Hyperlipaemia following phlebotomies. Hyperlipaemia of Fredrickson's type V after phlebotomies for control of erythrocytosis.
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A study was undertaken to determine whether large amounts of blood (antiserum) could be rapidly removed from rabbits over a two-month period using a simple suction technique. It was found that half a blood volume could be readily removed each week (over 900 ml/rabbit/54 days) without a single fatality. The rabbits efficiently replaced the essential components of their blood during the experimental period as shown by a study of their blood parameters. They moderately overcompensated in replacing some of their blood components after a 6-week rest period. The study demonstrates that rabbits are satisfactory (in lieu of larger animals) for supplying relatively large amounts of antisera.
A method for bleeding rats from the tail vein was developed. Sufficient vasodilation of the tail was accomplished by the use of a specially designed warming device. With the help of a physical restrainer, up to 5 ml of blood can be collected from the tail vein and no anaesthesia is required. This bleeding procedure is fast, simple to perform, and imposes practically no risk to the animal.
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Rabbits were made reticulocytotic by repeated bleeding or by injection of phenylhydrazine. Up to reticulocyte levels of 70%, the baseline activity of magnesium-dependent calcium-stimulated adenosine triphosphatase ( ( Ca + Mg)-ATPase, EC 3.6.1.3.) of the red cell plasma membrane was not significantly changed. Maximal activity in the presence of calmodulin was significantly reduced, the stimulation by the activator falling from about 350% to about 50%.
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Regardless of type, uncontrolled diabetes represents a serious disruption of fuel homeostasis with consequences throughout the body. This may hamper the applicability of predeposited autologous blood transfusion in diabetic patients because metabolic changes are expected as a consequence of repeated bleeding. We undertook this study to determine whether the presence of non-insulin-dependent diabetes mellitus (NIDDM) influences the erythropoietin (EPO) response to repeated phlebotomies with respect to normal subjects. We included 22 consecutive patients scheduled for major surgery during a 2-year period in which clinical and metabolic complications were excluded and renal and liver function was considered unaffected. Selected biochemical and hematologic variables were serially measured during donation of several units of blood in a 12- to 29-day period. Bleeding produced a significant decrease in serum glucose, cholesterol, triglyceride, and apoprotein B concentration in diabetic patients. Except for glucose, this effect was not observed in controls. Both groups were comparable with respect to initial hemoglobin concentrations and all hematologic variables measured. The decrease in hemoglobin concentration did not produce clinical symptoms in these patients, and recovery was regarded as normal in both groups. Serum EPO levels in diabetic patients were negatively influenced by the initial hemoglobin A1c (HbA1c) proportion. Moreover, three nonrespondent diabetic patients with poor glycemic control responded normally 6 to 13 months later, in a second operation, when glycemic control had improved significantly. In conclusion, NIDDM may limit the donation of requested units for major surgery only if poor glycemic control is present. When possible, phlebotomies should be delayed and metabolic control reinforced.
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An immunoglobulin M anti-phenolic glycolipid 1 assay was standardized and optimized using specimens of dried blood collected on commercial precut filter paper discs, followed by a computer-assisted enzyme-linked immunosorbent assay (ELISA). The correlation between venepuncture and finger-prick methods, the calibration of the quantity of absorbed blood, and the reproducibility of the ELISA test were excellent. A slight decline of activity was observed when the samples were stored for 3 months at +4 degrees C. Skimmed milk can be used as diluent instead of bovine serum albumin, contributing to lessening the cost of the test. Using the method described, as many as 300 samples can be collected in the field and 480 ELISAs per day can be run in the central laboratory by one trained person.
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The time course of ADP induced aggregation of human platelets was determined in aliquots of stored platelet rich plasma 3.5, 10, 30 and 100 minutes after venepuncture. The maximal rate of aggregation was found to increase throughout this entire period, even though pH (7.4), CO2 (7 volume per cent) and temperature (35 degrees C) of the samples were kept constant. The mean acceleration (+/- SEM) between 3.5 and 100 minutes was 41.7 +/- 6.9 per cent (n = 67) at an ADP-concentration of 1 mumol/l and 18.3 +/- 6.2 per cent (n = 23) at 2 mumol/l ADP. The effect did not result from changes of any platelet regulatory factors putatively present alone in the plasma. Acceleration of aggregability was only found when the platelets themselves underwent storage, but not when freshly prepared plasma was given to prestored platelets. The change in aggregability was not diminished after inhibition of platelet cyclooxygenase by oral administration of acetylsalicylic acid.
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Erythrocyte complement receptors (CR) are unique to primates and play a role in the clearance of immune complexes from the circulation. Immune complex-mediated diseases (e.g., systemic lupus erythematosus, SLE) cause decreased erythrocyte CR levels, resulting in decreased capacity of the erythrocytes to bind immune complexes that form in the circulation. Thus, raising erythrocyte CR levels might benefit patients with immune complex-mediated diseases. Because young erythrocytes express more CR than old erythrocytes, increasing erythropoiesis should increase the average number of CR expressed per erythrocyte. The present study was undertaken to test that hypothesis. Erythropoiesis was stimulated in nine cynomolgus monkeys (CYN) by weekly phlebotomy (30% of blood volume was removed, erythrocytes were discarded, and leukocytes were returned to the animal) for 8 weeks. Sham phlebotomy (30% of blood removed, then all components returned to the animal) was carried out weekly in four additional CYN for a period of 4 to 8 weeks. Sham phlebotomy did not change any of the parameters measured. However, phlebotomy resulted in a progressive increase in the mean number of CR expressed per erythrocyte (CR/erythrocyte): 2780 +/- 700 to 4230 +/- 820, P less than 0.0005. The increase in erythrocyte CR was first detected at about 2 weeks after the start of phlebotomy and was sustained through the course of phlebotomy. The increase in CR/erythrocyte included an increase in the percentage of erythrocyte expressing CR in clusters (37.9 +/- 6.4 vs 50.8 +/- 8.7%, P less than 0.01) as demonstrated by a flow cytometry study of the binding of fluorescent beads coated with anti-CR1 antibody. No significant change in leukocyte or platelet counts were observed. We conclude that stimulating erythropoiesis causes an increase in CR/erythrocyte. The magnitude of the increase suggests that it could be biologically significant.
A sample (N = 16,204) of the U.S. population, 6 to 74 years of age, was examined in NHANES II with a variety of routine medical procedures, including prick-puncture allergen skin testing (AST), venipuncture, and body measurements. Eight unstandardized extracts licensed by the Food and Drug Administration, a positive and negative control, were used. AST was performed to screen the population for immediate hypersensitivity responses to common aeroallergens. No anaphylactic reactions after AST were observed. One asthmatic reaction occurred during venipuncture. Other adverse reactions (ARs) were limited to syncope, near syncope, and malaise. The rates for any AR were venipuncture, 0.49% (95% confidence interval [CI], 0.38% to 0.60%); AST, 0.04% (95% CI, 0.01%-0.08%); body measures, 0.006% (95% CI, 0 to 0.018%). Sex or fasting status had little effect on the occurrence of AR. The age group 20 to 49 years had the highest occurrence of any AR to venipuncture (0.87%; 95% CI, 0.633% to 1.107%). The risk of prick-puncture AST with eight extracts licensed by the Food and Drug Administration is low and similar to other routine medical procedures.
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