Abstract
BackgroundIn systolic chronic heart failure, a heterogeneous blood volume (BV) regulation can be found with plasma volume expansion in many cases, possibly leading to pseudoanemia. Little is known about the volume status after heart transplantation (HTX). So far, anemia of HTX recipients was solely investigated using hemoglobin-concentration that may be misleading in a clinical context. The objective of the study was whether a difference in plasma volume and red cell volume can be observed in clinically stable heart transplant recipients compared to matched control subjects. Secondary, the aim was to describe anemia in the long-term after HTX based on quantitative data.MethodsBlood volume and its constituents red cell volume and plasma volume were quantified using an abbreviated carbon monoxide rebreathing method (aCORM) with focus on its primary measure total hemoglobin mass (Hbmass) and coincidental anemia in 36 (7 women) heart transplant recipients. For comparison, a matched control group of 46 (5 women) healthy subjects was selected.ResultsNeither Hbmass nor blood volumes were significantly different in HTX patients compared to matched healthy control group subjects. The prevalence of anemia 6.3 ± 4.3 years after transplantation was 19%. Hbmass and red cell volume were significantly lower in anemic HTX patients compared to non-anemic patients while plasma volume was not expanded. Various immunosuppressant regimens did not have an effect on Hbmass, plasma volume or red cell volume.ConclusionsThere was no difference in blood volumes and Hbmass between HTX patients and control subjects. The pathophysiologic blood volume regulation in chronic heart failure does not seem to be longer active in long-term HTX recipients. However, in the long-term after HTX, anemia occurs in a considerable number of patients as true anemia without a clear association with immunosuppression.Trial registrationGerman registry for clinical studies, DRKS00006078. Registered 09 May 2014, https://www.drks.de/drks_web/navigate.do?navigationId=trial. HTML&TRIAL_ID=DRKS00006078.
Highlights
In systolic chronic heart failure, a heterogeneous blood volume (BV) regulation can be found with plasma volume expansion in many cases, possibly leading to pseudoanemia
After heart transplantation (HTX), that can be considered the definitive treatment for chronic heart failure (CHF), there is limited data available concerning the quantitative assessment of BV
N indicates the number of patients/subjects for whom data was available. p indicates the p-value we present quantitative measurements of hemoglobin mass (Hbmass) and plasma volume (PV) in the context of coincidental anemia in the longterm after heart transplant recipients (HTX) and showed that anemia occurs in a considerable number of patients as true anemia without a clear association with immunosuppression
Summary
In systolic chronic heart failure, a heterogeneous blood volume (BV) regulation can be found with plasma volume expansion in many cases, possibly leading to pseudoanemia. The objective of the study was whether a difference in plasma volume and red cell volume can be observed in clinically stable heart transplant recipients compared to matched control subjects. Extracellular fluid volume expansion was found in clinically stable heart transplant recipients who became hypertensive [3, 4]. This was explained to some extent by a failure to suppress the renin-angiotensin-aldosterone system (RAAS) when hypervolemia occurs after heart transplantation [5]. Reflecting on the complex pathophysiology, our group recently described an increased RCV as a “relevant contributing factor to hypervolemia in addition to an expanded PV in compensated chronic heart failure with reduced ejection fraction (EF)” [11]
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