Abstract
This study was designed to determine the effects of phlebotomy on iron body contents and coagulation tests of COPD patients with polycythemia secondary to hypoxemia. Seventeen patients with COPD and hematocrits higher than 54 percent (mean Hct: 57 +/- 0.49 percent), who had not received anti-inflammatory or antiplatelet aggregation agents recently. Their mean forced expiratory volume at 1 second (FEV1) was 0.92 +/- 0.11 L. Blood work was collected to evaluate the following: serum iron and ferritin levels, total iron binding capacity, transferrin saturation index, fibrinogen plasma levels, activated partial thromboplastin time, platelet count, platelet aggregation measurements, and thromboelastography coagulation parameters. The blood samples were obtained before and about 7 days after the hematocrit correction by 300-400 ml phlebotomies done every other day. The mean number of phlebotomies done for each patient was 4.4. Postphlebotomy iron serum levels decreased from 90.1 +/- 14.8 to 59.7 +/- 9.9 mg/dl and the ferritin serum levels from 133.8 +/- 37.9 to 70.8 +/- 32.7 ng/ml (p < 0.05). Regarding the coagulation studies, there were significant increases in the platelet count, from 227,300 +/- 13,900 to 312,500 +/- 30,200 per mm3, and in the maximum clot amplitude (a) obtained by thromboelastography (from 53.6 +/- 1.4 percent to 60.4 +/- 1.1 percent). The coagulation time (k) of the thromboelastography also decreased significantly, from 7.5 +/- 0.7mm prephlebotomy to 4.5 +/- 0.3mm postphlebotomy. Although the coagulation changes were small amount, the observed significant decrease in iron contents may have clinical implications.
Highlights
B loodlettings, or phlebotomies, are still adyocated in the care of chronic obstructive pulmonary disease (COPD) patients with cor pulmonale and severe secondary polycythemia.[1]
A great deal has been published in this field, no attention has been paid to the potential hematological consequences of phlebotomies
To what happens with blood donors and during the treatment of hemochromatosis, repeated phlebotomies in COPD patients could lead to reductions in their iron body contents.14.1S Iron deficiency states may run with decrements in work performance secondary to drops in MARTINEZ, J.A.B.; GUERRA,C.C.C,; NERY, L.E. et aI. - lron stores and coagulation parameters in patients with hypoxemic polycythemia secondary to chronic obstructive pulmonary disease: The effect of phlebotomies helTIoglobin leveIs, and disturbances in muscular oxidative with readings made with a Colelnan 6/20 metaboIism.1ó In the case of reductions in iron body spectrophotometer
Summary
B loodlettings, or phlebotomies, are still adyocated in the care of chronic obstructive pulmonary disease (COPD) patients with cor pulmonale and severe secondary polycythemia.[1] Several authors have shown that hematocrit (Hct) reductions in hypoxemic patients with COPD and polycythemia are followed by improvement in general symptoms,2-S mental activity[2,3,4,5,6] and exercise performance.2-4.7.8. - lron stores and coagulation parameters in patients with hypoxemic polycythemia secondary to chronic obstructive pulmonary disease: The effect of phlebotomies helTIoglobin leveIs, and disturbances in muscular oxidative with readings made with a Colelnan 6/20 metaboIism.1ó In the case of reductions in iron body spectrophotometer. We hypothesized that a reduction in Hct leveIs determinations were made: by phlebotolnies could aIso have a favorable effect on decreasing s'uch thrombotic risk
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