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Hemoglobin concentration, total hemoglobin mass and plasma volume in patients: implications for anemia

Otto, JM; Plumb, JOM; Clissold, E; Kumar, S; Wakeham, DJ; Schmidt, W; Grocott, MPW; ... Montgomery, H; + view all (2017) Hemoglobin concentration, total hemoglobin mass and plasma volume in patients: implications for anemia. Haematologica , 102 (9) pp. 1477-1485. 10.3324/haematol.2017.169680. Green open access

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Abstract

In practice, clinicians generally consider anemia (circulating hemoglobin concentration < 120 g.l-1 in non-pregnant females and < 130 g.l-1 in males) as due to impaired hemoglobin synthesis or increased erythrocyte loss or destruction. Rarely is a rise in plasma volume relative to circulating total hemoglobin mass considered as a cause. But does this matter? We explored this issue in patients, using the optimized carbon-monoxide rebreathing method to measure hemoglobin concentration and thereby calculate plasma volume in healthy volunteers, surgical patients, and those with inflammatory bowel disease, chronic liver disease or heart failure. We studied 109 participants. Hemoglobin mass correlated well with its concentration in the healthy, surgical and inflammatory bowel disease groups (r= 0.687-0.871, p< 0.001). However, they were poorly related in liver disease (r= 0.410, p= 0.11) and heart failure patients (r= 0.312, p= 0.16). Here, hemoglobin mass explained little of the variance in its concentration (adjusted R2= 0.109 and 0.052; p= 0.11 and 0.16), whilst plasma volume did (R2 change 0.724 and 0.805 in heart and liver disease respectively, p<0.0001). Exemplar patients with identical (normal or raised) total hemoglobin masses were diagnosed as profoundly anemic (or not) depending on differences in plasma volume that had not been measured or even considered as a cause. The traditional inference that anemia generally reflects hemoglobin deficiency may be misleading, potentially resulting in inappropriate tests and therapeutic interventions to address 'hemoglobin deficiency not plasma volume excess. Measurement of total hemoglobin mass and plasma volume is now simple, cheap and safe, and its more routine use advocated.

Type: Article
Title: Hemoglobin concentration, total hemoglobin mass and plasma volume in patients: implications for anemia
Location: Italy
Open access status: An open access version is available from UCL Discovery
DOI: 10.3324/haematol.2017.169680
Publisher version: http://dx.doi.org/10.3324/haematol.2017.169680
Language: English
Additional information: ©2017 Ferrata Storti Foundation Material published in Haematologica is covered by copyright. All rights are reserved to the Ferrata Storti Foundation. Use of published material is allowed under the following terms and conditions: https://creativecommons.org/licenses/by-nc/4.0/legalcode. Copies of published material are allowed for personal or internal use. Sharing published material for non-commercial purposes is subject to the following conditions: https://creativecommons.org/licenses/by-nc/4.0/legalcode, sect. 3. Reproducing and sharing published material for commercial purposes is not allowed without permission in writing from the publisher.
Keywords: Anemia, Laboratory Hematology, Red Cells, Total hemoglobin mass (t-Hb-mass)
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Experimental and Translational Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
URI: https://discovery.ucl.ac.uk/id/eprint/1559698
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