Abstract
Bilirubinemia has been reported in man and animals exposed to high altitude, but the cause is not well known. Altered conjugation and delayed excretion of the pigment by the liver has been reported to contribute to the high serum bilirubin levels in man and animals exposed to high altitude, but the rate of development of bilirubinemia, the effects of severe polycythemia, altered erythrocyte fragility and intravascular hemolysis have not been thoroughly investigated. A study was made of the serum bilirubin concentration and the extent of intravascular hemolysis in rats during acclimatization to a simulated altitude of 5,500 m. During both continuous and intermittent (4h/d) exposure the serum bilirubin was significantly elevated at the end of 4 to 6 weeks. The elevations occurred only after severe polycythemia developed (hematocrit 68.5%, Hb 21.6 g/100 ml). An increase in intravascular hemolysis was found after 2 weeks intermittent exposure and after 4 weeks continuous exposure to 5,500 m. No change in erythrocyte fragility to account for increased intravascular hemolysis was found in any of the rats exposed continuously or intermittently to high altitude. No liver pathology was observed in rats exposed to 5,500 m. Bilirubinemia in the rat exposed to high altitude may have been due to the greatly increased erythrocyte number (hematocrit above 68%) and to a proportionate increase in destruction of erythrocytes, to increased intravascular hemolysis associated with the increased blood viscosity and possibly to an inability of the liver to handle increased levels of serum bilirubin.
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Altland, P.D., Parker, M.G. Bilirubinemia and intravascular hemolysis during acclimatization to high altitude. Int J Biometeorol 21, 165–170 (1977). https://doi.org/10.1007/BF01553710
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DOI: https://doi.org/10.1007/BF01553710