Acad. doi: 10.1152/ajpheart.1999.276.6.H2188. An increase in circulating proteins can also affect platelet aggregation and cause prolonged bleeding time. Plasmas viscosity is determined by water-content and macromolecular components, so these factors that affect blood viscosity are the plasma protein concentration and types of proteins in the plasma 5. While hydration during exercise was able to decrease blood viscosity below the pre-exercise levels in sickle cell trait carriers, blood viscosity increased similarly in healthy individuals in both the hydration and water deprivation conditions. The role of nitric oxide in regulation of deformability of red blood cells in acute phase of endotoxaemia in rats. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518963, Lenz C, Rebel A, Waschke KF, Koehler RC, Frietsch T. Blood viscosity modulates tissue perfusion: sometimes and somewhere. doi: 10.1073/pnas.1210236109. Blood 121, 30543056. Although the loss of RBC deformability is a fundamental characteristic of SCA, patients exhibit varying degrees of RBC rigidity, which can differentially affect SCA disease severity and complications (Renoux et al., 2016). Optimal Result: 1.5 - 1.9 Units. Laboratory evidence of high serum viscosity establishes the diagnosis. Blood rheology and hemodynamics. Hemorheol. Blood rheology abnormalities and vascular cell adhesion mechanisms in sickle cell trait carriers during exercise. RBC aggregation depends on both plasma and cellular factors. Red blood cells have unique mechanical behavior, which can be discussed under the terms erythrocyte deformability and erythrocyte aggregation4. 10:1329. doi: 10.3389/fphys.2019.01329. The cellular phase of blood includes, erythrocytes, leukocytes, and platelets. Connes, P. (2010). Minimal and noninvasive biomarkers of esophageal cancer are Khi cc vi khun v virus xm nhp vo bn trong c th, khng th s chng li chng. Blood Viscosity - an overview | ScienceDirect Topics (2007). Microcirc. doi: 10.1371/journal.pone.0158182, Robach, P., Boisson, R. C., Vincent, L., Lundby, C., Moutereau, S., Gergele, L., et al. Martini et al. 2018 Jun 01;97(11):741-748. Monoclonal diseases include multiple myeloma, Waldenstrom macroglobulinemia, and cryoglobulinemia. Impaired oxygen uptake efficiency slope and off-transient kinetics of pulmonary oxygen uptake in sickle cell anemia are associated with hemorheological abnormalities. (2003). PLoS One 11:e0162652. Blood pressure and blood viscosity are not correlated in normal healthy subjects. Jelkmann W. Erythropoietin. Sickle cell anemia (SCA) is by far the most common form of SCD, followed by hemoglobin SC disease (SC) (Piel et al., 2010). The presence of problems and birth defects in the heart. Vasc Health Risk Manag. Omwanghe, O. The impact of ultra-run events on RBC deformability is unknown. Hyperviscosity syndrome - Wikipedia Increased RBC aggregation has been shown to promote RBC axial migration in these vessels, which in turn increases the cell free layer width (Baskurt and Meiselman, 2007). It gives your provider information about your blood and overall health. Clin. For example, RBC surface properties, including surface charge and glycocalyx depth, also play an important role in this process. Normal plasma at 37 degrees Celsius has a viscosity of around 1.21.3 cP, but these values may be higher in various inflammatory, metabolic, or cardiovascular diseases (Kesmarky et al., 2008). Haemolysis and abnormal haemorheology in sickle cell anaemia. (2001) demonstrated that episodes of intrahepatic hypoxia-reoxygenation, which can occur in SCA, induce the release of plasma XO. Hyperviscosity syndrome is a condition in which blood isn't able to flow freely through your arteries. Microcirc. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Georgakopoulos CD, Plotas P, Angelakis A, Kagkelaris K, Tzouvara E, Makri OE. 5, 507510. Low values of resting blood viscosity and erythrocyte aggregation are associated with lower increases in blood lactate during submaximal exercise. doi: 10.1161/01.res.68.1.1. 42, 305306. Am J Physiol. J. Finally, an increase in RBC aggregation of over 150% caused blood flow resistance to increase once again. (2003) reported that several eNOS inhibitors also decreased RBC deformability, suggesting that basal release of NO actively maintains RBC deformability. Blood viscosity also increases with increases in red cell aggregability. 13, 506511. doi: 10.1111/bjh.12594, Faes, C., Charrin, E., Connes, P., Pialoux, V., and Martin, C. (2015). Impaired red cell filterability with elimination of old red blood cells during a 100-km race. Viscosity is the property of fluids to resist flow. 289, 1151211521. Hemorheol. Chronic physical activity limits blood rheology alterations in transgenic SAD mice. Addiction to smoking, whether cigarettes or hookah. Haematologica 100, e383e386. CV Physiology | Viscosity of Blood Self-Reported physical activity and exercise patterns in children with sickle cell disease. doi: 10.1007/s40279-015-0447-z. Hearing loss, either completely or partially. However, when endothelial/vascular dysfunction is present, like in SCA (Kato et al., 2007; Ataga et al., 2016; Charlot et al., 2016), vasodilation is impaired. Blood viscosity is resistance to blood flow due to friction of the lamina that moves along the axis of the blood vessel due to differences in speed. Acta Physiol. Physiol. However, since regular physical activity has been shown to provide health benefits in various chronic diseases, several groups have begun to study the effects of acute and chronic exercise in individuals and mice with SCA. Microcirc 44, 5561. Although the exact reasons for these findings are unknown, it has been suggested that increased NO production during exercise could increase RBC deformability. However, while the deformability of RBC decreases during acute vaso-occlusive events in SCD, patients with the highest RBC deformability at steady-state have a higher risk of developing frequent painful vaso-occlusive crises. doi: 10.3233/CH-2011-1454, Sandor, B., Nagy, A., Toth, A., Rabai, M., Mezey, B., Csatho, A., et al. doi: 10.1126/science.715448, Galea, G., and Davidson, R. J. J. Physiol. 2019:3765643. doi: 10.1155/2019/3765643, Grau, M., Jerke, M., Nader, E., Schenk, A., Renoux, C., Collins, B., et al. Another important factor that influences blood viscosity is temperature. (2013). Albuminuria is associated with endothelial dysfunction and elevated plasma endothelin-1 in sickle cell anemia. (1991). Heart Circ. Hemorheology and exercise: effects of warm environments and potential consequences for sickle cell trait carriers. 9, 104107. J. Haematol. Effect of diet on blood viscosity in healthy humans: a systematic RBC aggregation then returned to baseline during the 2 h following the cycling test. Moderate-intensity endurance-exercise training in patients with sickle-cell disease without severe chronic complications (EXDRE): an open-label randomised controlled trial. Seminars in Thrombosis and Haemostasis. Water behaves as a Newtonian fluid and therefore under non-turbulent conditions, its viscosity is independent of flow velocity (i.e., viscosity does not change with changes in velocity) (Figure 2). Multiple studies have shown that an acute bout of maximal or submaximal cycling exercise may cause plasma viscosity to increase by 1012%, compared to resting values (Ernst, 1985; Ernst et al., 1991b; Brun et al., 1994b, 1998; Bouix et al., 1998; Connes et al., 2004b). Could maximal exercise be a hemorheological risk factor? Blood is a shear-thinning fluid, meaning that its viscosity decreases when shear rate increases. Exercise limitation, exercise testing and exercise recommendations in sickle cell anemia. Shear-dependent deformation of erythrocytes in rheology of human blood. Clin. However, this has to be performed with caution because aggressive plasma exchange can cause the elimination of clotting factors, albumin, and platelets. Clin. Occup. J. Physiol. White blood cells and platelets can affect blood rheology, but under normal conditions, red blood cells (RBCs) have the biggest influence (Pop et al., 2002). Is blood like your waistline - the thinner, the better? Med. (2011). Semin. The relationship between the rheological behavior of RBCs and angiogenesis in the morbidly obese. One of the first works to suggest that NO could affect RBC deformability was the study of Starzyk et al. J. Physiol. 60, 413421. Connes, P., Caillaud, C., Py, G., Mercier, J., Hue, O., and Brun, J. F. (2007). (2010). However, the magnitude of the change in RBC deformability that occurs during exercise seems to depend on the training status and physical fitness of the subjects. Varlet-Marie et al. A., Gething, P. W., Williams, T. N., et al. (2015) reported higher concentrations of soluble VCAM-1 in the plasma of SCA patients at rest compared to a control group, but progressive and maximal exercise tests did not induce any further rise of VCAM-1. Sickle RBC are rigid, and therefore do not easily flow through the microcirculation, causing frequent vaso-occlusive episodes in affected patients. For instance, when a viscous fluid is forced through a tube, it flows . 22 However, . Overview What is hyperviscosity syndrome? While extracellular sources of NO may impact the deformability of RBC, several works suggest that endogenous RBC NO synthesis may also modulate RBC deformability (Kleinbongard et al., 2006). Chien, S., Usami, S., Dellenback, R. J., and Gregersen, M. I. Microcirc 47, 261268. A., Akbarpour, M., Connes, P., Romana, M., Lapping-Carr, G., et al. doi: 10.3233/CH-180405. J. Physiol. Am. J. Physiol. Meiselman, H. J., Neu, B., Rampling, M. W., and Baskurt, O. K. (2007). (2016). Hemorheol. This will lead to decreased oxygen delivery 7. reads. The definitive treatment of hyperviscosity syndrome involves chemotherapy for the underlying hematologic condition. The more definitive short-term treatment is plasmapheresis. Among these diseases, can include diabetes, high blood pressure or hyperlipidemia. Presently, only a few studies have been conducted to evaluate chronic exercise in people with SCA. U.S.A. 113, 1328913294. 339-48. The pathologic rise of acellular components can either be monoclonal or polyclonal. Clin Hemorheol Microcirc. Metab. Sports Exerc. Hyperviscocity: Treatment, Symptoms, and Causes - WebMD Deformability of different red blood cell populations and viscosity of differently trained young men in response to intensive and moderate running. (2004a). Sensation of tickling or itching in different areas of the body. doi: 10.3324/haematol.2010.026740, Lemonne, N., Charlot, K., Waltz, X., Ballas, S. K., Lamarre, Y., Lee, K., et al. Although plasma is mostly water, it also contains other molecules such as electrolytes, proteins (especially albumin and fibrinogen), and other macromolecules. Red blood cell deformability is another important determinant of blood viscosity. doi: 10.14814/phy2.12338. Erythrocyte density in sickle cell syndromes is associated with specific clinical manifestations and hemolysis. Neurological findings can include a headache, neuropathic syndromes, generalized stupor, coma, dizziness, ataxia, hearing impairment, seizures, and stroke syndromes. RBC aggregates disaggregate in high shear rate areas, such as in arteries and arterioles. Physiol. Circulating extra-vesicles, such as microparticles (Camus et al., 2012, 2015) and exosomes (Khalyfa et al., 2016), are also thought to play a role in the development of vascular dysfunction in SCA. Instead, increasing blood viscosity can facilitate vasodilation and decrease vascular resistance through shear stress-dependent mechanisms, which increase NO production. Pathophysiology and physical activity in patients with sickle cell anemia. 11 Articles, This article is part of the Research Topic, Blood Flow Resistance and the Cardiovascular System, Sickle Cell Disease, Blood Rheology and Vascular Dysfunction, Exercise and Blood Rheology in Healthy Individuals and Individuals With SCA, Creative Commons Attribution License (CC BY). Haematologica 96, 15891594. Am. Hypergammaglobulinemia is the most common cause of hyperviscosity syndrome, specifically the monoclonal condition Waldenstrom macroglobulinemia. Am. doi: 10.3233/CH-2011-1469, Salazar Vazquez, B. Y., Cabrales, P., Tsai, A. G., and Intaglietta, M. (2011). (2001). Viscosity denotes opposition to flow. Sports Med. Br. Medline . In addition, hemolysis releases the arginase contained in erythrocytes into the plasma. 23, 12651269. Alterations in any of these factors can modify blood flow resistance in the vasculature and alter tissue perfusion. Blood is a non-Newtonian, shear thinning fluid with thixotropic and viscoelastic properties. Blood becomes less viscous at high shear rates like those experienced with increased flow such as during exercise or in peak-systole. Just like molasses, when blood gets cold, it becomes thicker and flows more slowly. The shear thinning property of blood is mainly attributed to red blood cell (RBC) rheological properties. Sci. Blood viscosity and blood pressure: role of temperature and Microcirc. (2018) found a higher proportion of young deformable RBCs in athletes than in untrained subjects. Hakim, T. S. (1988). Erythrocyte deformability and segmental pulmonary vascular resistance: osmolarity and heat treatment. However, when patients become older HbF is replaced by HbS, and, as a result, RBC deformability decreases (Renoux et al., 2016). Hemorheol. 83, 746752. Effects of exercise training on blood rheology: a meta-analysis. Slight increases of the plasma soluble forms of VCAM-1 and ICAM-1 were noted at the end of the exercise in SCA patients, suggesting slight endothelial activation (Faes et al., 2014). doi: 10.1016/j.ymgme.2017.11.010. (2012). Clin. Pediatr. J. Hematol. Blood Rheology: Key Parameters, Impact on Blood Flow, Role in Sickle 13, 3749. One reason for this change is that plasma volume increases few hours or several days after a single bout of exercise (Fellmann, 1992; Brun et al., 1998), resulting in an autohemodilution (Ernst, 1987; Ernst et al., 1991a). Delayed beneficial effect of acute exercise on red blood cell aggregate strength in patients with sickle cell anemia. "Viscosity is an indication of the 'thickness' of the blood, or its resistance to flowing normally. When the hematocrit rises to 60 or 70%, which it often does in polycythemia rubra vera 6, the blood viscosity can become as great as 10 times that of water, and its flow through blood vessels is greatly retarded because of increased resistance to flow 2. Clin. Physiol. (1999) and Tomschi et al. Hyperviscosity syndrome is a condition that occurs when your blood becomes so thick that your body's overall blood flow decreases. Crit. J. Pediatr. Normal serum viscosity relative to water is 1.4 to 1.8 cp 1. Faes, C., Balayssac-Siransy, E., Connes, P., Hivert, L., Danho, C., Bogui, P., et al. Vazquez, B. Y., Vazquez, M. A., Jaquez, M. G., Huemoeller, A. H., Intaglietta, M., and Cabrales, P. (2010). Capillaries can have a diameter of less than 5 m. Br. This paradox seems to be due to the fact that in SCD RBC with the highest deformability are also the most adherent, which would trigger vaso-occlusion. 303, H1096H1106. Sports Med. 7, 418. doi: 10.1055/s-2003-44551, Baskurt, O. K., and Meiselman, H. J. 2019 Jan-Dec;11:2515841418820441. 165, 564572. 10, 512516. However, most of the studies performed in the field of blood rheology have been done in laboratory conditions where water is not allowed during the various exercise tests and water loss cannot be compensated by water intake. Hyperviscosity syndrome is a group of symptoms triggered by an increase in the viscosity of the blood.Symptoms of high blood viscosity include spontaneous bleeding from mucous membranes, visual disturbances due to retinopathy, and neurologic symptoms ranging from headache and vertigo to seizures and coma.. Hyperviscosity occurs from pathologic changes of either cellular or protein fractions of . Sickle-cell disease. 88, 20742080. Sports Exerc. For liquids, it corresponds to the informal concept of "thickness": for example, syrup has a higher viscosity than water. (2014). The information on the www.vinmec.com is ONLY for references. (2012). Curr Hematol Rep. 2003 May;2(3):237-41. https://www.ncbi.nlm.nih.gov/pubmed/12901345, Kwon O, Krishnamoorthy M, Cho YI, Sankovic JM, Banerjee RK (February 2008). If temperature increases from 36.5 to 39.5C, blood viscosity decreases 10.38%. Indeed, the effects of hemoconcentration, increased plasma viscosity, decreased RBC deformability and increased RBC aggregation on blood viscosity during exercise could be counterbalanced by the effects of increasing shear rate (Connes et al., 2013b). (2019). Clin. Ernst, E. (1985). However, clinical works performed to study aggregation in cardiovascular, metabolic, or inflammatory diseases consistently show that people with these diseases generally have higher RBC aggregation levels than healthy individuals, and the elevated aggregation contributes to the development of adverse disease outcomes (Totsimon et al., 2017; Biro et al., 2018; Brun et al., 2018; Ko et al., 2018; Lapoumeroulie et al., 2019; Piecuch et al., 2019; Sheremetev et al., 2019). Hematol. Hemorheol. doi: 10.3324/haematol.2008.005371, Tripette, J., Hardy-Dessources, M. D., Beltan, E., Sanouiller, A., Bangou, J., Chalabi, T., et al. Femoral shear rate response to knee extensor exercise: an age and sex comparison. Hemorheol. Physiol. Blood 116, 21522159. Effect of enhanced red blood cell aggregation on blood flow resistance in an isolated-perfused guinea pig heart preparation. Pflugers. Brun, J. F., Sekkat, M., Lagoueyte, C., Fdou, C., and Orsetti, A. Association between oxidative stress and vascular reactivity in children with sickle cell anaemia and sickle haemoglobin C disease. Clin. Normal plasma viscosity is around 1.3-1.7mPas (millipascal second). Acute hyperviscosity: syndromes and management | Blood | American Physiol. 45, 917. Ernst, E., Daburger, L., and Saradeth, T. (1991b). Whole blood viscosity is the sum of plasma viscosity (mainly determined by colloid components such as albumin) plus the density and packing of all blood cells and their rigidity (see Figure 1) 2. (2002). Gueguen-Duchesne, M., Durand, F., Beillot, J., Dezier, J., Rochcongar, P., Legoff, M., et al. Clin. Cokelet, G. R., and Goldsmith, H. L. (1991). (2018) found a slight but significant increase in RBC deformability in response to a short and maximal exercise test. Red blood cell aggregation is the reversible formation of three-dimensional stacks of RBC, called rouleaux, which takes place at low shear rates. Maximal exercise and lactate do not change red blood cell aggregation in well trained athletes. We aimed to investigate the effect of blood viscosity on stroke occurrence and the clinical utility of blood viscosity measurements obtained immediately upon hospital arrival.<break . The changes in hematocrit, hemoglobin, plasma volume and proteins during and after different types of exercise. Blood rheology plays an important role in the regulation of tissue perfusion at rest and during exercise. Microcirc 30, 169178. Esophageal cancer is a deadly cancer that includes the subtypes of adenocarcinoma and squamous cell carcinoma. J. Next, a 100150% increase in RBC aggregation caused blood flow resistance to decrease. Biro, K., Sandor, B., Kovacs, D., Csiszar, B., Vekasi, J., Totsimon, K., et al. J. Haematol. 52, 1526. Dexamethasone implant for immunogammopathy maculopathy associated with IgA multiple myeloma. 57, 373381. These results indicate that regular moderate exercise is safe and feasible in children with SCA. 94, 9971002. J. Appl. 2007;43(2):171-5. Any pathologic elevation of the cellular components (erythrocytes, leukocytes, or platelets) or acellular components (protein) of blood can cause hyperviscosity. Overview Examples Blood tests can be used in a number of ways, such as helping to diagnose a condition, assessing the health of certain organs or screening for some genetic conditions. 87:E129. Several investigators have reported significant correlations between blood fluidity and indices of physical fitness in sportsmen, such as time of endurance until exhaustion, aerobic working capacity at 170 W (W170), and maximal oxygen consumption (VO2max) (Ernst et al., 1985; Brun et al., 1986, 1989, 1995). (2017). Sci. Vinmec is not responsible for any cases of self-application without a doctor's prescription. Indeed, although hematocrit increased, blood viscosity remained unchanged (and tended to decrease), as has been observed in previous studies (Neuhaus and Gaehtgens, 1994; Tripette et al., 2011). doi: 10.3233/CH-131762, Waltz, X., and Connes, P. (2014). Rouleaux formation on a peripheral blood smear is highly suggestive of serum stasis. This rise in hematocrit has been attributed to several mechanisms such as fluid shift between intra- and extra-vascular spaces (Sjogaard et al., 1985; Ploutz-Snyder et al., 1995), dehydration (Nosadova, 1977; Stephenson and Kolka, 1988) the release of sequestered RBCs from the spleen (Isbister, 1997), and water trapping in muscle (Ploutz-Snyder et al., 1995). A., Popovicheva, A. N., Rogozin, M. M., and Levin, G. Y. Blood viscosity is the thickness or stickiness of blood. If clotting mechanisms are stimulated in the blood, platelet aggregation and interactions with plasma proteins occur. (1997). They also showed that increasing blood viscosity promoted the activation of endothelial NO-synthase through shear stress-dependent mechanisms, resulting in higher NO production, compensatory vasodilation, and decreased arterial pressure. Surprisingly, a recent study did not show a further rise of blood viscosity during acute painful vaso-occlusive crisis (Lapoumeroulie et al., 2019). doi: 10.3233/CH-189103, Bor-Kucukatay, M., Wenby, R. B., Meiselman, H. J., and Baskurt, O. K. (2003). Am. In a study performed in Ivory Coast, 17 patients with SCA performed a 20 min moderate exercise (45 Watts) with blood sampling before and at the end of exercise (Balayssac-Siransy et al., 2011; Faes et al., 2014). Endothelium 8, 147155. There is an inverse relationship between flow and viscosity; therefore, the greater the viscosity the smaller the slope of the flow-pressure relationship, meaning that at a given driving pressure flow will be reduced at higher viscosities. 18, 1021. Biorheology 12, 341346. Oostenbrug, G. S., Mensink, R. P., Hardeman, M. R., De Vries, T., Brouns, F., and Hornstra, G. (1997). For instance, Robach et al. Eryptosis and hemorheological responses to maximal exercise in athletes: comparison between running and cycling. (1988). Senturk, U. K., Gunduz, F., Kuru, O., Kocer, G., Ozkaya, Y. G., Yesilkaya, A., et al. Additionally, Khalyfa et al. Normally, blood temperature does not change much in the body. With a normal hematocrit of about 40%, the relative viscosity of whole blood to the plasma's . Overall, these works suggest that therapies focusing both on blood rheology and vascular function could be helpful to decrease the clinical severity of SCA patients. doi: 10.1111/j.1600-0838.2012.01481.x, Romain, A. J., Brun, J. F., Varlet-Marie, E., and Raynaud De Mauverger, E. (2011). Erythrocyte Sedimentation Rate - StatPearls - NCBI Bookshelf On the other hand, in vertical tubes RBC aggregation increases RBC axial migration and facilitates blood flow. 18, CR351CR360. The slight physiological hyperthermia was shown to increase RBC deformability, which compensated the rise in hematocrit and resulted in a lack of change in blood viscosity. Hemorheol. (2005a) reported that a short, progressive, maximal cycling exercise test promoted oxidative stress in both sedentary and well-trained subjects, but they only observed a decrease in RBC deformability and an increase of RBC fragility in sedentary individuals. Chronic hemolysis is highly implicated in the development of vascular dysfunction in SCA. Pulmonary vascular pressure profile in adult ferrets: measurements in vivo and in isolated lungs.