Hematocrit Reading Research Articles

Effects of short duration high intensity competition on cardiac and cell damage biomarkers

The purpose of this study was to investigate the cardiac biomarkers like cardiac troponin T (cTnT), cardiac troponin I, and creatine kinase-MB (CK-MB) and the cell damage biomarkers including creatine phosphokinase (CPK), C-reactive protein (CRP), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) in response to a short-duration high-intensity competition with correction of the post-exercise raw data with the plasma volume loss in trained athletes. Thirty-two male athletes (age, 26.9±4.7 years) competed in 8 min high-intensity competition. The competition items included: running for 400 meters; three-stage deadlifting; bar pulling up; and 30 kg kettlebell swinging. Venous blood samples were obtained before and immediately after the competition and biomarkers analysed. Plasma volume changes were estimated from haemoglobin and haematocrit readings before and after the competition. A significant increase was shown immediately after the competition compared to resting in cTnT, AST, ALT, CPK, and CRP (P<0/001). CK-MB showed no significant difference. When raw data were corrected for plasma volume loss, CPK showed a significant increase (P<0.001), and LDH and CK-MB a significant decrease (P<0.001), however cTnT, AST, ALT and CRP showed no significant difference. The plasma volume loss can affect the response of cardiac and cellular damage biomarkers to exercise. High-intensity competition for 8 min did not elevate the cardiac biomarkers, but elevated the muscle biomarkers.

Nerocila orbignyi, Cymothoid isopoda infestation in European sea bass, Dicentrarchus labrax. Trials for treatment with evaluation of immune and antioxidative responses.

Cymothoid isopods cause serious infestations in fish that may adversely affect the aquaculture. Current study targeted investigating the enormous infestation of European sea bass Dicentrarchus labrax with cymothoid isopod, Nerocila species in a marine fish farm at Kafr El Sheikh Governorate, Egypt; accompanied with trials for treatment with malathion 57% at 0.15 and 0.30 mg/L concentrations and evaluation of the immune and antioxidants responses. For this purpose, 450 D. labrax were randomly collected alive during April 2020 and thoroughly examined for detection of external parasites. Malathion 57% treatment trial was carried out. Blood and tissue samples were collected from infested fish at zero-day (before malathion treatment) and at 24hrs, 48hrs, 3rd day, 4th day and 5th day (after malathion treatment). Isopods collected from infested fish were identified as N. orbigny and fish's external body surface and gills were the predilection sites. Both malathion concentrations were effective in eradicating N. orbigny and decreasing the isopod prevalence from 100 to 0% at the 5th day sampling point. Infested fish revealed improved hematological parameters (Erythrocyte counts, hemoglobin, and hematocrit readings), however leucocyte and differential cells counts showed significant decrease in infested fish. Immunological parameters (Lysozyme and IgM activities) decreased, but nitric oxide increased by time after malathion application. Nerocila is considered serious parasite in aquaculture that negatively affects fish's immune and antioxidative responses; and malathion denoted as a promising treatment to control N. orbigny in infested D. labrax.

The effect of ultrafiltration on end-cardiopulmonary bypass hematocrit during cardiac surgery.

Ultrafiltration (UF) during cardiopulmonary bypass (CPB) is a well-accepted method for hemoconcentration to reduce excess fluid and increase hematocrit, platelet count and plasma constituents. The efficacy of this technique may confer specific benefit to certain patients presenting with acquired cardiac defects. The purpose of this study was to retrospectively evaluate the effect of UF on end-CPB hematocrit by cardiac surgical procedure type. A review of 73,506 cardiac procedures from a national registry (SCOPE) was conducted between April 2012 and October 2016 at 197 institutions. Cases included in this analysis were those completed without intraoperative red blood cell transfusion and where zero-balance UF was not used. The primary end point was the last hematocrit reading taken before the end of CPB, with a secondary end point of urine output during CPB. In order to isolate the effect of the UF volume removed, we controlled for a number of confounding factors, including: first hematocrit on CPB, total asanguineous volume, estimated circulating blood volume, CPB urine output, total volume of crystalloid cardioplegia, total volume of other asanguineous fluids administered by both perfusion and anesthesia, type of cardiac procedure, acuity, gender, age and total time on CPB. Descriptive statistics were calculated among five subgroups according to the UF volume removed: no volume removed and quartiles across the range of UF volume removed. The effect of UF volume on primary and secondary end points was modeled using ordinary least squares and restricted cubic splines in order to assess possible non-linearity in the effect of the UF volume while controlling for the above-named confounding factors. An interaction term was included in each model to account for possible differences by procedure type. The study found a statistically significant non-linear pattern in the relationship between the UF volume removed and the last hematocrit on bypass (X2 = 172.5, df=24, p<0.001). For most procedure types, UF was most effective at increasing the last hematocrit on CPB, from 1 mL to approximately 2.5 L, with continued improvements in hematocrit coming more slowly as the UF volume was increased above 2.5 L. There were statistically significant interactions between UF and procedure type (X2 = 78.5, df=24, p<0.0001) as well as UF and starting hematocrit on CPB (X2 = 234.0, df=4, p<0.0001). In a secondary end-point model, there was a statistically significant relationship between the ultrafiltration volume removed and urine output on bypass (X2 = 598.9, df=28, p<0.001). The use of UF during CPB resulted in significant increases in end-hematocrit, with the greatest benefit shown when volumes were under 2.5 L. We saw a positive linear benefit up to 2.5 L removed and, thereafter, in most procedures, the benefit leveled off. However, of note is markedly decreased urine output on bypass as the ultrafiltration volumes increase.

Alterations in haematological parameters among workers of fuel stations in White Nile State, Sudan

Benzene exposure is one of the main health concerns for occupations with risk of exposure to volatile solvents such as petrol pump workers. Human exposure to benzene is associated with multiple adverse health effects including pancytopenia, hence aplastic anaemia and an increased risk of developing cancer (acute myeloblastic leukemia). Morphological effect on RBCs (microcytosis) also occurs. This cross sectional descriptive study involved workers at fuel stations in Kosti and Rabak cities, White Nile State, during December 2014-March 2015 and aimed to determine any alterations in haematological parameters among these employees. Workers at fifty fuel stations were recruited to participate, individually giving written informed consent. Venous blood (2.5 ml) was taken into EDTA containers and a full blood count (FBC) was done for each participant, using a fully automated haematology analyzer (Sysmex). The results from the fuel stations workers include the following high prevalence of abnormalities: Fifty percent had low haemoglobin levels, 60 percent low RBS counts (although 30% were higher than normal), haematocrit readings showed 24% with reduced values and for MCV 92% were reduced. Half of the participants showed microcytic cytology. The current study concluded that there are abnormalities in haematological parameters among fuel stations workers, particularly in Hb and RBC indices, as well as lymphocytosis and neutropenia. Workers at fuel stations should be protected from exposure to benzene by training with the equipment to minimising leakge and spillage and by wearing protective devices, such as masks and goggles. Further studies are necessary to determine the possible effects of benzene on haematological parameters among long-duration workers in fuel stations.

A Portable Centrifuge for Point-of-Care Measurement of Hematocrit in Low-Resource Settings

A portable centrifuge was developed for point-of-care measurement of hematocrit in low-resource settings. The centrifuge consists of an electromechanical motor with performance optimized and controlled for centrifugal separation of blood in capillary tubes. The motor is powered by a set of rechargeable batteries and spins the samples at a controlled rate between 1000 and 15,000 revolutions per minute (RPM). Preliminary test results show that an accurate hematocrit reading can be made after operating the centrifuge for 110 seconds at 10,000 RPM. The centrifuge can be operated for almost three 8-hour work days at a 25% duty cycle when the batteries are fully charged, and it can measure hematocrits over the entire clinically relevant range with minimal experimental error. With a total system cost of less than $30, the portable centrifuge developed in this work has the potential to make a large impact on centrifugal separation applications such as the screening process for anemia in any clinical setting.

Erythrocytosis Post Allogeneic Stem Cell Transplantation, An Observational Study Of Hemoglobin Levels On Long-Term Follow Up Post Transplantation In Patients With Fanconi Or Acquired Aplastic Anemia

Post-transplant erythrocytosis is an ominous complication of kidney transplantation, occurring in the first 8 to 24 months after surgery in 10% to 15% of transplant recipients; this is frequently associated with significant thromboembolic events and sometimes death. In patients undergoing allogeneic hematopoietic cell transplantation (HCT), erythrocytosis has not been previously well described. At our institution, we observed that some aplastic anemia (AA), and Fanconi anemia (FA) patients developed progressively increased hemoglobin (HB), hematocrit (HCT) and RBC readings on long term follow up. Thus, this study was conducted to assess the validity of this observation in AA/FA patients post HCT, and its impact on their health. Patients and Methods From January 1993 until December 2011, 144 pediatric patients underwent successful allogeneic HCT for AA or FA; median age at HCT 11.6 years (range, 6.6 -15). All patients included were alive at the time of the analysis, and had sustained engraftment; all have had a follow up time of ≥ 12 months. For those who underwent more than one HCT, only events after the last HCT were included. We retrospectively examined the HB levels as an indicator for erythrocytosis (Corresponding RBC, HCT, WBC, and platelet counts were also collected). HB values of 150, and 160 gm/l were considered the trigger value in females and males, respectively. Patients who reached this value were studied for higher values on follow up, and only those whose HB persisted for at least 3 months above trigger value were included in the analysis; 29 patients (15 females, 14 males) were identified after causes of secondary erythrocytosis were ruled out. Erythrocytosis was defined as HB ≥ 160 gm/l in females, a HB ≥ 170 gm/l in males. Results Median time to trigger HB was 51.4 months (range, 15-121) in females, and 65 months (range, 23.3-114) in males, and median age at trigger HB was 14.7 years (range, 8.6-21.4) in females, and 16.9 years (range, 13.4-20.6) in males. Median highest HB reached was 160 gm/l (range, 151-162) in females, and 172 gm/l (range, 164-189) in males, with a median time of 67 months (range, 17-164) in females, and 103 months (range, 23.3-206) in males; the median age at highest HB was 16 years (range, 9.7-24.8) in females, and 20.2 years (range, 13.4-27.4) in males. Upon follow up, the HB fell below the trigger level in 16 patients (9 females, 7 males) (55.2%), at a median time of 37.2 months from the trigger value (range, 3.6-104). Seventeen patients qualified for the diagnosis of erythrocytosis (12%); 8 females, and 9 males. In all 8 females and in 4 males, HB fell below the erythrocytosis value upon follow up. All HB values correlated positively with HCT and RBC, no correlation was detected with platelet count or WBC. On univariate analysis, patients with older age at HCT (≥ 10 years) appeared to be more likely to develop elevated HB (P=0.003); and those who had radiation in the conditioning regimen were less likely to develop elevated HB (P=0.008). Three of the males with persistent erythrocytosis were tested further and all 3 had normal erythropoietin levels and were negative for JAK-2 mutations. None of the 29 patients had any adverse clinical symptoms during the follow up visits, and no thromboembolic events were reported. Conclusion A proportion of patients with AA/FA who undergo HCT may experience elevated HB on long term follow up; 12% subsequently qualifying as erythrocytosis, with the highest reading requiring between 1.5-2 years to evolve. Unlike erythrocytosis post renal transplant, the phenomenon we are describing in our patient cohort does not appear to be associated with any adverse symptoms, or any increased risk of thrombosis. More in depth investigation to study the potential pathophysiology behind it is currently underway at our institution, together with further exploration of this observation in patients with other illnesses undergoing allogeneic HCT. Disclosures: No relevant conflicts of interest to declare.

Legal Briefs: Devastating Consequences From Prolonged Use of an Umbilical Arterial Catheter

A 960-g, 26-3/7 weeks’ gestation male twin B was delivered by normal vaginal spontaneous delivery in the breech position to 31-year-old, healthy, gravida 3 para 1 mother whose pregnancy was complicated by preterm labor and diamniotic dichorionic twins. The mother received antibiotics, a partial course of betamethasone, and magnesium sulfate for tocolysis. At delivery, the infant had a heart rate (HR) less than 100 beats per minute, no respiratory effort, and was blue. The infant was intubated and required resuscitation, including chest compressions for 15 seconds, and 2 doses of epinephrine via an endotracheal tube (ETT). Apgar scores were 2 at 1 minute, 4 at 5 minutes, and 7 at 10 minutes. The infant was then admitted to the NICU, where an umbilical venous catheter (UVC) and an umbilical arterial catheter (UAC) were placed. The UVC was placed in the right atrium, where it remained until its removal several days later, and his UAC was placed appropriately at the seventh thoracic vertebrae and removed on day 13. The infant’s vital signs and blood pressure were normal. He had respiratory distress syndrome, for which he was given 3 doses of surfactant. Initially, the infant required 100% oxygen, but after several hours, the inspired oxygen was weaned to 30%, and the ventilator settings were low. His initial complete blood cell count revealed a white blood cell count (WBC) of 3.1 × 103/uL, a platelet count of 185 × 103/uL, and a hematocrit reading of 51% (0.51). The infant was given ampicillin and gentamicin after blood culture results were obtained, and he was started on low-dose indomethacin for intraventricular hemorrhage prophylaxis. On day 1, the fraction of inspired oxygen (Fio2) and ventilatory settings were low. The blood gas values were normal, with some permissive hypercarbia in the …

M protein deposition in the skin: a rare manifestation of Waldenström macroglobulinemia

Waldenstrom macroglobulinemia (WM) is defined by diffuse and nodular bone marrow infiltration of lymphoplasmacytic lymphoma as defined by the World Health Organization (WHO), and by a monoclonal IgM serum paraprotein (macroglobulin) [1]. Clinical symptoms at presentation are frequently unspecific, including fatigue, weakness, and weight loss. Clinical symptoms such as hyperviscosity syndrome, peripheral neuropathy, and glomerular disease are often related to the IgM paraprotein, both in form of circulating IgM and IgM deposition in tissue. The skin constitutes an unusual site of manifestation of WM, both for tumor infiltrates and IgM paraprotein deposition. A 70-year-old male patient was hospitalized in April 2009 with progressive peripheral neuropathy and poor general condition. Further examination revealed small, non-pruritic, soft indolent wart-like papules on both knees. As noted by the patient, the lesions were easily scratched off, bled slightly, leaving scabs and causing additional papules to appear during healing. Laboratory findings included slight anemia with a hemoglobin level of 8.2 mmol/l (normal 8.4–10.9 mmol/l) and a hematocrit reading of 0.379 l/l (normal 0.400–0.530 l/l). The RBC count was 4.22 9 10/l (normal 4.50–5.90 9 10/l) with 3% reticulocytes (normal 6–18%). The thrombocyte count and the differential white blood count were within the normal range. Renal, hepatic and cardial functions were also normal, and there was no splenomegaly or lymphadenopathy. The total protein level was 94.8 g/l (normal 66.0–87.0 g/l), and quantitative immunoglobulin findings were as follows: IgM 23.70 g/l (normal 0.40–2.80 g/l), j-light chains 5.63 g/l (normal 1.50–3.90 g/l), free j-light chains 284.00 mg/l (normal 3.30–19.40 mg/l), free k-light chains 13.90 mg/l (normal 5.71–26.30 mg/l) and a free j-light chains/k-light chains ratio of 20.43 (normal 0.26–1.65). Serum electrophoresis presented an elevated IgM gradient. Serum immunofixation provided a clear precipitation pattern of monoclonal IgM j-type immunoglobulin. The b2 microglobulin level was 1.7 mg/l (normal \2.0 mg/l). Bone marrow microscopy revealed atypical lymphoplasmocytic cells. Immunohistochemistry demonstrated low proliferation and B cell nature of the lymphocytes (25% of all hematopoietic cells) beside a mature CD138 positive plasma cell population (15%) with monotypic restriction for j-light chain and IgM heavy chain (Fig. 1). Given these findings, the diagnosis of Waldenstrom’s macroglobulinemia was established. Skin sections displayed multifocal nodular strongly eosinophilic, PASpositive and Elastica van Gieson, Congo red, and Alcian blue-negative homogeneous deposits in the upper portion of the dermis. Immunohistochemistry presented a faint monotypic staining for IgM and j-light chains, manifesting as multifocal nodular depositions of monoclonal immunoglobulin (Fig. 1). A diagnosis of macroglobulinemia cutis presenting as IgM storage papules was therefore established. To suppress disease activity, the patient received four cycles of Rituximab-CHOP, during which the cutaneous lesions disappeared. B. Oberschmid U. Siebolts (&) A. Beller C. Wickenhauser Institute of Pathology, University of Leipzig, Leipzig, Germany e-mail: udo.siebolts@medizin.uni-leipzig.de

Disodium EDTA used as anticoagulant causes hemolysis in common carp blood

Disodium EDTA used as anticoagulant for common carp blood caused a significant increase and high variability in hematocrit readings comparing to the heparinized samples. Na2EDTA induced erythrocyte swelling, causing cell membrane disruption (hemolysis). The nuclei released from destroyed cells changed shape from oval to round, and underwent gradual swelling and vacuolation, followed by karyolysis. The degree of observed changes was similar at all Na2EDTA concentrations (0.1, 0.5, and 1.0 mg/mL); on the other hand, percentage of abnormal and destroyed cells showed considerable differences among blood sampled from various carp individuals. The obtained results revealed that Na2EDTA caused gradual damage to erythrocytes, and thus should not be applied as anticoagulant for blood analysis of common carp.

ORIGINAL ARTICLE: Are 10 min of seating enough to guarantee stable haemoglobin and haematocrit readings for the athlete’s biological passport?

SummaryHaemoglobin (Hb) and haematocrit (Hct) are measured as indirect markers of doping in athletes. We studied the effect of posture on these parameters in a typical antidoping setting. Venous blood samples were obtained from nine endurance athletes (six males, three females) and nine control subjects (six males, three females) immediately and after 5, 10, 15, 20 and 30 min after having adopted a seated position from normal daily activity. Hb (CV 0.72%) and Hct (CV 0.87%) were determined using an automated cell counter, plasma volume changes were calculated. Differences between the time points, gender and groups were calculated using a mixed‐model procedure. Significant changes were observed in the first 10 min after sitting down but no further changes were noted between 10 and 30 min. Mean directional change for Hb and Hct between 0 min and the average of the period from 10 to 30 min was −2.4% (−0.35 g/dl) for Hb and −2.7% (−1.2%) for Hct. Plasma volume increased accordingly. Neither group nor gender had significant effects. Under typical conditions encountered during blood testing in doping control, a period of 10 min in a seated position is sufficient for the vascular volumes to re‐equilibrate and to adapt to the new posture.

深部静脈血栓症を合併し,血液凝固・線溶マーカーの異常高値が長期間持続した維持血液透析患者の一例

A 70-year-old woman on maintenance hemodialysis for 3 years was admitted to our hospital because of deep vein thrombosis (DVT) in the right femoral vein. Seven days before admission, she suddenly noticed severe pain in her right inguinal region while she was walking on the street. A wide range of stenosis from the iliac to the distal femoral region was detected by both CT scanning and venography. Her hematocrit reading was 30% and her serum erythropoietin level was 10.5 MU/ml, which was within the normal range, on the day of admission. The results of routine coagulation tests, including prothrombin time, activated partial thrombin time and plasma fibrinogen values, were normal. Plasma anti-thrombin III and plasminogen were also normal. In contrast, beta-thromboglobulin, platelet factor IV, fibrinogen degradation product, D-dimer, thrombin-antithrombin III complex (TAT) and fibrinopeptide A were abnormally elevated. In the venous occlusion test which was performed in the forearm of the opposite side of the arterio-venous shunt, plasma tissue type plas-minogen activator values showed little response to occlusion indicating that the vessel endothelium may have been partially damaged. These data suggest that the DVT had been induced by imbalance of increased blood coagulation and decreased fibrinolytic activity. Damaged vascular wall may also have contributed to the production of DVT. Furthermore, it is surprising that the patient had elevated values of D-dimer and TAT for many years without recurrence of the DVT. Spontaneous DVT in an apparently healthy individual on maintenance hemodialysis seems to be rare, compared with arterial thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemorrhage in Pelvic Fractures Does Not Correlate With Fracture Length

To analyze whether hematogenous marrow bleeding is the major source of hemorrhage after fractures of the pelvic ring. Retrospective cohort study. Academic Level I trauma center. Three hundred seven consecutive pelvic ring injuries from January 1, 2000 to December 31, 2003 were evaluated. After exclusion for age, significant nonpelvic hemorrhage sources, and delayed transfer to this institution, 72 patients remained. Pelvic injuries were classified as fractures, fracture dislocations, or pure dislocations. These classifications were correlated to change in hematocrit between assumed preinjury and final hematocrit readings, correcting for blood transfused. The dislocation group had a greater change in hematocrit than the fracture group (2.1%), though not statistically significant. No significant correlations were found between change in hematocrit and length of fracture lines. Pelvic fracture surfaces may be sources of bleeding in pelvic injuries, but the fact that bleeding is similar in fractures and dislocations indicates fracture surfaces do not constitute the primary source. Based on our analysis one cannot reliably predict pelvic hemorrhage based on A/P radiograph assessments, such as fracture type.

Effect of Hemolysis and Free Hemoglobin on Optical Hematocrit Measurements in the Extracorporeal Circulation

Clinically significant hemolysis is a rare but serious problem in dialysis. Because hemolysis affects red blood cell count and optical density of plasma it has been speculated whether techniques used for online blood volume monitoring would be useful to detect hemolysis. In this study the influence of free hemoglobin on hematocrit and relative blood volume changes measured by optical means (CritLine, HemaMetrics, Kaysville, UT) were examined using an in vitro model with bovine blood. Free hemoglobin solutions were added in steps to circulating whole blood at baseline hematocrits covering a range from 30% to 60% and at blood flows of approximately 200 and 400 ml/min. The free hemoglobin concentration reached was in the range of 2 to 3 g/dl. The presence of free hemoglobin led to a relative increase in hematocrit in the range of 0.3% per 0.1 g of free hemoglobin per dl (+3% dl/g). As an increase in hematocrit is interpreted as a decrease in blood volume, this change referred to an apparent decrease in relative blood volume in the same order of magnitude (-3% dl/g). Effects were more pronounced at low baseline hematocrit. Thus, although optical hematocrit readings are affected by the presence of free hemoglobin the changes at levels associated with clinical symptoms appear to be too small to be accurately detected in the in vivo situation where the hematocrit and the resulting optical signal is affected by various physiological processes and therefore much noisier.

This Month in ANESTHESIOLOGY

This Month in ANESTHESIOLOGY

Effects of phentolamine on hemorrheology and hemodynamics in dogs with acute liver damage

The effects of phentolamine on hemorrheology and hemodynamics were studied in dogs with acute liver damage induced by acetaminophen. After 1 h of phentolamine application, the viscosity of plasma and whole blood was significantly diminished. The hematocrit readings followed the same pattern as the alterations in viscosity. The portal venous resistance and the value of K were remarkably decreased and the portal venous blood flow was obviously increased. It can be assumed, therefore, that the decrease in viscosity induced by phentolamine results from internal hemodilution and phentolamine may improve hepatic blood circulation through the decrease of portal venous resistance caused by the reduction of blood viscosity and the dilation of portal vascular beds.

The incomplete central retinal artery occlusion (ICRAO):Visual recovery with conservative therapy

Abstract Objective: The conservative treatment and favorable prognosis of ten patients who presented with acute loss of vision is described. They showed only slight signs of occlusion of the central retinal artery on ophthalmoscopy; i.e. incomplete central retinal artery occlusion (ICRAO). Design: Case series. Methods: Ten patients with ICRAO were treated conservatively with massage of the globe, immediate depression of the blood pressure where hypertension was present, isovolemic hemodilution in the presence of an increased hematocrit reading and the daily administration of 100 mg acetylsalicylic acid. Results: ICRAO has a good visual prognosis, and these patients showed a marked recovery of vision following conservative treatment. Their initial clinical signs included a slight and localized degree of perimacular edema, visible on ophthalmoscopy and showing also a faint cherry-red macular spot. Delay in fluorescein filling of the retinal arteries was found, but in most of the patients the loss of vision ...

Use of hematocrit changes as an indicator of blood loss in adult trauma patients who receive intravenous fluids

To validate the use of changes in hematocrit as an indicator of blood loss in adult trauma patients receiving IV fluids and to identify parameters of hematocrit changes that may differentiate between patients with and without hemorrhage. A descriptive, retrospective chart review. A convenience sample of 90 adult trauma patients at an urban level I trauma center emergency department who received IV fluids for whom hematocrit measurements were available. Records were reviewed for patients with documented hematocrit readings before and after receiving 2 L of IV fluid, noting the time between hematocrit measurements. Patients were divided into groups: Group 1 consisted of 74 subjects with no hemorrhaging (< 500 ml blood loss); group 2 consisted of 16 subjects in whom hemorrhage occurred (> 500 ml of blood loss). In group 1 (nonhemorrhage group), the mean hematocrit change was -5.3%; in group 2 (hemorrhage group) the hematocrit change was -8.3%. The findings showed a statistically significant difference (p < 0.05) between the groups for both the repeat hematocrit scores and the change in hematocrit scores. On the basis of a hematocrit decrease of 5% or less, 97% of the patients would have been correctly assigned to the nonhemorrhage group. Hematocrit determinations are a valid indicator of blood loss in trauma patients receiving IV therapy. The use of repeat hematocrit readings for clinicians trying to differentiate those with significant blood loss and the effects of IV fluid administration remains limited.

Diagnostic blood loss in the patient undergoing head and neck surgery.

To examine retrospectively the amount of blood lost solely for diagnostic purposes in a defined group of patients. Retrospective medical chart review of a case series. Operating theater and surgical intensive care unit in a major tertiary care center. Thirty-nine consecutive patients with head and neck cancer undergoing major surgical procedures and requiring overnight intensive care unit monitoring. Patient medical records were analyzed for procedure, starting hematocrit reading, intraoperative estimated blood loss and intravenous fluids, operative time, history of blood product transfusion, blood lost for each phlebotomy encounter, and the immediate cost therefrom. The mean diagnostic blood loss was 181 mL, which was 36% of estimated blood loss. In the group of 23 nontransfused patients, the average drop in hematocrit was 9.7%. This change in hematocrit correlated most strongly with operating time (P < .02) and the amount of intraoperative intravenous fluid administration (P < .05). The average cost to the patient directly from phlebotomy-associated charges was $542. Diagnostic blood loss contributes significantly to the overall blood loss in the patient undergoing head and neck surgery.

A justification for high resolution hematocrit measurement

The purpose of this study was to determine the feasibility of using a 6" digital caliper and a 20x viewing microscope to measure hematocrit (HCT) from microhematocrit tubes. The reliability and validity of the digital caliper technique (DC) was simultaneously compared with that of the conventional "turntable" style microhematocrit method (MC) and the Coulter Counter hematocrit (CC) for a comprehensive comparison of the three methods. The reliability of the three methods was assessed by computing the standard error of the measurement (SEm) on triplicate readings of human blood samples. The SEm for MC, CC, and DC methods were 0.3555, 0.3004, and 0.1491, respectively. Validity was assessed by comparing the average of the triplicate HCT readings for each method with HCT determined by densitometry. Average HCT values (+/- SE) for the MC, CC, DC, and densitometry methods were 42.3 +/- 3.2, 42.4 +/- 3.4, 43.1 +/- 3.4, 43.7 +/- 3.3, respectively. Only the DC HCT values were not different from the densitometry HCT (P > 0.05). The MC and CC values were significantly lower (P < 0.01). It is concluded that accurate, highly precise measurements of HCT are obtainable using the digital caliper. The significance for this is the increased ability to perform extremely accurate measurement of changes in plasma volume. With this information, research labs can reliably measure smaller changes in plasma than was previously possible with commercial procedures.

Dismal Rehabilitation in Geriatric Inner-city Hemodialysis Patients

To assess the extent of functional and vocational rehabilitation achieved by elderly inner-city patients sustained on maintenance hemodialysis. Inception cohort study of elderly patients who have end-stage renal disease using a modified Karnofsky rating system. The need for a wheelchair, participation in household activities, and effect of comorbid conditions were noted. Current status was compared with patient's recollection of functional activity level 2 years before commencing maintenance hemodialysis. Seven outpatient, hospital-affiliated and private hemodialysis units in Brooklyn, NY. One hundred four patients aged 65 years or older who were receiving maintenance hemodialysis for at least 6 months. A score of 76 or greater on a modified Karnofsky scale indicated independent function at a level that permitted participation in activities beyond those mandated by the hemodialysis regimen. A comorbidity score 6 or greater on a newly constructed index correlated with severe debility. Employment status was also recorded. Present functional activity had deteriorated to a modified Karnofsky score of 66 +/- 12.3 (+/- SD) compared with patients' recollection of a mean score of 84 +/- 14.3 (P < .001) 2 years before initiation of hemodialysis. Diabetic patients had a lower score than nondiabetic patients. The mean comorbidity index of the entire study group was 7.8 +/- 2.9 (mean +/- SD). Within the diabetic subset, severe debility constrained 71 patients (68%) to limit all activity to their residence with the exception of travel to and from their dialysis facility. By contrast, 2 years prior to commencing dialytic therapy, 81 diabetic patients (78%) had interests and activities that took them outside their homes (P < .001). Generalized weakness was the most common explanation given for the lack of outside activity by nine patients (9%) who were wheelchair bound. Erythropoietin, though regularly administered to 87 patients (84%) in the study group, was unsuccessful in raising mean hematocrit reading above 0.28 +/- 0.05 (mean +/- SD). Maintenance hemodialysis does not return inner-city elderly patients to their predialysis level of functioning. Few elderly, diabetic hemodialysis patients conduct any substantive portion of their lives outside their homes. For nondiabetic patients, the modified Karnofsky score of whites (70.4 +/- 11.9) and blacks (66.5 +/- 15.3), though low, was equivalent (P < .4).