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Circulating blood volumes in pulmonary hypertension associated with erythrocytosis – the effects of therapeutic hemodilution

Published online by Cambridge University Press:  24 May 2005

Rilvani C. Gonçalves ,
Carlos Alberto Buschpigell  and
Antonio Augusto Lopes
Rilvani C. Gonçalves
Affiliation:
Department of Pediatric Cardiology and Adult Congenital Heart Disease, Heart Institute, São Paulo, Brazil
Carlos Alberto Buschpigell
Affiliation:
Department of Nuclear Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
Antonio Augusto Lopes
Affiliation:
Department of Pediatric Cardiology and Adult Congenital Heart Disease, Heart Institute, São Paulo, Brazil
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Abstract

In the Eisenmenger syndrome, indirect estimation of blood volumes may provide quite inaccurate information when seeking to define therapeutic strategies. With this in mind, we analyzed directly the red cell mass, plasma volume, and total blood volume in patients with pulmonary hypertension associated with congenital cardiac defects and erythrocytosis, comparing the results with the respective estimated volumes, and examining the changes induced by therapeutic hemodilution.

Thus, we studied 17 patients with the Eisenmenger syndrome, aged from 15 to 53 years, in the basal condition, studying 12 of them both before and after hemodilution. We also investigated five individuals with minimal cardiac lesions, aged from 14 to 42 years, as controls. Red cell mass and plasma volumes were measured using [51 chromium]-sodium chromate and [131iodine]-albumin respectively. Hemodilution was planned so as to exchange 10% of the total blood volume, using 40,000 molecular weight dextran simultaneously to replace the removed volume. The mean values of the red cell mass, plasma volume and total blood volume as assessed by radionuclide techniques were 32%, 31% and 32% higher than the respective volumes as estimated using empirical mathematical formulas (p < 0.002). The measured total blood volume was also 19% higher in the patients compared with controls. Following a period of 5 days after hemodilution, we noted a 13% reduction in red cell mass (p = 0.046), and 10% reduction in total blood volume (p = 0.02), albeit with no changes in the plasma volume.

We conclude that direct measurement of blood volumes is useful for proper management of these patients, and provides results that are considerably different from those obtained by empirical estimations.

Keywords

Plasma volumered cell masscongenital heart disease
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 6 , December 2003 , pp. 544 - 550
Copyright
© 2003 Cambridge University Press

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