Microcirculation in striated muscle after acute reduction in systemic hematocrit

The Relevance of Fluid and Blood Management Using Microcirculatory Parameters in Children Undergoing Craniofacial Surgery

ABSTRACT

Perioperative management of bleeding in children can be challenging. Microvascular imaging techniques have allowed evaluating the effect of blood transfusion on the microcirculation, but little is known about these effects in children. We aimed to investigate the effects of blood management using macro- and micro-hemodynamic parameters measurement in children undergoing craniofacial surgery. This is a prospective observational repeated measurement study including fourteen children. The indications for blood transfusion were changes of hemoglobin/hematocrit (Hct) levels, the presence of signs of altered tissue perfusion and impaired microcirculation images. Total and perfused vessel densities, proportion of perfused vessels, microvascular flow index, and systemic parameters (hemoglobin, Hct, lactate, mixed venous oxygen saturation, K+, heart rate, mean arterial blood pressure) were evaluated baseline (T1), at the end of the surgical bleeding (T2) and end of the operation (T3). Four patients did not need a blood transfusion. In the other 10 patients who received a blood transfusion, capillary perfusion was higher at T3 (13[9-16]) when compared with the values of at T2 (11[8-12]) (P < 0.05) but only 6 patients reached their baseline values. Although blood transfusions increased Hct values (17 ± 2.4 [T2]-19 ± 2.8 [T3]) (P < 0.05), there was no correlation between microvascular changes and systemic hemodynamic parameters (P > 0.05). The sublingual microcirculation could change by blood transfusion but there was not any correlation between microcirculation changes, hemodynamic, and tissue perfusion parameters even with Hct values. The indication, guidance, and timing of fluid and blood therapy may be assessed by bedside microvascular analysis in combination with standard hemodynamic and biochemical monitoring for intraoperative bleeding in children.

Impact of red blood cell transfusion on oxygen transport and metabolism in patients with sepsis and septic shock: a systematic review and meta-analysis

Red blood cell transfusion is thought to improve cell respiration during septic shock. Nevertheless, its acute impact on oxygen transport and metabolism in this condition remains highly debatable. The objective of this study was to evaluate the impact of red blood cell transfusion on microcirculation and oxygen metabolism in patients with sepsis and septic shock. We conducted a search in the MEDLINE®, Elsevier and Scopus databases. We included studies conducted in adult humans with sepsis and septic shock. A systematic review and meta-analysis were performed using the DerSimonian and Laird random-effects model. A p value < 0.05 was considered significant. Nineteen manuscripts with 428 patients were included in the analysis. Red blood cell transfusions were associated with an increase in the pooled mean venous oxygen saturation of 3.7% (p < 0.001), a decrease in oxygen extraction ratio of -6.98 (p < 0.001) and had no significant effect on the cardiac index (0.02L/minute; p = 0,96). Similar results were obtained in studies including simultaneous measurements of venous oxygen saturation, oxygen extraction ratio, and cardiac index. Red blood cell transfusions led to a significant increase in the proportion of perfused small vessels (2.85%; p = 0.553), while tissue oxygenation parameters revealed a significant increase in the tissue hemoglobin index (1.66; p = 0.018). Individual studies reported significant improvements in tissue oxygenation and sublingual microcirculatory parameters in patients with deranged microcirculation at baseline. Red blood cell transfusions seemed to improve systemic oxygen metabolism with apparent independence from cardiac index variations. Some beneficial effects have been observed for tissue oxygenation and microcirculation parameters, particularly in patients with more severe alterations at baseline. More studies are necessary to evaluate their clinical impact and to individualize transfusion decisions.

Cremaster muscle perfusion, oxygenation, and heterogeneity revealed by a new automated acquisition system in a rodent model of prolonged hemorrhagic shock

Local blood flow/oxygen partial pressure (Po₂) distributions and flow-Po₂ relationships are physiologically relevant. They affect the pathophysiology and treatment of conditions like hemorrhagic shock (HS), but direct noninvasive measures of flow, Po₂, and their heterogeneity during prolonged HS are infrequently presented. To fill this void, we report the first quantitative evaluation of flow-Po₂ relationships and heterogeneities in normovolemia and during several hours of HS using noninvasive, unbiased, automated acquisition. Anesthetized rats were subjected to tracheostomy, arterial/venous catheterizations, cremaster muscle exteriorization, hemorrhage (40% total blood volume), and laparotomy. Control animals equally instrumented were not subjected to hemorrhage/laparotomy. Every 0.5 h for 4.5 h, noninvasive laser speckle contrast imaging and phosphorescence quenching were employed for nearly 7,000 flow/Po₂ measurements in muscles from eight animals, using an automated system. Precise alignment of 16 muscle areas allowed overlapping between flow and oxygenation measurements to evaluate spatial heterogeneity, and repeated measurements were used to estimate temporal heterogeneity. Systemic physiological parameters and blood chemistry were simultaneously assessed by blood samplings replaced with crystalloids. Hemodilution was associated with local hypoxia, but increased flow prevented major oxygen delivery decline. Adding laparotomy and prolonged HS resulted in hypoxia, ischemia, decreased tissue oxygen delivery, and logarithmic flow/Po₂ relationships in most regions. Flow and Po₂ spatial heterogeneities were higher than their respective temporal heterogeneities, although this did not change significantly over the studied period. This quantitative framework establishes a basis for evaluating therapies aimed at restoring muscle homeostasis, positively impacting outcomes of civilian and military trauma/HS victims.NEW & NOTEWORTHY This is the first study on flow-Po₂ relationships during normovolemia, hemodilution, and prolonged hemorrhagic shock using noninvasive methods in multiple skeletal muscle areas of monitored animals. Automated flow/Po₂ measurements revealed temporal/spatial heterogeneities, hypoxia, ischemia, and decreased tissue oxygen delivery after trauma/severe hemorrhage. Hemodilution was associated with local hypoxia, but hyperemia prevented a major decline in oxygen delivery. This framework provides a quantitative basis for testing therapeutics that positively impacts muscle homeostasis and outcomes of trauma/hemorrhagic shock victims.

Accounting for Tube Hematocrit in Modeling of Blood Flow in Cerebral Capillary Networks

The aim of this paper consists in the derivation of an analytic formula for the hydraulic resistance of capillaries, taking into account the tube hematocrit level. The consistency of the derived formula is verified using Finite Element simulations. Such an effective formula allows for assigning resistances, depending on the hematocrit level, to the edges of networks modeling biological capillary systems, which extends our earlier models of blood flow through large capillary networks. Numerical simulations conducted for large capillary networks with random topologies demonstrate the importance of accounting for the hematocrit level for obtaining consistent results.

Effects of haemoglobin levels on the sublingual microcirculation in pregnant women

Anemia in pregnant women is associated with increased maternal and perinatal mortality and represents an important economic burden in many developing countries. Our goal was to evaluate the impact of anemia on the capillary network during pregnancy. Therefore, we compared microcirculatory parameters of anemic pregnant study participants to that of non-anemic pregnant women employing sublingual microcirculation video imaging technology and novel automated video analysis software.Non-anemic (n = 7) and anemic (n = 44) pregnant women were enrolled in the study at second and third trimesters. Video imaging was applied to the sublingual mucosal surface in five visual fields. The resultant videos were analyzed automatically, avoiding observer bias. Total vessel density (TVD), perfused vessel density (PVD) and proportion of perfused vessels (PPV) were calculated by the software. Both, mean TVD and PVD were significantly increased in the anemic pregnant group, while the PPV was not significantly different. Significant negative correlations were observed between haemoglobin (Hb) levels and both, TVD and PVD. Haemoglobin level seems to play an important determinant role in restructuring the capillary network. An effect that could compensate the impaired tissue oxygen delivery associated with anemia during pregnancy.

Effects of erythropoietin on systemic hematocrit and oxygen transport in the splenectomized horse

To test the hypotheses that erythropoietin (rhuEPO) treatment increases systemic hematocrit, maximal O2 uptake (VO2max, by elevated perfusive and diffusive O2 conductances) and performance five female horses (4-13 years) received 15 IU/kg rhuEPO (erythropoietin) three times per week for three weeks. These horses had been splenectomized over 1 year previously to avoid confounding effects from the mobilization of splenic red blood cell reserves. Each horse performed three maximal exercise tests (one per month) on an inclined (4°) treadmill to the limit of tolerance; two control trials and one following EPO treatment. Measurements of hemoglobin concentration ([Hb] and hematocrit), plasma and blood volume, VO2, cardiac output as well as arterial and mixed venous blood gases were made at rest and during maximal exercise. EPO increased resting [Hb] by 18% from 13.3 ± 0.6 to 15.7 ± 0.8 g/dL (mean ± SD) corresponding to an increased hematocrit from 36 ± 2 to 46 ± 2% concurrent with 23 and 10% reductions in plasma and blood volume, respectively (all P<0.05). EPO elevated VO2max by 20% from 25.7 ± 1.7 to 30.9 ± 3.4 L/min (P<0.05) via a 17% increase in arterial O2 content and 18% greater arteriovenous O2 difference in the face of an unchanged cardiac output. To achieve the greater VO2max after EPO, diffusive O2 conductance increased ∼ 30% (from 580 ± 76 to 752 ± 166 mL O2/mmHg/min, P<0.05) which was substantially greater than the elevation of perfusive O2 conductance. These effects of EPO were associated with an increased exercise performance (total running time: control, 216 ± 72; EPO, 264 ± 48 s, P<0.05). We conclude that EPO substantially increases VO2max and performance in the splenectomized horse via improved perfusive and diffusive O2 transport.

Fiber optical spatial filter anemometry--intravital measurement of red blood flow velocity (RBCV) in the microcirculation

The fiberoptical spatial filter anemometry (SFA) is a common technique based on an optical grid to measure the velocity of corpuscular components in a multiphase flow, e.g. in the microvessels. The technical innovation is the analysis of flow velocities using an optical grid sensor and frequency analysis by Fast Fourier Transformation (FFT). This study describes a non-invasive, on-line technique to measure RBCV in the microcirculation. The sensor's validity was proven by in vitro measurements using a rotation disk of an exactly defined velocity with a correlation coefficient of 0.99967. For validation of RBCV measurements in the microcirculation in vivo, the setup was adapted to an intravital microscope. RBCV was measured in arterioles, capillaries, and postcapillary venules ranging from 8-140 microm diameter. As reference method for velocity measurements a computer assisted imaging system was used to measure the RBC-velocity in the identical vessels by frame to frame analysis. Both methods revealed a high significant correlation using transillumination technique for capillaries (r=0.986, p<0.001) and venules (r=0.952, p<0.001) as well as epiillumination technique (capillaries r=0.939, venules r=0.975, p<0.001).

Erythrocyte-associated transients in capillary PO2: an isovolemic hemodilution study in the rat spinotrapezius muscle

Mathematical simulations of oxygen delivery to tissue from capillaries that take into account the particulate nature of blood flow predict the existence of oxygen tension (Po(2)) gradients between erythrocytes (RBCs). As RBCs and plasma alternately pass an observation point, these gradients are manifested as rapid fluctuations in Po(2), also known as erythrocyte-associated transients (EATs). The impact of hemodilution on EATs and oxygen delivery at the capillary level of the microcirculation has yet to be elucidated. Therefore, in the present study, phosphorescence quenching microscopy was used to measure EATs and Po(2) in capillaries of the rat spinotrapezius muscle at the following systemic hematocrits (Hct(sys)): normal (39%) and after moderate (HES1; 27%) or severe (HES2; 15%) isovolemic hemodilution using a 6% hetastarch solution. A 532-nm laser, generating 10-micros pulses concentrated onto a 0.9-microm spot, was used to obtain plasma Po(2) values 100 times/s at points along surface capillaries of the muscle. Mean capillary Po(2) (Pc(O(2)); means +/- SE) significantly decreased between conditions (normal: 56 +/- 2 mmHg, n = 45; HES1: 47 +/- 2 mmHg, n = 62; HES2: 27 +/- 2 mmHg, n = 52, where n = capillary number). In addition, the magnitude of Po(2) transients (DeltaPo(2)) significantly decreased with hemodilution (normal: 19 +/- 1 mmHg, n = 45; HES1: 11 +/- 1 mmHg, n = 62; HES2: 6 +/- 1 mmHg, n = 52). Results suggest that the decrease in Pc(O(2)) and DeltaPo(2) with hemodilution is primarily dependent on Hct(sys) and subsequent microvascular compensations.

Influence of acute plasma volume expansion on V̇o2 kinetics, V̇o2peak, and performance during high-intensity cycle exercise

The purpose of this study was to examine the influence of acute plasma volume expansion (APVE) on oxygen uptake (V̇o2) kinetics, V̇o2peak, and time to exhaustion during severe-intensity exercise. Eight recreationally active men performed “step” cycle ergometer exercise tests at a work rate requiring 70% of the difference between the gas-exchange threshold and V̇o2max on three occasions: twice as a “control” (Con) and once after intravenous infusion of a plasma volume expander (Gelofusine; 7 ml/kg body mass). Pulmonary gas exchange was measured breath by breath. APVE resulted in a significant reduction in hemoglobin concentration (preinfusion: 16.0 ± 1.0 vs. postinfusion: 14.7 ± 0.8 g/dl; P < 0.001) and hematocrit (preinfusion: 44 ± 2 vs. postinfusion: 41 ± 3%; P < 0.01). Despite this reduction in arterial O2 content, APVE had no effect on V̇o2 kinetics (phase II time constant, Con: 33 ± 15 vs. APVE: 34 ± 12 s; P = 0.74), and actually resulted in an increased V̇o2peak (Con: 3.90 ± 0.56 vs. APVE: 4.12 ± 0.55 l/min; P = 0.006) and time to exhaustion (Con: 365 ± 58 vs. APVE: 424 ± 64 s; P = 0.04). The maximum O2 pulse was also enhanced by the treatment (Con: 21.3 ± 3.4 vs. APVE: 22.7 ± 3.4 ml/beat; P = 0.04). In conclusion, APVE does not alter V̇o2 kinetics but enhances V̇o2peak and exercise tolerance during high-intensity cycle exercise in young recreationally active subjects.

Physiologic aspects of anemia

The most important adaptive responses from a physiological stance involved the cardiovascular system, consisting in particular of elevation of the cardiac output and its redistribution to favor the coronary and cerebral circulations, at the expense of the splanchnic vascular beds. The evidence regarding these physiological responses, especially in experimental studies that permit the control of many variables, is particularly powerful and convincing. On the other hand, there is a remarkable lack, in quality and quantity, of clinical studies addressing how normal physiological adaptive responses may be affected by a variety of diseases and conditions that often accompany and may complicate anemia, and interactions with other such compounding variables as age and different patient populations. For these reasons, it is not possible to offer guidelines on how to increase, maintain, or even to determine optimal DO2 in high-risk patients and how best transfusion strategies might be used under these conditions. From the brief review of physiological principles and the strong consensus in the literature, it is evident that cardiac function must be a central consideration in decisions regarding transfusion in anemia, because of the critical role it plays in assuring adequate oxygen supply of all vital tissues. Particular attention should be paid to the possible presence of CAD or incipient or cardiac failure, as these conditions may require careful transfusions to improve DO2 at levels that may not necessitate such interventions when cardiac disease is absent. Although the cerebral circulation also serves an obligate aerobic organ unable to tolerate significant hypoxia, there is little convincing evidence to support the notion that cerebral ischemia is aggravated by anemia and that this can be prevented by improved DO2 through rapid correction of anemia. Consequently, the arguments favoring transfusions in the presence of ischemic heart disease do not appear to apply to occlusive cerebrovascular disease. Because firm evidence is lacking on the interactions of concurrent diseases and anemia in various patient populations, understanding of the physiological consequences of anemia, and of the diseases concerned, is useful but not fully sufficient to provide firm and rational guidance to transfusion practice in specific complex clinical instances. A good deal of clinical and experimental investigation is required to support fully rational and comprehensive guidelines. In the meantime, prudent and conservative management, based on awareness of risks and sound understanding of the normal and pathological physiology, must remain the guiding principle.

Calculations of oxygen transport by red blood cells and hemoglobin solutions in capillaries

A theoretical model is developed to investigate the influence of hemoglobin-based oxygen carriers (HBOCs) on oxygen transport in capillary-size vessels. A discrete cell model is presented with red blood cells (RBCs) represented in their realistic parachute shape flowing in a single file through a capillary. The model includes the free and Hb-facilitated transport of O2 and Hb-O2 kinetics in the RBC and plasma, diffusion of free O2 in the suspending phase, capillary wall, interstitium and tissue. A constant tissue consumption rate is specified that drives the simultaneous release of O2 from RBC and plasma as the cells traverse the capillary. The model mainly focuses on low capillary hematocrits and studies the effect of free hemoglobin affinity, cooperativity and concentration. The results are expressed in the form of cell and capillary mass transfer coefficients, or inverse transport resistances, that relate the spatially averaged flux of O2 coming out of the RBC and capillary to a driving force for O2 diffusion. The results show that HBOCs at a concentration of 7 g/dl reduce the intracapillary transport resistance by as much as 60% when capillary hematocrit is 0.2. HBOCs with high O2 affinity unload most O2 at the venular end, while those with low affinity supply O2 at the arteriolar end. A higher cooperativity did not favor O2 delivery due to the large variation in the mass transfer coefficient values during O2 unloading. The mass transfer coefficients obtained will be used in simulations of O2 transport in complex capillary networks.

Effect of acute normovolemic hemodilution on distribution of blood flow and tissue oxygenation in dog skeletal muscle

Acute normovolemic hemodilution (ANH) is efficient in reducing allogenic blood transfusion needs during elective surgery. Tissue oxygenation is maintained by increased cardiac output and oxygen extraction and, presumably, a more homogeneous tissue perfusion. The aim of this study was to investigate blood flow distribution and oxygenation of skeletal muscle. ANH from hematocrit of 36 +/- 3 to 20 +/- 1% was performed in 22 splenectomized, anesthetized beagles (17 analyzed) ventilated with room air. Normovolemia was confirmed by measurement of blood volume. Distribution of perfusion within skeletal muscle was determined by using radioactive microspheres. Tissue oxygen partial pressure was assessed with a polarographic platinum surface electrode. Cardiac index (3.69 +/- 0.79 vs. 4.79 +/- 0.73 l. min-1. m-2) and muscle perfusion (4.07 +/- 0.44 vs. 5.18 +/- 0.36 ml. 100 g-1. min-1) were increased at hematocrit of 20%. Oxygen delivery to skeletal muscle was reduced to 74% of baseline values (0.64 +/- 0.06 vs. 0.48 +/- 0.03 ml O2. 100 g-1. min-1). Nevertheless, tissue PO2 was preserved (27.4 +/- 1.3 vs. 29.9 +/- 1. 4 Torr). Heterogeneity of muscle perfusion (relative dispersion) was reduced after ANH (20.0 +/- 2.2 vs. 13.9 +/- 1.5%). We conclude that a more homogeneous distribution of perfusion is one mechanism for the preservation of tissue oxygenation after moderate ANH, despite reduced oxygen delivery.

Conducted signals within arteriolar networks initiated by bioactive amino acids

Our purpose was to determine the specificity of L-arginine (L-Arg)-induced conducted signals for intra- vs. extracellular actions of L-Arg. Diameter and red blood cell velocities were measured for arterioles [18 +/- 1.6 (SE) micrometer] in the cremaster muscle of pentobarbital sodium-anesthetized (Nembutal, 70 mg/kg) hamsters (n = 53). Remote (conducted) responses were viewed approximately 1,000 micrometer upstream from the local (micropipette) application. Six amino acids were tested: L-arginine, L-cystine, L-leucine, L-lysine, L-histidine, and L-aspartate (100 microM each). Only L-Arg induced a remote dilation; L-lysine and L-aspartate had no effect, and the others each induced a significant remote constriction. There is a second conducted signal initiated by L-arginine that preconditions the arteriolar network and upregulates a direct response of L-arginine to dilate the remote site. This was blocked by inhibition of L-arginine uptake at the local (preconditioning) site (100 microM L-histidine or 1 mM phenformin). Arginine-glycine-aspartate (100 microM)-induced remote dilations (+3. 2 +/- 0.3 micrometer) were not mimicked by a peptide control and were prevented by anti- integrin alphav monoclonal antibody. Remote dilations were greater in animals with a higher wall shear stress for arginine-glycine-aspartate (r2 = 0.92) but not for L-arginine (r2 = 0.12). Thus L-arginine initiates separate conducted signals related to system y+ transport, integrins, and baseline flow.

Reversal and protection against indomethacin-induced blood stasis and mucosal damage in the rat jejunum by a beta3-adrenoceptor agonist

BACKGROUND

In the rat, indomethacin causes jejunal villous shortening, microvascular distortion, and blood stasis prior to ulceration. The beta3-adrenoceptor agonist CL316,243 (CL) prevents both the early histological changes and ulceration.

AIM

To test the hypothesis that the beta3-adrenoceptor agonist CL316,243 exerts its protective effect by prevention and/or reversal of blood flow changes in the rat jejunum exposed to indomethacin.

METHODS

In anaesthetized rats, jejunal villous blood flow was measured in surface capillaries using fluorescence microscopy. Stasis of superficial capillary blood flow was induced by combined topical and i.v. indomethacin (100 microg/mL, 2.8 x 10(-4) M). To examine the effect of CL on blood stasis, CL was applied either i.v. (1 mg/kg) or luminally (100 microg/mL, 2.5 x 10(-5)M) at the onset of stasis. Prophylactic protection was assessed by giving i.v. CL simultaneously with indomethacin. Results were compared with controls which received luminal saline applied at blood stasis. The effect of i.v. CL (1 mg/kg) alone, or luminal CL (100 microg/mL) alone on basal villous blood flow was also examined. The small intestines were perfusion-fixed with 10% formol saline, and removed for histology, n = 5 for all groups.

RESULTS

Luminal CL given at stasis reversed indomethacin-induced stasis within 10 min, whereas i.v. CL did not. Pretreatment with i.v. CL prevented the onset of stasis. Basal blood flow was raised slightly only by luminal CL.

CONCLUSION

The beta-adrenoceptor agonist CL316,243 can protect against indomethacin-induced blood stasis in rat jejunal villi.

CO2 transport in normovolemic anemia: complete compensation and stability of blood CO2 tensions

Isovolemic hemodilution does not appear to impair CO2 elimination nor cause CO2 retention despite the important role of red blood cells in blood CO2 transport. We studied this phenomenon and its physiological basis in eight New Zealand White rabbits that were anesthetized, paralyzed, and mechanically ventilated at a fixed minute ventilation. Isovolemic anemia was induced by simultaneous blood withdrawal and infusion of 6% hetastarch in sequential stages; exchange transfusions ranged from 15-30 ml in volume. Variables measured after each hemodilution included hematocrit (Hct), arterial and venous blood gases, mixed expired PCO2 and PO2, and blood pressure; also, O2 consumption, CO2 production, cardiac output (Q), and physiological dead space were calculated. Data were analyzed by comparison of changes in variables with changes in Hct and by using the model of capillary gas exchange described by Bidani (J. Appl. Physiol. 70: 1686-1699, 1991). There was complete compensation for anemia with stability of venous and arterial PCO2 between Hct values of 36 +/- 3 and 12 +/- 1%, which was predicted by the mathematical model. Over this range of hemodilution, Q rose 50%, and the O2 extraction ratio increased 61% without a decline in CO2 production or a rise in alveolar ventilation. The dominant compensations maintaining CO2 transport in normovolemic anemia include an increased Q and an augmented Haldane effect arising from the accompanying greater O2 extraction.

Effects of lost surface area on red blood cells and red blood cell survival in mice

The effects of removing area from mouse red blood cells on the fate of the cells after reinfusion were investigated. When cells were made nearly spherical (by reducing cell area by approximately 35%) and then reinfused into the animal, most were cleared from the circulation within 1-2 h, although approximately 20% of the cells survived for 4 h or longer. When only 20% of the area was removed (leaving a 15% excess), more than 90% of the cells continued to circulate for 4 h. After reinfusion, the mean surface area of the surviving cells remained constant (73-75 microns2), but the mean volume decreased, from 56.6 +/- 2.1 to 19.1 +/- 1.5 microns3 (+/- SD of 5 replicates) over 4 h. These changes did not occur in cells suspended in plasma but not reinfused into the animal. Thus a loss of surface area results in a decrease in cell volume, as if to maintain a requisite degree of deformability. The results support the hypothesis that the increase in cell density associated with increasing cell age may be a consequence of surface area loss.

Endothelial cell dilatory pathways link flow and wall shear stress in an intact arteriolar network

Our purpose was to determine whether the endothelial cell-dependent dilatory pathways contribute to the regulation of flow distribution in an intact arteriolar network. Cell flow, wall shear stress (T omega), diameter, and bifurcation angle were determined for four sequential branches of a transverse arteriole in the superfused cremaster muscle of pentobaribtal sodium (Nembutal, 70 mg/kg)-anesthetized hamsters (n = 51). Control cell flow was significantly greater into upstream than into downstream branches [1,561 +/- 315 vs. 971 +/- 200 (SE) cells/s, n = 12]. Tissue exposure to 50 microM N omega-nitro-L-arginine + 50 microM indomethacin (L-NNA + Indo) produced arteriolar constriction of 14 +/- 4% and decreased flow into the transverse arteriole. More of the available cell flow was diverted to downstream branches, yet flow distribution remained unequal. Control T omega was higher upstream than downstream (31.3 +/- 6.8 vs. 9.8 +/- 1.5 dyn/cm2). L-NNA + Indo decreased T omega upstream and increased T omega downstream to become equal in all branches, in contrast to flow. To determine whether constriction in general induced the same changes, 5% O2 (8 +/- 4% constriction) or 10(-9) M norepinephrine (NE; 4 +/- 3% constriction) was added to the tissue (n = 7). With O2, flow was redistributed to become equal into each branch. With NE, flow decreased progressively more into the first three branches. The changes in flow distribution were thus predictable and dependent on the agonist. With O2 or NE, the spatial changes in flow were mirrored by spatial changes in T omega. Changes in diameter and in cell flux were not related for L-NNA + Indo (r = 0.45), O2 (r = 0.07), or NE (r = 0.36). For all agonists, when the bifurcation angle increased, cell flow to the branch decreased significantly, whereas if the angle decreased, flow was relatively preserved; thus active changes in bifurcation angle may influence red cell distribution at arteriolar bifurcations. Thus, when the endothelial cell dilatory pathways were blocked, the changes in flow and in T omega were uncoupled; yet when they were intact, flow and T omega changed together.

Rheological characteristics of horse blood: significance during exercise

When horses maximally exercise, splenic contraction and fluid movement out of the vascular compartment greatly increase the hematocrit (up to 0.70). We studied the in vitro rheological characteristics of blood from Thoroughbreds and Quarter Horses to determine the interaction of hematocrit and shear rate on apparent viscosity. We also compared the rheological characteristics of the blood before and after horses received furosemide, a drug commonly used to prevent exercise-induced pulmonary hemorrhage. Although the apparent viscosity of blood with a high hematocrit was high at low shear rates, it rapidly decreased as the shear rate increased and appeared to continue to decrease at shear rates above 450 sec-1, which was the limit of our measurement capability. Furosemide had no detectable influence on the measured in vitro rheological characteristics of the blood at any hematocrit or shear rate studied. We postulate that during exercise, when shear rates in the circulation are high, apparent viscosity at high hematocrit may approach values similar to those that occur during rest when both hematocrit and shear rates are lower. Consequently, the shear-dependent properties of blood may create a homeostasis of viscosity in vivo during exercise so that high viscosity is not a major factor contributing to vascular resistance.

A comparison of tumor and normal tissue microvascular hematocrits and red cell fluxes in a rat window chamber model

This laboratory has previously used a window chamber model to measure red blood cell velocity in mammary tumors and normal granulation tissues of the F-344 rat. Because red cell flux and hematocrit more accurately reflect the oxygen carrying potential of blood, we used this model to measure these parameters. Red blood cells were labelled with fluorescein isothiocyanate, and 0.2 ml. packed cells were injected intravenously into rats bearing an 8 to 10 day old R-3230 mammary carcinoma. beta-phycoerythrin (0.15 mg.) was also injected and served as a plasma dye to outline the blood vessels. A sample of peripheral blood was then taken and analyzed by flow cytometry to determine the labeled fraction of red blood cells. Flowing tumor and normal tissue vessels were recorded onto a VCR, and these video images were used to determine vascular length and diameter, RBC flux and velocity, and hematocrit. Median vessel diameter and loge (red blood cell flux) were significantly greater in tumors than in normal tissues (p = 0.007 and p < 0.025, respectively). After controlling for these variables, the median tumor hematocrit of 19% was not significantly greater than the median normal tissue hematocrit of 15%. This technique provides a nontoxic and reproducible method that is now being used to assist in the in vivo definition of tumor oxygenation.

Intestinal villus microcirculatory response to hemorrhage in adult and immature rats

The response of the villus microcirculation to moderate hemorrhage was compared in adult and immature rats. As an estimate of villus blood flow, flux of red blood cells through the terminal arteriole loop at the villus tip was quantified in vivo using fluorescence epilumination videomicroscopy. Baseline red blood cell flux and mean arterial pressure (MAP) of immature rats (973 cells/s, 84 mm Hg) were significantly less than that of adults (1,435 cells/s, 131 mm Hg). Following hemorrhage of 30% of estimated blood volume, MAP of immature rats was still 24% less than that of adults; however, villus flux was not significantly different (578 cells/s immature, 640 cells/s adult; P = .63). Thus, as indicated by changes in villus flux, immature rats do not appear to be more susceptible to acute intestinal blood flow reduction induced by a single moderate hemorrhage. Immaturity of villus microvascular anatomy and of intestinal vasoregulatory mechanisms may account for the differential response.

Changes in haemorheology in the racing greyhound as related to oxygen delivery

Arterial blood samples were obtained from six greyhounds during rest, immediately before, and after a 704-m (7/16th mile) race. Measurements were made of various haematological (red cell count, haemoglobin, packed cell volume, white cell count, plasma proteins) and haemorheological variables. Blood and plasma viscosity were determined at high wall shear stresses (67-200 dynes.cm-2, 670-2000 microN.cm-2) in a 20-microns glass capillary device which was designed to take the diameter dependence of blood viscosity (Fahraeus-Lindqvist effect) into account. Compared to values at rest, substantial haemoconcentration occurred before the race, mainly due to splenic discharge of red cells. Additional haemoconcentration was found after the race. The increase of effective blood viscosity caused by elevation of packed cell volume was greater than the increase in O2 binding capacity resulting from the elevated haemoglobin concentration, suggesting that the haemoconcentration observed in the exercising greyhound does not enhance O2 delivery to skeletal muscle. The main physiological effect of red cell discharge from the contracting spleen appeared to be a consequence of the volume rather than the composition of the circulating blood.

An analysis of microcirculatory flow heterogeneity using measurements of transit time

Heterogeneity of blood flow distribution was measured in capillary networks in cremaster muscles of anesthetized Golden hamsters (nembutal, 70 mg/kg, ip). The relative dispersion of Q/PS, where Q is blood flow, P is permeability, and S is exchange surface area, was estimated; in microvascular terms (and assuming uniform permeability) this ratio reduces to vr/l, where v is plasma velocity, r is vessel radius, and l is vessel length, and where v/l = 1/T, where T is transit time. Distributions of 1/T across complete capillary networks significantly increased in relative dispersion from 68.2 to 97.8% during hyperemia, suggesting an increase in flow heterogeneity with increased inflow. In contrast, relative dispersion of 1/T did not change significantly from rest (72.0%) to hyperemia (66.1%) in capillary segments sampled randomly across the tissue. Other microvascular indices of flow (velocity, cell content) did not reflect the changes in relative flow dispersion shown by the changes in 1/T. The analysis demonstrates that estimates of flow heterogeneity are sensitive both to the selection of an appropriate flow variable and to the manner in which this variable is sampled in the capillary bed.