant increases in PV and PFC of HbSS compared with others (P0.05; respectively). However; relative erythrocyte viscosity (REV) of HbSS became significantly reduced when repeated with saline after replacing plasma with saline (P0.05; respectively); to ascertain the erythrocytic cellular viscosity. We conclude that increased plasma viscosity coupled with that of PFC in HBSS could be due to plasmatic components and that cellular rheologic properties of the erythrocytes may be dependent on its content of hemoglobin while whole blood viscosities are stable in native blood irrespective of haemoglobin genotypes

Therapeutic Leukapheresis for the Management of Hyperleukocytosis: Ten-year Experience in a Tertiary Care Hospital

BACKGROUND: Hyperleukocytosis is a medical emergency that is characterized by increased blood viscosity and predisposition to various neurological, pulmonary, and gastrointestinal complications. In addition, patients are at risk of the tumor lysis syndrome because of the increased tumor burden. Therapeutic leukapheresis is an important treatment for these emergent states. In this study, we retrospectively analyzed therapeutic leukapheresis procedures that were performed in our institution during the last 10 yr. METHODS: We retrospectively analyzed therapeutic leukapheresis procedures conducted from July 2005 to March 2015 at a tertiary care hospital. We present our observations, especially the procedural characteristics and hematological parameters before and after the aforementioned procedures. RESULTS: Seventy-two patients underwent a total of 146 therapeutic leukapheresis procedures. The average presenting white blood cell (WBC) count was 268×10(3)/µL, and ranged from 54×10(3)/µL to 673×10(3)/µL. After an average of two sessions, a statistically significant drop in the WBC counts was observed. The average WBC removal rates during the initial and entire therapeutic leukapheresis procedures of each patient were 33% and 46%, respectively. The platelet count and hemoglobin concentration were significantly reduced. CONCLUSIONS: Therapeutic leukapheresis significantly reduces peripheral WBC counts and is a safe and effective procedure for the treatment of hyperleukocytosis.

Hemorheological Alteration in Patients Clinically Diagnosed with Chronic Liver Diseases

Since liver function is changed by chronic liver diseases, chronic liver disease can lead to different hemorheological alterations during the course of the progression. This study aims to compare alterations in whole blood viscosity in patients with chronic liver disease, focusing on the gender effect. Chronic liver diseases were classified into three categories by patient’s history, serologic markers, and radiologic findings: nonalcoholic fatty liver disease (NAFLD) (n = 63), chronic viral hepatitis B and C (n = 50), and liver cirrhosis (LC) (n = 35). Whole blood viscosity was measured by automated scanning capillary tube viscometer, while liver stiffness was measured by transient elastography using FibroScan®. Both systolic and diastolic whole blood viscosities were significantly lower in patients with LC than NAFLD and chronic viral hepatitis (P < 0.001) in male patients, but not in female patients. In correlation analysis, there were inverse relationships between both systolic and diastolic whole blood viscosity and liver stiffness (systolic: r = −0.25, diastolic: r = −0.22). Whole blood viscosity was significantly lower in male patients with LC than NAFLD or chronic viral hepatitis. Our data suggest that whole blood viscosity test can become a useful tool for classifying chronic liver disease and determining the prognosis for different types of chronic liver diseases.

Health Effects of Particulate Matter / 대한내과학회지

Sand dust is a source of particulate matter (PM) in Korea. Recently, an attention has been focused on the health effects of PM and fine PM. Here we examine the possible mechanisms of PM disposition and review the literature on the health effects of PM. PM can enter and accumulate in the respiratory tract via impaction, gravitational settling, diffusion, and electrostatic attractions. PM may cause oxidative stress, inflammation, direct penetration, and increased blood viscosity. This literature review revealed that PM exposure is associated with several health risks, such as mortality and respiratory and cardiovascular diseases. Furthermore, PM exposure may be linked to lung cancer. Thus, a comprehensive approach is needed to manage PM and reduce its environmental exposure and related health effects.

The Association between Whole Blood Viscosity and Coronary Collateral Circulation in Patients with Chronic Total Occlusion

BACKGROUND AND OBJECTIVES: Coronary collateral circulation (CCC) has been attributed as inborn bypass mechanisms supporting ischemic myocardium. Various factors have been postulated in CCC. Whole blood viscosity (WBV) has been an underappreciated entity despite close relationships between multiple cardiovascular diseases. WBV can be calculated with a validated equation from hematocrit and total plasma protein levels for a low and high shear rate. On the grounds, we aimed to evaluate the association between WBV and CCC in patients with chronic total occlusion. SUBJECTS AND METHODS: A total of 371 patients diagnosed as having at least one major, chronic total occluded coronary artery were included. 197 patients with good CCC (Rentrop 2 and 3) composed the patient group. The poor collateral group consisted of 174 patients (Rentrop grade 0 and 1). RESULTS: Patients with poor CCC had higher WBV values for a low-shear rate (LSR) (69.5±8.7 vs. 60.1±9.8, p<0.001) and high-shear rate (HSR) (17.0±2.0 vs. 16.4±1.8, p<0.001) than the good collateral group. Correlation analysis demonstrated a significant negative correlation between the grade of CCC and WBV for LSR (β=0.597, p<0.001) and HSR (β=0.494, p<0.001). WBV for LSR (β=0.476, p<0.001) and HSR (β=0.407, p<0.001) had a significant correlation with the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score. A multivariate analysis showed that the WBV for both shear rates were independent risk factors of poor CCC (WBV at LSR, OR: 1.362 CI 95%: 1.095-1.741 p<0.001 and WBV at HSR, 1.251 CI 95%: 1.180-1.347 p<0.001). CONCLUSION: WBV has been demonstrated as the overlooked predictor of poor coronary collateralization. WBV seemed to be associated with microvascular perfusion and angiogenesis process impairing CCC development.

The Effect of Pulsatile Versus Nonpulsatile Blood Flow on Viscoelasticity and Red Blood Cell Aggregation in Extracorporeal Circulation

BACKGROUND: Extracorporeal circulation (ECC) can induce alterations in blood viscoelasticity and cause red blood cell (RBC) aggregation. In this study, the authors evaluated the effects of pump flow pulsatility on blood viscoelasticity and RBC aggregation. METHODS: Mongrel dogs were randomly assigned to two groups: a nonpulsatile pump group (n=6) or a pulsatile pump group (n=6). After ECC was started at a pump flow rate of 80 mL/kg/min, cardiac fibrillation was induced. Blood sampling was performed before and at 1, 2, and 3 hours after ECC commencement. To eliminate bias induced by hematocrit and plasma, all blood samples were adjusted to a hematocrit of 45% using baseline plasma. Blood viscoelasticity, plasma viscosity, hematocrit, arterial blood gas analysis, central venous O2 saturation, and lactate were measured. RESULTS: The blood viscosity and aggregation index decreased abruptly 1 hour after ECC and then remained low during ECC in both groups, but blood elasticity did not change during ECC. Blood viscosity, blood elasticity, plasma viscosity, and the aggregation index were not significantly different in the groups at any time. Hematocrit decreased abruptly 1 hour after ECC in both groups due to dilution by the priming solution used. CONCLUSION: After ECC, blood viscoelasticity and RBC aggregation were not different in the pulsatile and nonpulsatile groups in the adult dog model. Furthermore, pulsatile flow did not have a more harmful effect on blood viscoelasticity or RBC aggregation than nonpulsatile flow.

Unsolved Favorable Effect of Statin on Blood Viscosity

No abstract available.