(1991). J. Appl. doi:10.1055/s-2003-44551, Plasma viscosity: a forgotten variable. Sickle RBC are rigid, and therefore do not easily flow through the microcirculation, causing frequent vaso-occlusive episodes in affected patients. Senturk, U. K., Yalcin, O., Gunduz, F., Kuru, O., Meiselman, H. J., and Baskurt, O. K. (2005b). There is controversy over whether whole blood viscosity versus serum viscosity is superior, but most clinical laboratories measure the viscosity of the serum component of blood. Clin. Physiol. Fibrinogen is the most physiologically relevant macromolecule that promotes RBC aggregation (Rampling et al., 2004), but other molecules, including thrombospondin and the von-Willebrand factor, also play a role (Nader et al., 2017). Sports Med. However, when patients become older HbF is replaced by HbS, and, as a result, RBC deformability decreases (Renoux et al., 2016). 60, 413421. When blood temperature decreases from 36.5 to 22C, blood viscosity increases 26.13%. Environ. 277, H2145H2157. Hemorheol. There is an inverse relationship between flow and viscosity; therefore, the greater the viscosity the smaller the slope of the flow-pressure relationship, meaning that at a given driving pressure flow will be reduced at higher viscosities. Description. doi: 10.1113/EP085504, Callahan, L. A., Woods, K. F., Mensah, G. A., Ramsey, L. T., Barbeau, P., and Gutin, B. Viscosity increases about 2% for each degree centigrade decrease in temperature. At the microcirculatory level, persisting RBC aggregates may increase pre-capillary resistance. (2019). Higdon ML, Atkinson CJ, Lawrence KV. (2014). Presently, only a few studies have been conducted to evaluate chronic exercise in people with SCA. Hemorheol. Although plasma is mostly water, it also contains other molecules such as electrolytes, proteins (especially albumin and fibrinogen), and other macromolecules. It is a direct measure of the ability of blood to flow through the blood vessels. Blood viscosity is resistance to blood flow due to friction of the lamina that moves along the axis of the blood vessel due to differences in speed. Blood rheology and hemodynamics. The hemorheological benefits induced by regular exercise are suspected to contribute to the improvements in cardiovascular health that are induced by training programs in patients with cardiovascular disorders (Sandor et al., 2014). Meiselman, H. J., Neu, B., Rampling, M. W., and Baskurt, O. K. (2007). The findings of Lanotte et al. doi: 10.1111/sms.13059, Nebor, D., Bowers, A., Hardy-Dessources, M. D., Knight-Madden, J., Romana, M., Reid, H., et al. However, in individuals with vascular dysfunction, the vessels are not able to effectively vasodilate. (2015) reported higher concentrations of soluble VCAM-1 in the plasma of SCA patients at rest compared to a control group, but progressive and maximal exercise tests did not induce any further rise of VCAM-1. doi: 10.12659/msm.882878, Kleinbongard, P., Schulz, R., Rassaf, T., Lauer, T., Dejam, A., Jax, T., et al. Because of that, blood behaves as a non-Newtonian fluid. Blood tests - Examples - NHS Blood. Microcirc. The main reason is that hematocrit and plasma viscosity usually remain very stable during these kinds of efforts, despite dehydration (Galea and Davidson, 1985; Neuhaus et al., 1992; Neuhaus and Gaehtgens, 1994). doi: 10.1164/rccm.2002036, Camus, S. M., De Moraes, J. Cokelet, G. R., and Goldsmith, H. L. (1991). Two models have been proposed to explain RBC aggregation mechanisms (Meiselman et al., 2007), the depletion model and the bridging model. Physiol. Impaired oxygen uptake efficiency slope and off-transient kinetics of pulmonary oxygen uptake in sickle cell anemia are associated with hemorheological abnormalities. The bridging model suggests that aggregates form due to crossbridges, made of plasma proteins or other macromolecules (Rampling et al., 2004). Thank you for subscribing. PLoS One 11:e0162652. doi: 10.3324/haematol.2011.047365, Neuhaus, D., Behn, C., and Gaehtgens, P. (1992). However, clinical works performed to study aggregation in cardiovascular, metabolic, or inflammatory diseases consistently show that people with these diseases generally have higher RBC aggregation levels than healthy individuals, and the elevated aggregation contributes to the development of adverse disease outcomes (Totsimon et al., 2017; Biro et al., 2018; Brun et al., 2018; Ko et al., 2018; Lapoumeroulie et al., 2019; Piecuch et al., 2019; Sheremetev et al., 2019). Hemorheol. J. Haematol. Senturk, U. K., Gunduz, F., Kuru, O., Kocer, G., Ozkaya, Y. G., Yesilkaya, A., et al. The reason for this is simple. University of California, San Diego, United States, School of Medicine, Ko University, Trkiye. J. 22 However, . 36, 223230. Physical and chemical properties of blood characterized by density of blood, viscosity, osmotic pressure. J. Appl. However, it is often difficult to determine whether the detected abnormalities are the true cause or effect of clinical thrombotic events. What is being tested? With a normal hematocrit of about 40%, the relative viscosity of whole blood to the plasma's . Sci. No use, distribution or reproduction is permitted which does not comply with these terms. Moreover, regular physical exercise has been shown to decrease blood viscosity in sickle cell mice, which could be beneficial for adequate blood flow and tissue perfusion. Respir. J. Physiol. Sports 20(Suppl. Br. Exercise limitation, exercise testing and exercise recommendations in sickle cell anemia. The viscosity of plasma is dependent on the concentration of plasma proteins, such as fibrinogen, 1-globulins, 2-globulins, -globulins, and -globulins (Connes et al., 2008). doi: 10.1371/journal.pone.0162652, Aufradet, E., Douillard, A., Charrin, E., Romdhani, A., De Souza, G., Bessaad, A., et al. Currently, no human studies have been conducted to determine whether chronic exercise can modulate the biological parameters (i.e., blood rheology, hematology, inflammation, oxidative stress) that cause the various acute complications experienced by people with SCA. While acute, intense exercise may increase blood viscosity in healthy individuals, recent works conducted in sickle cell patients have shown that light cycling exercise did not cause dramatic changes in blood rheology. However, the picture could be slightly different during ultra-running events. Therefore, elevated blood viscosity can increase vascular resistance. Instead, the authors found a decrease of RBC deformability, as a result of massive RBC sickling (Ballas and Smith, 1992), and a rise in RBC aggregation and RBC aggregates robustness, which would probably impair blood flow into the microcirculation (Lapoumeroulie et al., 2019). One reason for this change is that plasma volume increases few hours or several days after a single bout of exercise (Fellmann, 1992; Brun et al., 1998), resulting in an autohemodilution (Ernst, 1987; Ernst et al., 1991a). (2013) showed that high levels of anemia, low fetal hemoglobin levels, and low RBC deformability were independent predictors of a low 6-min walking test performance. 92, E629E630. Studies conducted in sickle SAD mice showed that 8 weeks of voluntary wheel running decreased blood viscosity (Faes et al., 2015), limited systemic oxidative stress (Charrin et al., 2015), and decreased pulmonary endothelial activation in response to an hypoxic-reoxygenation stimulus (Aufradet et al., 2014). The higher the result, the more viscous (or "thicker") the blood is. This resistance is expressed in sec(-1) by the ratio W/2r. Clin. doi: 10.3324/haematol.2008.005371, Tripette, J., Hardy-Dessources, M. D., Beltan, E., Sanouiller, A., Bangou, J., Chalabi, T., et al. (2016) showed that RBCs display a wide variety of cell shapes for any given flow condition. doi: 10.1152/jappl.1981.50.6.1255. Baskurt, O., and Meiselman, H. J. Effects of hydration and water deprivation on blood viscosity during a soccer game in sickle cell trait carriers. The impact of the environment and higher dehydration rate on blood viscosity are unknown and further studies are needed. 97, 10531058. Exerc. Blood viscosity also increases with increases in red cell aggregability. It gives your provider information about your blood and overall health. Exercise-induced oxidative stress leads hemolysis in sedentary but not trained humans. J. Hematol. Blood viscosity is an important determinant of blood flowthe higher the viscosity, the lower the flow-and this is significantly linked with cognitive function. Blood 79, 21542163. However, there is limited evidence to date regarding the role of high blood viscosity in acute thrombogenic events. The mainstays of treatment include supportive therapy, plasma exchange or plasmapheresis, and chemotherapy. Am. Hyperviscosity syndrome is an oncologic emergency that classically presents with the triad of neurological deficits, visual changes, and mucosal bleeding 1. Many cardiovascular handbooks consider blood viscosity values between 3.5 and 5.5 cP to be normal. A., et al. 2018 Jun 01;97(11):741-748. Incidence of convulsions, and epilepsy, and this occurs in advanced cases of the disease. Brun, J. F., Supparo, C., Mallard, C., and Orsetti, A. Effects of different kind of exercise on blood viscosity measured at several shear rates in the same trained subject (maximal oxygen consumption, VO2max = 64 ml/kg/min). (2004b). Overall, predicting the consequences of increased RBC aggregation in vivo appears to be complex. The best example would be automotive engine oil, which is available in multiple viscosities defined by the Society of Automotive Engineers (SAE) followed by a number. Hyperviscosity Syndrome: Causes, Symptoms, and Diagnosis - Healthline Microcirc. Biorheology 47, 95115. Blood rheology as a mirror of endocrine and metabolic homeostasis in health and disease1. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). This paradox seems to be due to the fact that in SCD RBC with the highest deformability are also the most adherent, which would trigger vaso-occlusion. Due to the shear thinning property of blood, which is dependent on RBC rheological properties, the viscosity of this fluid changes depending on the hemodynamic conditions. (2009). At a normal hematocrit of 40%, the relative viscosity of blood is about 4. (2016) demonstrated that exosomes isolated from SCA patients with frequent vaso-occlusive crises decreased endothelial permeability and promoted P-selectin expression on cultured endothelial cells. Interpret your laboratory results instantly with us. This relationship becomes increasingly sensitive as hematocrit increases. PLoS One 8:e79680. Martini, J., Carpentier, B., Negrete, A. C., Frangos, J. The hydrophobic residue of valine associates with other hydrophobic residues, which causes HbS molecules to aggregate, forming fibrous precipitates when hemoglobin is deoxygenated. Dis. Paris 1, 554560. Clin. Although the role of blood viscosity in vascular adaptations is often ignored, these studies clearly demonstrate that vascular geometry and blood viscosity should not be considered separately when studying the regulation of vascular resistance in healthy populations or in people with cardiovascular diseases. Physiol. Pulmonary vascular pressure profile in adult ferrets: measurements in vivo and in isolated lungs. Several studies have shown that light to moderate intensity acute exercise is well-tolerated in individuals with SCA (Figure 2). Vazquez, B. Y., Vazquez, M. A., Jaquez, M. G., Huemoeller, A. H., Intaglietta, M., and Cabrales, P. (2010). C R Acad. (2012). doi: 10.3233/CH-2009-1255. Lancet Haematol. 299, H908H914. Grau et al. Int. In a study performed in Ivory Coast, 17 patients with SCA performed a 20 min moderate exercise (45 Watts) with blood sampling before and at the end of exercise (Balayssac-Siransy et al., 2011; Faes et al., 2014). (2005a). Hemorheology - Wikipedia The viscosity of blood is 4-6 times that of water, it depends on the number of red blood cells. Further research should be conducted to determine how decreased RBC deformability could affect RBC shape transitions. It is normally 40.7-50.3% for males and 36.1-44.3% for females. Clin. Ernst, E., Daburger, L., and Saradeth, T. (1991b). 24, 1827. Physiol. Capillaries can have a diameter of less than 5 m. Acute hyperviscosity: syndromes and management | Blood | American Hemorheol. Changes in plasma volume after prolonged endurance exercise. Sci. Therefore, blood viscosity strongly depends on hematocrit. In horizontal tubes, elevated RBC aggregation increases RBC sedimentation, thereby increasing flow resistance. Clin. A., Buerk, D. G., et al. When blood has low viscosity, it travels quickly and without much difficulty. In this context, any increase in blood viscosity can promote vaso-occlusive like events. Semin. Microcirc. Effects of nitric oxide on red blood cell deformability. Plasma exchange in acute and chronic hyperviscosity syndrome: a rheological approach and guidelines study. Fatigue, general fatigue, in addition to laziness and lethargy. (2010). Instead, observations by Lanotte et al. Plasma Cell Neoplasms Nikhil C. Munshi, Sundar Jagannath, in Hematology (Seventh Edition), 2018 Hyperviscosity Hyperviscosity is less frequent in myeloma than in Waldenstrm macroglobulinemia, where higher-molecular-weight IgM molecules frequently cause an increase in viscosity. Instead, increasing blood viscosity can facilitate vasodilation and decrease vascular resistance through shear stress-dependent mechanisms, which increase NO production. In healthy individuals, the vascular system can adapt to elevations in blood viscosity because increased shear stress results in endothelium-dependent NO production. Red blood cell aggregation is the reversible formation of three-dimensional stacks of RBC, called rouleaux, which takes place at low shear rates. Gonzales, J. U., Parker, B. Repeated exercise bouts on consecutive days leads to a chronic autohemodilution resulting in a low baseline hematocrit low baseline viscosity pattern (Ernst, 1987; Brun et al., 1998; Kilic-Toprak et al., 2012). Using recombinant versions of erythropoietin produced pharmacologically (e.g., epoetin, darbepoetin, and methoxy polyethylene glycol-epoetin beta), Perez Rogers A, Estes M. Hyperviscosity Syndrome. doi: 10.1111/j.1365-2141.2011.08728.x. Clin. (2006). EN, SS, and PC wrote the first version of the manuscript. Environ. Effect of antioxidant vitamin treatment on the time course of hematological and hemorheological alterations after an exhausting exercise episode in human subjects. (2012). Ernst, E., Matrai, A., Aschenbrenner, E., Will, V., and Schmidlechner, C. (1985). (1983). Int. Your hematocrit is a measure of both the number and the size of red blood cells. Finally, Barbeau et al. Increases in core temperature counterbalance effects of haemoconcentration on blood viscosity during prolonged exercise in the heat. Physiol. (2018). Tripette et al. Importance of Blood Rheology in the Pathophysiology of Atherothrombosis. Goldsmith, H. L., Frank, J. M., and Maclntosh, C. (1972). Measurement of blood viscosity is very valuable in the evaluation of thrombotic diseases. Clin. What can cause high plasma viscosity? - Studybuff.com 52, 1526. Dehydration can worsen hyperviscosity syndrome, and these patients are usually dehydrated. Microcirc. (1987). Deconstructing sickle cell disease: reappraisal of the role of hemolysis in the development of clinical subphenotypes. J. Appl. J. Physiol. Hemorheol. Serum stasis can also lead to the malfunction of laboratory testing equipment in which lab samples cannot be analyzed. Contrarily, blood viscosity increases when shear rate goes down with increased vessel diameters or with low flow, such as downstream from an obstruction or in diastole. Physiol. Transfus. Sports Med. While an increase of blood viscosity is usually considered as a risk for an increase in blood flow resistance, several studies demonstrated that a moderate rise in blood viscosity (if not supra-physiologic) may be very positive for the endothelial function and vasomotor tone [54,55] or even endurance performance [56]. Newborns usually have almost normal RBC deformability because they still have a high percentage of fetal hemoglobin (HbF) (Renoux et al., 2016). Acta. Intaglietta, M. (2009). (2001) demonstrated that episodes of intrahepatic hypoxia-reoxygenation, which can occur in SCA, induce the release of plasma XO. doi: 10.1126/science.715448, Galea, G., and Davidson, R. J. Blood 116, 21522159. Exp. Both hematocrit and plasma viscosity influence blood viscosity. 1:104. doi: 10.1038/ncomms1104. (2018) found a higher proportion of young deformable RBCs in athletes than in untrained subjects. Omwanghe, O. 69, 4552. doi: 10.1161/01.res.68.1.1. Therefore, a loss of RBC deformability at very low shear rates (less than 1 s1) results in a decrease in blood viscosity (Chien et al., 1970). The role of nitric oxide in regulation of deformability of red blood cells in acute phase of endotoxaemia in rats. doi: 10.3233/CH-2012-1540, Waltz, X., Romana, M., Lalanne-Mistrih, M. L., Machado, R. F., Lamarre, Y., Tarer, V., et al. Physiol. Blood viscosity is determined by red blood cells and plasma protein composition. The impact of hematocrit on blood viscosity is much higher at low shear rates (veins for instance) than at high shear rate (arteries for instance) (Cokelet and Meiselman, 2007). The maximal treadmill and cycling tests consisted in a progressive and maximal exercise conducted until VO2max and performed in laboratory conditions (temperature: 24C). Res. Indian J. Exp. doi: 10.1111/j.1600-0838.2012.01481.x, Romain, A. J., Brun, J. F., Varlet-Marie, E., and Raynaud De Mauverger, E. (2011). Decreased hematocrit-to-viscosity ratio and increased lactate dehydrogenase level in patients with sickle cell anemia and recurrent leg ulcers. Hypergammaglobulinemia is the most common cause of hyperviscosity syndrome, specifically the monoclonal condition Waldenstrom macroglobulinemia. Hemost. (2018). Effect of enhanced red blood cell aggregation on blood flow resistance in an isolated-perfused guinea pig heart preparation. When blood has low viscosity, it travels quickly and without much difficulty. Whole blood has a much higher viscosity than water and therefore the slope of the flow-pressure relationship is less steep (see figure). More than 30% of all Waldenstrom macroglobulinemia patients develop hyperviscosity syndrome at some point in their life because of the large star-shaped IgM pentamers that are highly viscous 1. More recent research has shown that RBC cellular properties can also modulate a cells intrinsic tendency to aggregate (termed RBC aggregability) (Baskurt and Meiselman, 2009). doi: 10.1136/bjsports-2015-095317. Blood Cells Mol. 165, 13091316. Furthermore, Mockesch et al. doi: 10.1371/journal.pone.0079680, Connes, P., Simmonds, M. J., Brun, J. F., and Baskurt, O. K. (2013b). 69, 2335. Capillary recruitment in response to tissue hypoxia and its dependence on red blood cell deformability. 87:E129. Blood viscosity and hemodynamics during exercise. 2016;47:115-27. Brun, J. F., Varlet-Marie, E., Connes, P., and Aloulou, I. J. Respir. Hemorheol. (2009). doi: 10.1055/s-2003-44551, Baskurt, O. K., and Meiselman, H. J. Increased viscosity increases the resistance to blood flow and thereby increases the work of the heart and impairs organ perfusion. (2013). Results are reported as a relative viscosity to water, where normal serum and plasma have a relative viscosity of . J. Hematol. Sports Exerc. doi: 10.2165/00007256-199213010-00004, Fischer, T. M., Stohr-Lissen, M., and Schmid-Schonbein, H. (1978). 303, H1096H1106. Physiol. If blood viscosity increases, it will make blood can not flow freely in arteries, reduce blood flow to organs such as heart, kidneys, brain,. Blood rheology abnormalities and vascular cell adhesion mechanisms in sickle cell trait carriers during exercise.
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