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Hemoglobin concentration, total hemoglobin mass and plasma volume in patients : implications for anemia

Title data

Otto, James M. ; Plumb, James O. M. ; Clissold, Eleri ; Kumar, Shriya ; Wakeham, Denis J. ; Schmidt, Walter ; Grocott, Michael P. W. ; Richards, Toby ; Montgomery, Hugh:
Hemoglobin concentration, total hemoglobin mass and plasma volume in patients : implications for anemia.
In: Haematologica. Vol. 102 (8 June 2017) Issue 9 . - pp. 1477-1485.
ISSN 1592-8721
DOI: https://doi.org/10.3324/haematol.2017.169680

Abstract in another language

In practice, clinicians generally consider anemia (circulating hemoglobin concentration < 120 g.l-1 in non-pregnant females and < 130 g.l-1 in males) as due to impaired hemoglobin synthesis or increased erythrocyte loss or destruction. Rarely is a rise in plasma volume relative to circulating total hemoglobin mass considered as a cause. But does this matter? We explored this issue in patients, using the optimized carbon-monoxide rebreathing method to measure hemoglobin concentration and thereby calculate plasma volume in healthy volunteers, surgical patients, and those with inflammatory bowel disease, chronic liver disease or heart failure. We studied 109 participants. Hemoglobin mass correlated well with its concentration in the healthy, surgical and inflammatory bowel disease groups (r= 0.687-0.871, p< 0.001). However, they were poorly related in liver disease (r= 0.410, p= 0.11) and heart failure patients (r= 0.312, p= 0.16). Here, hemoglobin mass explained little of the variance in its concentration (adjusted R2= 0.109 and 0.052; p= 0.11 and 0.16), whilst plasma volume did (R2 change 0.724 and 0.805 in heart and liver disease respectively, p<0.0001). Exemplar patients with identical (normal or raised) total hemoglobin masses were diagnosed as profoundly anemic (or not) depending on differences in plasma volume that had not been measured or even considered as a cause. The traditional inference that anemia generally reflects hemoglobin deficiency may be misleading, potentially resulting in inappropriate tests and therapeutic interventions to address 'hemoglobin deficiency not plasma volume excess. Measurement of total hemoglobin mass and plasma volume is now simple, cheap and safe, and its more routine use advocated.

Further data

Item Type: Article in a journal
Refereed: Yes
Institutions of the University: Faculties > Faculty of Cultural Studies > Department of Sport Science
Faculties > Faculty of Cultural Studies > Department of Sport Science > Professorship Sports Science IV
Faculties
Faculties > Faculty of Cultural Studies
Result of work at the UBT: Yes
DDC Subjects: 600 Technology, medicine, applied sciences > 610 Medicine and health
Date Deposited: 07 Sep 2017 12:31
Last Modified: 07 Sep 2017 12:31
URI: https://eref.uni-bayreuth.de/id/eprint/39245