The optimal hematocrit

Evidence that ectoparasites influence the hematological parameters of the host: a systematic review

Ectoparasites are important to the one health concept because their parasitism can result in the transmission of pathogens, allergic reactions, the release of toxins, morbidity, and even death of the host. Ectoparasites can affect host physiology, as reflected in immune defenses and body condition as well as hematological and biochemical parameters. Thus, evidence that ectoparasites influence host hematological parameters was systematically reviewed, and the methodological quality of these studies was analyzed. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed, and the studies included were limited to those that evaluated changes in hematological tests in ectoparasite-infested and non-infested animals, and bias and methodological quality were evaluated using the Animal Research: Reporting of In Vivo Experiments guideline. Thirty-four studies were selected and information about the host, ectoparasite infestation, blood collection, and analysis was collected and compared whenever possible. In this review, the presence of ectoparasites influenced both the red series and the white series of hematological parameters. Among the main parameters analyzed, hematocrit, red blood cells, hemoglobin, and lymphocytes showed reductions, probably due to ectoparasite blood-feeding, while including eosinophils, neutrophils, and basophils increased in infested animals due to the host immune response. However, methodologic improvements are needed to reduce the risk of bias, enhance the reproducibility of such studies, and ensure results aligned with the mechanisms that act in the ectoparasite-host relationship.

Emergency Medicine Evaluation and Management of Anemia

Anemia is a common condition and is diagnosed on laboratory assessment. It is defined by abnormally low hemoglobin concentration or decreased red blood cells. Several classification systems exist. Laboratory markers provide important information. Acute anemia presents with symptoms owing to acute blood loss; chronic anemia may present with worsening fatigue, dyspnea, lightheadedness, or chest pain. Specific treatments depend on the underlying anemia and etiology. Iron is an alternative treatment for patients with microcytic anemia owing to iron deficiency. Hyperbaric oxygen is an option for alternative rescue therapy. Most patients with chronic anemia may be discharged with follow-up if hemodynamically stable.

Perioperative blood transfusions increases the risk of anastomotic leakage after surgery for GEJ-cancer

OBJECTIVE

To investigate the effect of blood transfusions on the risk of anastomotic leakage (AL) in patients with gastro-esophageal-junction (GEJ) cancer.

BACKGROUND

The incidence of GEJ cancer is increasing in the western world. Surgery is the curative treatment of choice. AL increases mortality and morbidity, and increases the risk cancer reoccurrence. In colo-rectal surgery a relation between AL and blood transfusions have been demonstrated.

METHOD

The risk of AL in relation to blood transfusions was investigated in a cohort study. 253 consecutive patients undergoing surgery for GEJ cancer was included. Data was based on a prospective maintained database and analyzed using logistic regressions models adjusting for multiple confounders.

RESULTS

We found an increased risk of AL when blood was transfused OR: 3.47, (1.51; 7.99). This relation was consistent after adjustment for multiple confounders OR: 4.60, (1.29; 16.4). Increasing number of blood units did not increase risk of AL further.

CONCLUSION

We present data demonstrating a strong correlation between receiving blood transfusions and the risk of AL after surgery in GEJ cancers patients.

Effects of non-leukocyte-reduced and leukocyte-reduced packed red blood cell transfusions on oxygenation of rat spinotrapezius muscle

Leukoreduction of blood used for transfusion alleviates febrile transfusion reactions, graft versus host disease and alloimmunization to leukocyte antigen. However, the actual clinical benefit of leukoreduction in terms of microcirculatory tissue O2 delivery after packed red blood cell (pRBC) transfusion has not been investigated. As such, the aim of this study was to determine the effects of non-leukoreduced (NLR) and leukoreduced (LR) fresh pRBC transfusion on interstitial oxygenation in anesthetized male Sprague-Dawley rats. Interstitial fluid PO2 and arteriolar diameters in spinotrapezius muscle preparations were monitored before and after transfusion with NLR- or LR-pRBCs. The major findings were that (1) transfusion of NLR-pRBCs significantly decreased interstitial oxygenation whereas transfusion of LR-pRBCs did not, and (2) transfusion with LR-pRBCs elicited a substantially greater increase in arterial blood pressure (ABP) than did transfusion with NLR-pRBCs. These changes in PO2 and ABP were not associated with changes in the diameters of resistance arterioles in the spinotrapezius muscle. These data suggest that transfusion of fresh NLR-pRBCs may negatively affect tissue oxygenation via enhanced leukocyte influx and decreased O2 delivery. They also suggest that leukocytes diminish the capability of transfused pRBCs to increase cardiac output. As such, transfusion of LR-pRBCs may be less deleterious on tissue PO2 levels than NLR-pRBCs although a concomitantly greater increase in ABP may accompany transfusion of LR-pRBCs.

Autoregulation and mechanotransduction control the arteriolar response to small changes in hematocrit

Here, we present an analytic model of arteriolar mechanics that accounts for key autoregulation mechanisms, including the myogenic response and the vasodilatory effects of nitric oxide (NO) in the vasculature. It couples the fluid mechanics of blood flow in arterioles with solid mechanics of the vessel wall and includes the effects of wall shear stress- and stretch-induced endothelial NO production. The model can be used to describe the regulation of blood flow and NO transport under small changes in hematocrit and to analyze the regulatory response of arterioles to small changes in hematocrit. Our analysis revealed that the experimentally observed paradoxical increase in cardiac output with small increases in hematocrit results from the combination of increased NO production and the effects of a strong myogenic response modulated by elevated levels of WSS. Our findings support the hypothesis that vascular resistance varies inversely with blood viscosity for small changes in hematocrit in a healthy circulation that responds to shear stress stimuli. They also suggest beneficial effects independent of changes in O(2) carrying capacity associated with the postsurgical transfusion of one or two units of blood.

Comparison of various approaches to calculating the optimal hematocrit in vertebrates

An interesting problem in hemorheology is to calculate that volume fraction of erythrocytes (hematocrit) that is optimal for transporting a maximum amount of oxygen. If the hematocrit is too low, too few erythrocytes are present to transport oxygen. If it is too high, the blood is very viscous and cannot flow quickly, so that oxygen supply to the tissues is again reduced. These considerations are very important, since oxygen transport is an important factor for physical performance. Here, we derive theoretical optimal values of hematocrit in vertebrates and collect, from the literature, experimentally observed values for 57 animal species. It is an interesting question whether optimal hematocrit theory allows one to calculate hematocrit values that are in agreement with the observed values in various vertebrate species. For this, we first briefly review previous approaches in that theory. Then we check which empirical or theoretically derived formulas describing the dependence of viscosity on concentration in a suspension lead to the best agreement between the theoretical and observed values. We consider both spatially homogeneous and heterogeneous distributions of erythrocytes in the blood and also possible extensions, like the influence of defective erythrocytes and cases where some substances are transported in the plasma. By discussing the results, we critically assess the power and limitations of optimal hematocrit theory. One of our goals is to provide a systematic overview of different approaches in optimal hematocrit theory.

Accuracy of formulas used to predict post-transfusion packed cell volume rise in anemic dogs

OBJECTIVE

To assess the accuracy of published formulas used to guide packed red blood cell (pRBC) transfusions in anemic dogs and to compare the predicted rise in packed cell volume (PCV) to the actual post-transfusion rise in PCV.

DESIGN

Prospective observational study from April 2009 through July 2009.

SETTING

A small animal emergency and specialty hospital.

ANIMALS

Thirty-one anemic client-owned dogs that received pRBC transfusions for treatment of anemia.

INTERVENTIONS

None

MEASUREMENTS

Four formulas were evaluated to determine their predictive ability with respect to rise in PCV following transfusion with pRBC. Post-transfusion rise in PCV were compared to calculated rise in PCV using 4 different formulas. Bias and limits of agreement were investigated using Bland-Altman analyses.

RESULTS

Accuracy of existing formulas to predict rise in PCV following transfusion varied significantly. Formula 1 (volume to be transfused [VT] [mL] = 1 mL × % PCV rise × kg body weight [BW]) overestimated the expected rise in PCV (mean difference, 6.30), while formula 2 (VT [mL] = 2 mL ×% PCV rise × kg BW) underestimated the rise in PCV (mean difference, -3.01). Formula 3 (VT [mL] = 90 mL × kg BW × [(desired PCV - Patient PCV)/PCV of donor blood]) and formula 4 (VT [mL] = 1.5 mL ×% PCV rise × kg BW) performed well (mean difference 0.23 and 0.09, respectively) in predicting rise in PCV following pRBC transfusion.

CONCLUSIONS

Agreement between 2 formulas, "VT (mL) = kg BW × blood volume (90 mL) × [(desired PCV - recipient PCV)/Donor PCV]" and "VT (mL) = 1.5 ×desired rise in PCV × kg BW," was found when they were compared to the actual rise in PCV following pRBC transfusion in anemic dogs. Further research is warranted to determine whether these formulas perform similarly well for other species.

Adhesive-based liquid metal radio-frequency microcoil for magnetic resonance relaxometry measurement

This paper reports the fabrication and characterization of an adhesive-based liquid-metal microcoil for magnetic resonance relaxometry (MRR). Conventionally, microcoils are fabricated by various techniques such as electroplating, microcontact printing and focused ion beam milling. These techniques require considerable fabrication efforts and incur high cost. In this paper, we demonstrate a novel technique to fabricate three-dimensional multilayer liquid-metal microcoils together with the microfluidic network by lamination of dry adhesive sheets. One of the unique features of the adhesive-based technique is that the detachable sample chamber can be disposed after each experiment and the microcoil can be reused without cross-contamination multiple times. The integrated microcoil has a low direct-current (DC) resistance of 0.3 Ω and a relatively high inductance of 67.5 nH leading to a high quality factor of approximately 30 at 21.65 MHz. The microcoil was characterized for ∼0.5 T proton MRR measurements. The optimal pulse duration, amplitude, and frequency for the 90° pulse were 131 μs, -30 dB (1.56 W) and 21.6553 MHz, respectively. In addition, we used the liquid-metal microcoil to perform a parametric study on the transverse relaxation rate of human red blood cells at different hematocrit levels. The transverse relaxation rate increases quadratically with the hematocrit level. The results from the liquid-metal microcoil were verified by measurements with a conventional solenoid coil.