Effects of increasing blood hemoglobin levels on systemic hemodynamics of acutely anemic cirrhotic patients
Journal of Hepatology. 1998;29((5):):789-95.
BACKGROUND/AIMS: In experimental portal hypertension, blood hemoglobin levels have been shown to influence the hyperdynamic circulatory state. The aim of this study was to assess the hemodynamic effects of increasing hemoglobin concentration in human portal hypertension. METHODS Sixteen cirrhotic patients recovering from a variceal bleeding episode were randomly assigned to receive two units of packed red cells or 500 ml of a protein solution. Systemic and portal hemodynamics, and rheological and hormonal parameters were measured at baseline and after expansion. RESULTS Both groups were similar with respect to the degree of liver failure, severity of the bleeding episode, activation of the endogenous vasopressor systems, and hemodynamic parameters. The administration of either erythrocytes or a protein solution prompted a similar increase in total blood volume and suppression of vasopressor systems. Both groups of patients experienced similar increases in wedged hepatic venous pressure. Hepatic venous pressure gradient was not significantly modified but tended to increase in erythrocyte-transfused patients. Cardiopulmonary pressures increased, but this increment was significant in the non-blood-transfused patients only. Cardiac output decreased in erythrocyte-transfused patients, while it increased in the group receiving a protein solution. Red blood cell transfusion resulted in an increase in systemic vascular hindrance (resistance/blood viscosity), whereas the administration of a protein solution prompted a decrease in this parameter, thus reflecting true vasoconstriction and vasodilation, respectively. CONCLUSIONS An increase in blood hemoglobin in acutely anemic cirrhotic patients attenuates their hyperdynamic circulation beyond viscosity-dependent changes, an effect which might be counteracted by the effects on portal venous pressure gradient.
Use of blood component therapy for gastrointestinal bleeding in patients with cirrhosis of the liver
Johns Hopkins Medical Journal. 1975;136((4):):163-7.
A prospective study was designed to compare the administration of available fresh blood and component therapy in the treatment of gastrointestinal bleeding in patients with cirrhosis of the liver. Fifty bleeding cirrhotic patients were randomly assigned to treatment: 17 patients recieved 51 percent fresh blood (Group 1), 16 patients received 22 percent fresh blood (Group 2), and 17 patients received 25 percent component therapy consisting of packed cells, fresh frozen plasma, and platelet concentrate (Group 3). The mortality rate was unaffected by the type of blood replacement. Neither the blood replacement requirement (Group 1:51 plus or minus 0.9 units Group 2:5.5 plus or minus 0.8 units, Group 3:7.1 plus or minus 1.1 units) nor the duration of bleeding (Group 1:39 plus or minus 0.8 days, Group 2:6.3 plus or minus 2.4 days, Groups 3:5.8 plus or minus 1.0 days) were significantly different. There was no correlation between the mean age of blood or plasma received and the units of blood replaced or the duration of bleeding. Patients with severe coagulation abnormalties had a significantly increased mortality. Component therapy was as effective as the fresh blood regimen in cirrhotic patients with acute gastrintestinal hemorrhage.