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Does sticky blood predict a sticky end? Associations of blood viscosity, haematocrit and fibrinogen with mortality in the West of Scotland.

There is increasing evidence that blood viscosity and its major determinants (haematocrit, plasma viscosity and fibrinogen) are associated with an increased risk of incident cardiovascular events; however, their associations with mortality are not established. We therefore studied the associations of these variables with cardiovascular events and total mortality in 1238 men and women aged 25-64 years, followed for 13 years in the first North Glasgow MONICA (MONItoring CArdiovascular disease) survey and West of Scotland centres in the Scottish Heart Health Study. After adjustment for age and sex, increasing whole blood viscosity, plasma viscosity, haematocrit and fibrinogen (analysed by both von Clauss and heat precipitation assays) were significantly associated with mortality. Only the association for fibrinogen (von Clauss assay) remained significant after adjustment for major cardiovascular risk factors. We conclude that clottable fibrinogen may be independently associated with mortality. However, the significance of this association, and the extent to which viscosity is associated with mortality, remain to be established in larger studies and meta-analyses.

Adult↗

Whole blood viscosity and red cell filterability as factors in sensorineural hearing impairment in the elderly.

Deficiencies in blood supply can lead to impairments in cochlear function. We have reported significant associations of both measures of whole blood viscosity and derived measures of red cell rigidity with hearing threshold levels in individuals with sensorineural hearing impairments. This paper describes direct measures of red cell filterability in a group balanced across the variables of hearing threshold level and age to facilitate dissociation of the effects of factors correlated with age. After controlling for effects of age, sex and social class, there were strong correlations between whole blood viscosity at high shear rate and hearing threshold levels at 250, 500, and 1,000 and 2,000 Hz. At 4,000 and 8,000 Hz, hearing threshold level was related to red cell filterability. When the data are divided into subgroups by age, the younger age group exhibited a pattern similar to the overall one, but in the older age group the effect of red cell filterability was more apparent, extending down to 1,000 Hz. The data support a strong association between aspects of blood rheology and sensorineural hearing impairment, but in a more complex manner than suggested by previous studies. They imply that there are two processes associated with sensorineural hearing impairment, one of which can be considered as due to bulk rheological properties, while the other appears more related to the properties of individual red cells. The bulk properties are more important at lower frequencies, while the cellular properties are more influential at higher frequencies.

Aged↗

[Blood viscosity and the erythrocyte charge in patients with chronic kidney failure and suppurative intoxication and during the correction of these conditions by hemosorption and hemodialysis].

Examinations of blood samples from healthy subjects and 16 patients suffering from chronic renal failure and purulent intoxication before and after hemodialysis and hemosorption showed changes in blood viscosity and red cell charges in the patients. Blood viscosity diminished following both hemodialysis and hemosorption, whereas red cell electric charge grew after hemodialysis, but fell after hemosorption. Correlations found between the viscosity, red cell charge and concentrations of urea and creatinine suggest a dependence of blood rheology and red cell surface electrostatic properties on azotemic intoxication. Thus, hemodialysis and hemosorption produce diverse effects on physiochemical characteristics of blood.

Adult↗

The influence of flow, vessel diameter, and non-newtonian blood viscosity on the wall shear stress in a carotid bifurcation model for unsteady flow.

OBJECTIVES: The atherosclerotic process in arteries is correlated with the local wall shear stress (WSS). Plaque development particularly occurs in regions with recirculation (ie, where the WSS oscillates). We investigated the effects of non-Newtonian blood viscosity, variations in flow rate, and vessel diameter on wall phenomena in a carotid bifurcation model. MATERIALS AND METHODS: The flow through a model of a carotid artery bifurcation was simulated by means of the finite element method. The whole-blood viscosity is a function of shear rate, and was modeled by the Carreau-Yasuda (CY) model. Flow rate and vessel morphology were assessed with magnetic resonance imaging. Flow rate, blood viscosity, and hematocrit levels (Hct) were measured in 49 healthy volunteers. We propose an adaptation of the CY model so that differences in Hct can be incorporated; furthermore, plasma viscosity was varied in the CY model. RESULTS: The data from our model indicate that flow increases have a larger effect on the WSS than predicted with a simple paraboloid model. Hct had more influence on the WSS when the plasma viscosity was low. Low plasma viscosity was associated with a low WSS, which implies a contradiction, because both high WSS and low plasma viscosity are thought to be indicators for a healthy system. Maximum WSS oscillations were found at the edges of the recirculation region. CONCLUSIONS: Flow and diameter changes have significant influence on wall shear stress values; the same is true for the viscosity, but to a lesser extent.

Adult↗

Increase in blood viscosity due to alcohol drinking.

To elucidate the effects of alcohol on thrombotic diseases we focussed on blood rheology which is one of the most important factors of blood flow. We measured the viscosity of whole blood and plasma of 18 healthy volunteers (11 males and 7 females) before and after drinking at a dinner party. There were significant increases in whole blood viscosity (7.4%, P less than 0.005) and plasma viscosity (3.0%, P less than 0.005) after drinking. Judging from the significant correlations between changes in blood viscosity and changes in variables related to hemoconcentration, the ability of alcohol to increase blood viscosity is considered to be due mainly to hemoconcentration. Alcohol itself did not increase whole blood viscosity in vitro at concentrations of 0.1, 0.2, 0.3 and 0.4% (w/v).

Adult↗

[Effect of treatment with indobufen on blood viscosity indices and exercise tolerance in patients with coronary disease].

The study included 20 patients aged from 50 to 65 years with stable coronary disease. In all patients exercise ECG test in Quinton moving track was performed before the treatment, and after one, three, and eight weeks of therapy. Besides that, before the treatment, and after each exercise, platelet aggregation, viscosity of whole blood and plasma, and filtration time of 1 ml of whole blood were evaluated. It was found that already after one week of treatment indobufen caused a decrease of platelet aggregation, reduction of viscosity of whole blood and plasma, and improvement of erythrocyte compliance which favourable effects increased with the continuation of the therapy up to eight weeks. At the same time as a result of eight weeks of treatment a significant improvement was achieved of exercise tolerance in the treated patients.

Adult↗

[Blood viscosity and triglyceridemia. Findings using a co-axial cylindrical viscosimeter at low "shear rates"].

Examination of blood viscosity at low shear rates using a co-axial cylinder viscometer showed a significant difference between the means of values observed in hypertrigliceridemic patients compared with that of control subjects. This result differs from what has been reported by most workers although generally greater shear rates have been used. Calculation of the "r" coefficient and plotting of the regression line for each shear rate showed that there is no linear correlation between blood viscosity and triglyceridaemia, whose variations occur quite independently. It is suggested that the absence of a correlation between the two parameters examined may depend on various factors, of which the most important are those pertaining to the rheological properties of red blood cells and to the structure and chemical and physical characteristics of the triglyceride molecule and of the lipoproteins and chylomicrons which transport them.

Blood Viscosity↗

Noninvasive average flow estimation for an implantable rotary blood pump: a new algorithm incorporating the role of blood viscosity.

The effect of blood hematocrit (HCT) on a noninvasive flow estimation algorithm was examined in a centrifugal implantable rotary blood pump (iRBP) used for ventricular assistance. An average flow estimator, based on three parameters, input electrical power, pump speed, and HCT, was developed. Data were collected in a mock loop under steady flow conditions for a variety of pump operating points and for various HCT levels. Analysis was performed using three-dimensional polynomial surfaces to fit the collected data for each different HCT level. The polynomial coefficients of the surfaces were then analyzed as a function of HCT. Linear correlations between estimated and measured pump flow over a flow range from 1.0 to 7.5 L/min resulted in a slope of 1.024 L/min (R2=0.9805). Early patient data tested against the estimator have shown promising consistency, suggesting that consideration of HCT can improve the accuracy of existing flow estimation algorithms.

Algorithms↗

The effect of early and late cord-clamping on blood viscosity and other hemorheological parameters in full-term neonates.

This study was done to compare postnatal alterations in blood viscosity (capillary viscometer) and its determinants: hematocrit, plasma viscosity (capillary viscometer), red cell aggregation (Myrenne aggregometer) and red cell deformability (rheoscope) in the first five days of postnatal life in full-term neonates with early (< 10 s) and late (3 min) cord-clamping. The fetal blood volume of the placenta ("residual placental blood volume") decreased from 52 +/- 8 ml/kg of neonatal body weight after early cord-clamping to 15 +/- 4 ml/kg after later cord-clamping. Neonatal blood volume, calculated as the difference between an assumed total feto-placental blood volume of 115 ml/kg and the measured fetal blood volume of the placenta, was 50% higher in the late cord-clamped infants than in the early cord-clamped infants. Both groups showed similar viscosity, hematocrit and other rheological parameters in cord blood. In the infants with early cord-clamping, the hematocrit decreased from 0.48 +/- 0.04 l/l at birth to 0.43 +/- 0.6 l/l after 24 h (p < 0.05). Whole blood viscosity did not change significantly with age. After late cord-clamping, the hematocrit rose from 0.50 +/- 0.04% at birth to 0.63 +/- 0.05 l/l at 2 h of age (p < 0.005) and dropped to 0.59 +/- 0.5 l/l (p < 0.05) at 24 h. Blood viscosity increased by 40% (p < 0.001) within the first 2 h, but did not change significantly during the following five days. In both groups, plasma viscosity and red cell aggregation increased significantly (p < 0.05) on day 5 due to significant increases in total plasma protein and fibrinogen concentrations (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Proteins↗

[The effect of high blood viscosity, caused by secondary polycythemia, on pulmonary circulation and gas exchange in patients with chronic cor pulmonale].

Blood viscosity, pressure of pulmonary artery, pulmonary functions, arterial and mixed venous oxygen content, cardiac output, oxygen transport capacity, oxygen consumption, ejection fraction have been examined at 25 patients with or without hypoxic cor pulmonale with or without secondary polycythaemia. Although secondary polycythaemia occurs in patients with hypoxic cor pulmonale as a compensatory process to increase the oxygen carrying capacity of the blood theoretically but as our findings: 1. The rise of haematocrit causes rise in blood viscosity significantly. 2. Polycythaemia secondary over 0.50 l/l of haematocrit contributes the rise of pressure in pulmonary artery. 3. The systemic oxygen carrying capacity is increasing with the rise of haematocrit up to 0.45 l/l but decreasing over 0.50 l/l. 4. Oxygen consumption is decreasing parallel with the rise of haematocrit. 5. Pulmonary functions, cardiac output do not change by the rise of haematocrit.

Blood Viscosity↗

Paradoxical hypotension following increased hematocrit and blood viscosity.

Hematocrit (Hct) of awake hamsters and CD-1 mice was acutely increased by isovolemic exchange transfusion of packed red blood cells (RBCs) to assess the relation between Hct and blood pressure. Increasing Hct 7-13% of baseline decreased mean arterial blood pressure (MAP) by 13 mmHg. Increasing Hct above 19% reversed this trend and caused MAP to rise above baseline. This relationship is described by a parabolic function (R2 = 0.57 and P < 0.05). Hamsters pretreated with the nitric oxide (NO) synthase (NOS) inhibitor N(omega)-nitro-L-arginine methyl ester (L-NAME) and endothelial NOS-deficient mice showed no change in MAP when Hct was increased by <19%. Nitrate/nitrite plasma levels of Hct-augmented hamsters increased relative to control and L-NAME treated animals. The blood pressure effect was stable 2 h after exchange transfusion. These findings suggest that increasing Hct increases blood viscosity, shear stress, and NO production, leading to vasodilation and mild hypotension. This was corroborated by measuring A1 arteriolar diameters (55.0 +/- 21.5 microm) and blood flow in the hamster window chamber preparation, which showed statistically significant increased vessel diameter (1.04 +/- 0.1 relative to baseline) and microcirculatory blood flow (1.39 +/- 0.68 relative to baseline) after exchange transfusion with packed RBCs. Larger increases of Hct (>19% of baseline) led blood viscosity to increase >50%, overwhelming the NO effect through a significant viscosity-dependent increase in vascular resistance, causing MAP to rise above baseline values.

Animals↗

Blood pressure and hematocrit in diabetes and the role of endothelial responses in the variability of blood viscosity.

OBJECTIVE: To investigate the relationship between mean arterial blood pressure and hematocrit in a population of treated diabetic patients and a control population of healthy individuals. RESEARCH DESIGN AND METHODS: Data on hematocrit and blood pressure were obtained from 129 diabetic subjects (87 women and 42 men) and 103 healthy subjects (76 women and 27 men) enrolled in a cross-sectional study. Alcohol consumption, ischemic heart disease, stroke, neoplasia, renal, hepatic, and chronic inflammatory disease were exclusion criteria. RESULTS: The hematocrit of diabetic patients ranged from 0.35 to 0.52, and blood pressure had a bimodal distribution described by a second-order polynomial (P < 0.001), whereby elevated pressures correlated with low and high hematocrit, while the minimum average pressure was at hematocrit 0.43. Hematocrit of normal control subjects (range 0.28-0.55) was uncorrelated to blood pressure (averaged 99.7 +/- 9.7 mmHg). High blood pressure, low hematocrit diabetic subjects up to the minimum average hematocrit of 0.43 had a negative correlation (P < 0.0001) between these variables. CONCLUSIONS: Our findings are compatible with the hypothesis that diabetic patients present normal responses to hematocrit variation and therefore blood viscosity and shear stress in mediating the release of vasodilators and lack the ability to autoregulate blood pressure relative to differences in hematocrit by comparison to nondiabetic subjects. These findings also suggest that the treatment of diabetes should target maintaining an optimal hematocrit in order to lower cardiovascular risk.

Adult↗

Effect of low-density lipoprotein cholesterol apheresis on blood viscosity.

Few studies have been designed to study the hemodynamic effects of low-density lipoprotein apheresis, especially on whole blood viscosity. Six patients with cardiovascular disease and hypercholesterolemia underwent a single low-density lipoprotein apheresis, resulting in significant reductions in whole blood viscosity at all shear rates.

Blood Component Removal↗

Effect of ionic and non-ionic contrast media on whole blood viscosity, plasma viscosity and hematocrit in vitro.

The effect of the ionic contrast media diatrizoate, iocarmate and metrizoate and the non-ionic metrizamide on whole blood viscosity, plasma viscosity and hematocrit was investigated. All the contrast media increased whole blood and plasma viscosity and reduced the hematocrit. The whole blood viscosity increased with increasing osmolality of the contrast medium solutions, whereas the plasma viscosity increased with increasing viscosity of the contrast medium solutions. The higher the osmolality of the contrast media, the lower the hematocrit became. The normal shear-thinning (decreasing viscosity with increasing shear rate) property of blood was reduced when contrast medium was added to the blood. At 50% volume ratio (contrast medium to blood), the ionic contrast media converted the blood into a shear-thickening (increasing viscosity with increasing shear rate) suspension, indicating a marked rigidification of the single red cell, while the non-ionic contrast medium still produced shear-thinning, indicating less rigidification of the red cell (p less than 0.01).

Blood Viscosity↗

The effect of propranolol on blood viscosity changes induced by experimental coronary occlusion.

The effect of propranolol treatment was investigated in the myocardial ischemia-induced hyperviscosity state in anesthetized dogs. In untreated control dogs, low shear blood viscosity rose progressively, following an acute occlusion of the left anterior descending coronary artery; this effect was partially but significantly reduced by intravenously administered propranolol (0.2 mg/kg). The effect of the in vitro addition of propranolol was also determined upon viscosity of blood samples obtained at hourly intervals from dogs subjected to similar coronary ligation. The in vitro addition of propranolol did not produce a similar reversal of the hyperviscosity state observed in the blood obtained from dogs after coronary ligation.

Animals↗

Blood viscosity, coagulation, and activated protein C resistance in central retinal vein occlusion: a population controlled study.

BACKGROUND: The role of blood viscosity and haemostasis has been investigated in mixed groups of patients with branch and central retinal vein occlusion (CRVO) with conflicting results. This may have partly been due to the different aetiologies of these two types of vein occlusion. METHODS: In this study viscosity and coagulation (including activated protein C resistance) were examined in 87 patients with CRVO and compared with the results from an age-matched, population based control group. RESULTS: Viscosity variables were higher in CRVO than in controls which suggested that reduced red cell deformability was associated with the occurrence of CRVO. A higher percentage of the patients with CRVO (12%) had activated protein C resistance than controls (5%). Patients who developed the complication of iris neovascularisation had relatively low antithrombin III, factor VII, and tissue plasminogen activator indicating both a tendency to thrombus formation and a reduction in fibrinolytic activity. CONCLUSION: Increased blood viscosity may contribute to the production of CRVO by inducing stasis of blood flow, with thrombus formation in at risk individuals who go on to develop iris neovascularisation.

Adult↗

Plasma volume and blood viscosity during 4 h sitting in a dry environment: effect of prehydration.

BACKGROUND: Deep vein thrombosis and pulmonary thromboembolism are potential problems for travelers, including those who fly. We hypothesized that prehydration with an electrolyte-glucose beverage (EGB) would be better than water for maintaining body fluid balance and preventing increased blood viscosity in immobilized men. METHODS: There were 12 healthy men (24-38 yr) who participated in crossover trials of prehydration using EGB and H2O as well as a control condition (Con) with no prehydration. Fluid intake was set at 6 ml x kg(-1) body weight (mean 418 ml). For each trial, subjects sat for 4 h at a dry-bulb temperature of 23.0-23.5 degrees C and a relative humidity of 18-36%. Plasma volume (PV) and whole blood viscosity (Bvis) were determined every hour; routine laboratory hematological tests, urine volume, and body weight were recorded at 2 h and 4 h. RESULTS: For Con, subjects lost approximately 110 ml h(-1); at 2 h, PV had decreased significantly by 3.4%, and Bvis had increased significantly by 9.3%, with no further change at 4 h. For prehydration, retention of the consumed fluid at 2 h was significantly higher for EGB (57%) than for H2O (38%), while both drinks prevented significant change in PV and Bvis. There were no significant differences between trials in coagulation variables, but Bvis measured at higher shear rates for EGB were significantly attenuated compared with Con. CONCLUSION: EGB and water prevented the increase of blood viscosity that occurred without prehydration. EGB was better than water for maintaining body fluid balance and preventing hypovolemia.

Adult↗