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Peripheral Venous Hemoglobin and Red Blood Cell Mass Mismatch in Volume Overload Systolic Heart Failure: Implications for Patient Management

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Abstract

Peripheral venous hemoglobin (Hb) measurements are considered to accurately reflect circulating red blood cell mass (RBCM). In volume overload decompensated chronic heart failure (DCHF), reliance on Hb values may be misleading. Using quantitative radiolabel blood volume analysis (BVA), we evaluated the relation of RBCM to volume overload and reliability of Hb measurements to reflect RBC status in patients hospitalized for DCHF. Of 32 patients evaluated (LVEF <50 %), 19 met WHO Hb criteria for anemia. By BVA, however, only 4/19 had true anemia (low Hb and low RBCM) while 15/19 demonstrated plasma volume expansion dilution-related “anemia” (6 low Hb/normal RBCM, 9 low Hb/excess RBCM). The remaining 13/32 had normal range Hb (12 with excess RBCM). Overall, 66 % of cohort demonstrated RBCM excess. RBC profiles are highly variable in DCHF, and peripheral Hb values are often misleading in identifying RBC status. These findings have implications for volume management.

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Abbreviations

HF:

Heart failure

PV:

Plasma volume

RBCM:

Red blood cell mass

Hb:

Hemoglobin

DCHF:

Decompensated chronic heart failure

LVEF:

Left ventricular ejection fraction

ACEI:

Angiotensin-converting enzyme inhibitors

ARBs:

Angiotensin receptor blockers

NYHA:

New York Heart Association

TBV:

Total blood volume

BVA:

Blood volume analysis

SD:

Standard deviation

WHO:

World Health Organization

ED:

Emergency department

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Human Subjects/Informed Consent Statement

IRB approval was obtained for collection of human clinical study data.

Animal Studies

No animal studies were carried out by the authors for this article.

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None. No funding support received for this study.

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Authors and Affiliations

  1. Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA

    Wayne L. Miller

  2. Division of Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA

    Brian P. Mullan

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  1. Wayne L. Miller
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  2. Brian P. Mullan
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Correspondence to Wayne L. Miller.

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Associate Editor Craig Stolen oversaw the review of this article

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Miller, W.L., Mullan, B.P. Peripheral Venous Hemoglobin and Red Blood Cell Mass Mismatch in Volume Overload Systolic Heart Failure: Implications for Patient Management. J. of Cardiovasc. Trans. Res. 8, 404–410 (2015). https://doi.org/10.1007/s12265-015-9650-4

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  • DOI: https://doi.org/10.1007/s12265-015-9650-4

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