Study of the Blood in Chronic Respiratory Diseases, With Special Reference to the Volume of the Blood 1

Abstract

The character of the changes in the blood in cases of chronic pulmonary diseases has not been settled. Although patients with respiratory disturbances often have the appearance of those with polycythemia, it is questionable whether there is an actual increase in the blood and cell volume. Some investigators believe that the blood in these cases shows a polycythemic picture, which they believe to be due to interference with the proper pulmonary exchange of oxygen, resulting in a low tension of oxygen in the arterial blood which in turn overstimulates the bone marrow. The usual response of the blood to low oxygen tensions obtained for short periods under experimental conditions has been studied extensively. But investigations of the changes occurring in cases of chronic pulmonary diseases with or without anoxemia due to faulty pulmonary exchange are not available except in a few isolated cases. We have attempted to clarify this problem by studying a group of cases with chronic pulmonary diseases; determining not only the characteristics of the erythrocytes and the blood volume but also correlating these findings with various factors such as arterial oxygen saturation, the pulmonary capacity and its sub-divisions and the duration and severity of the disease. We feel that these observations of the volume and morphology of the blood are enhanced by other studies, to be reported later, which we have made on these patients in order better to classify and understand their functional pathology.Well established standards of the normal morphology of the red blood cells are available in the literature, but the values for the blood volume reported by different observers, using similar technique and experimental conditions, vary markedly. We have collected in Table I the values for

Blood volume studies in chronic obstructive non-specific lung disease

“…Blood volume studies in chronic obstructive non-specific lung disease have produced conflicting results. Some workers have concluded that red cell volume is not consistently elevated in a quantitatively normal manner for the level of hypoxia (Lemon, 1929;Kaltreider, Hurtado, and Brooks, 1934;Freedman and Penington, 1963;Vanier, Dulfano, Wu, and Desforges, 1963;Murray, 1965;Ayvazian, Richardson, and Silber, 1969). This subnormal response has been attributed in turn to severe hypoxia, hypercapnia, iron deficiency, chronic infection, and gastrointestinal bleeding.…”

Erythropoietic Response in Chronic Pulmonary Disease

“…[1][2][3][4][5][6] Hypoxia under almost all other conditions is associated with a secondary polycythemia. In natives of the Peruvian Andes, Hurtado and co-workers clearly demonstrated that prolonged exposure to high altitudes will produce an increase in hemoglobin and hematocrit proportional to the degree of hypoxia.7 Similarly, it has been observed that patients with arterial hypoxemia due to cyanotic heart disease8,9 and occasionally due to chronic pulmonary disease have secondary polycythemia.…”

Haematologic Adaptation in Patients with Chronic Bronchitis and Pulmonary Insufficiency

“…This could be due to an increase in total red cell volume being masked by an increase in plasma volume (29,33). However, the total red cell volume and the haemoglobin mass were often found to be less than expected (12, 19,33); a suboptimal haematologic response was shown despite normal erythrocyte life (7,12,29,33) and apparently adequate production of erythropoietin (6,7,23,33). Only in a group of ex-miners with chronic bronchitis and/or silicosis did a close correlation between arterial oxygen saturation and the haematologic data point to an adequate polycythaemic response (4).…”