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Blood viscosity and its relationship to iron deficiency, symptoms, and exercise capacity in adults with cyanotic congenital heart disease

Broberg, CS; Bax, BE; Okonko, DO; Rampling, MW; Bayne, S; Harries, C; Davidson, SJ; Uebing, A; Khan, AA; Thein, S; et al. Broberg, CS; Bax, BE; Okonko, DO; Rampling, MW; Bayne, S; Harries, C; Davidson, SJ; Uebing, A; Khan, AA; Thein, S; Gibbs, JS; Burman, J; Gatzoulis, MA (2006) Blood viscosity and its relationship to iron deficiency, symptoms, and exercise capacity in adults with cyanotic congenital heart disease. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 48 (2). 356 - 365. ISSN 0735-1097 https://doi.org/10.1016/j.jacc.2006.03.040
SGUL Authors: Bax, Bridget Elizabeth

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Abstract

Objectives This study sought to determine the relationship between blood viscosity and iron deficiency and their impact on symptoms and exercise function in adults with cyanotic congenital heart disease. Background Iron deficiency is believed to raise whole blood viscosity in cyanotic congenital heart disease, although available data are inconsistent. Methods Thirty-nine cyanotic adults were prospectively assessed for iron deficiency (transferrin saturation ≤5%), hyperviscosity symptoms, and exercise capacity. Same-day measurement of whole blood viscosity and hematocrit (Hct) adjusted viscosity (cells resuspended in autologous plasma to Hct of 45%) was performed at shear rates ranging from 0.277 s−1 to 128.5 s−1. Results Viscosity did not differ between patients with iron deficiency (n = 14) and those without (n = 25). Whole blood viscosity correlated with Hct (r = 0.63, p < 0.001 at low shear and r = 0.84, p < 0.001 at high shear) but not with red blood cell size or iron indices. Hyperviscosity symptoms were independent of iron indices but directly correlated with increased Hct-adjusted viscosity (r = 0.41, p = 0.01). Exercise capacity did not differ in iron-deficient patients. However, peak oxygen consumption was higher in those with Hct ≥ 65% (12.6 ± 3.4 ml/kg/m2 vs. 9.8 ± 2.6 ml/kg/m2, mean ± SD, p = 0.036) despite higher whole blood viscosity in these same individuals (p < 0.01 for all shear rates). Conclusions Iron deficiency is common in cyanotic adults but does not alter viscosity. Hyperviscosity symptoms are associated with a higher Hct-adjusted viscosity independent of cell size or iron stores. Higher Hct is associated with better exercise capacity. Further work to understand the origin of hyperviscosity symptoms is warranted.

Item Type: Article
Additional Information: NOTICE: this is the author’s version of a work that was accepted for publication in the Journal of the American College of Cardiology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in the Journal of the American College of Cardiology [48, 2 (18 July 2006)] 10.1016/j.jacc.2006.03.040
Keywords: Adult, Anemia, Iron-Deficiency, Blood Viscosity, Erythrocyte Aggregation, Erythrocyte Count, Erythrocyte Indices, Exercise Test, Exercise Tolerance, Female, Heart Defects, Congenital, Hematocrit, Humans, Iron, Male, Middle Aged, Oxygen Consumption, Prospective Studies, Science & Technology, Life Sciences & Biomedicine, Cardiac & Cardiovascular Systems, Cardiovascular System & Cardiology, ERYTHROCYTE DEFORMABILITY, CEREBROVASCULAR ACCIDENTS, HEMATOLOGIC MANAGEMENT, POLYCYTHEMIA SECONDARY, TREATED POLYCYTHEMIA, CHILDREN, RHEOLOGY, ANEMIA, HYPERVISCOSITY, COAGULATION
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Cell Sciences (INCCCS)
Journal or Publication Title: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
ISSN: 0735-1097
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Dates:
DateEvent
18 July 2006Published
Web of Science ID: WOS:000239080000020
URI: http://openaccess.sgul.ac.uk/id/eprint/100458
Publisher's version: https://doi.org/10.1016/j.jacc.2006.03.040

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