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Accuracy evaluation of a new glucometer with automated hematocrit measurement and correction.

BACKGROUND: Blood glucose meters are widely used in point of care testing, however, many studies have shown inaccuracies in the glucose measurement due to a number of factors. The present study evaluated the accuracy of a new glucometer capable of simultaneous measurement of patient's hematocrit with algorithmic adjustment of glucose result. This meter was compared with a reference method and 2 other existing meters widely used in the market. METHODS: Venous whole blood samples from healthy volunteers were pooled and reconstituted to produce 5 different hematocrit (30-60%) concentrations. Each hematocrit specimen was spiked to produce 4 different glucose (50-500 mg/dl) concentrations. RESULTS: Hematocrit measured by the new meter correlated well with the reference method. Mean percentage error differences, compared to the reference method, showed obvious differences between existing meters across the wide hematocrit range at various glucose concentrations. The new meter showed a steady and consistent glucose concentrations compared to the reference method. CONCLUSION: The new glucometer, which simultaneously measures hematocrit and performs automated correction for the hematocrit effect, provides a glucose result with improved accuracy. Its measurement of hematocrit from the same blood sample will eliminate the need for additional collection of blood or measurement using another method.

Blood Glucose↗

Hematocrit was not validated as a surrogate end point for survival among epoetin-treated hemodialysis patients.

OBJECTIVE: To evaluate the use of hematocrit as a surrogate end point for survival among end-stage renal disease (ESRD) patients treated with epoetin. STUDY DESIGN AND SETTING: Using United States Renal Data System (USRDS) data, we conducted an observational prospective study to analyze the relationships among epoetin dose, hematocrit, and survival for 31,301 facility-based hemodialysis patients incident to ESRD therapy in 1998. To address our objective, we used criteria developed by Prentice based on results from a Cox regression model. RESULTS: Results indicate that hematocrit is inversely associated with epoetin dose. For the same epoetin treatment-related achieved hematocrit levels, there were widely varying treatment-related survival outcomes, thereby challenging a central criterion required to empirically validate a surrogate end point. CONCLUSION: Our results support earlier clinical trial and epidemiological data suggesting that hematocrit may not be a valid surrogate for survival among the epoetin-treated renal failure population. We hypothesize that hematocrit may not be in the causal pathway or that epoetin may have important mechanisms of action apart from increasing hematocrit. Effective treatment for anemia may therefore not be simply a matter of increasing hematocrit. This study has potential implications for revising the existing treatment guidelines for anemia management and selecting an appropriate treatment regimen.

Dose-Response Relationship, Drug↗

Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group.

BACKGROUND: Cardiac surgery patients' hematocrits frequently fall to low levels during cardiopulmonary bypass. METHODS: We investigated the association between nadir hematocrit and in-hospital mortality and other adverse outcomes in a consecutive series of 6,980 patients undergoing isolated coronary artery bypass graft surgery. The lowest hematocrit during cardiopulmonary bypass was recorded for each patient. Patients were divided into categories based on their lowest hematocrit. Women had a lower hematocrit during bypass than men but both sexes are represented in each category. RESULTS: After adjustment for preoperative differences in patient and disease characteristics, the lowest hematocrit during cardiopulmonary bypass was significantly associated with increased risk of in-hospital mortality, intra- or postoperative placement of an intraaortic balloon pump and return to cardiopulmonary bypass after attempted separation. Smaller patients and those with a lower preoperative hematocrit are at higher risk of having a low hematocrit during cardiopulmonary bypass. CONCLUSIONS: Female patients and patients with smaller body surface area may be more hemodiluted than larger patients. Minimizing intraoperative anemia may result in improved outcomes for this subgroup of patients.

Aged↗

Effects of oncotic pressure and hematocrit on outcome after hypothermic circulatory arrest.

BACKGROUND: A recent study found that a higher-perfusate hematocrit was associated with improved neurologic recovery after deep hypothermic circulatory arrest. The current study examined the relative contributions of oxygen delivery and colloid oncotic pressure to this result, as well as the efficacy of different colloidal agents and modified ultrafiltration. METHODS: Twenty-six piglets were randomized into five groups (n = 5 or 6 animals per group): control group 1--blood and crystalloid prime, hematocrit of 20%; group 2--blood and hetastarch prime, hematocrit of 20%; group 3--blood and pentafraction prime, hematocrit of 20%; group 4--blood and crystalloid prime with 10 minutes of modified ultrafiltration; group 5--whole blood prime, hematocrit of 30%. All groups underwent 60 minutes of deep hypothermic circulatory arrest at 15 degrees C. RESULTS: Groups 2 and 3 showed less body weight gain (analysis of variance, p = 0.001; group 2 versus group 1, p = 0.0009; group 3 versus group 1, p = 0.0009) and body water content after cardiopulmonary bypass (analysis of variance, p = 0.001; group 2 versus group 1, p = 0.003; group 3 versus group 1, p = 0.013). Group 5 showed more rapid recovery of phosphocreatine and intracellular acidosis, as measured by magnetic resonance spectroscopy, during rewarming than group 1 did (phosphocreatine, p = 0.0329; intracellular acidosis, p = 0.0462). Group 3 also showed accelerated recovery of intracellular acidosis (p = 0.0411). Cytochrome a,a3 recovery, determined by near-infrared spectroscopy, was significantly better in group 5 than in group 1 and worse in group 2 than in group 1 after rewarming. The neurologic deficit score and overall performance category score were best in group 5 (neurologic deficit score, p = 0.012; overall performance category score, p = 0.046) on the first postoperative day. Group 3 also had a better overall performance category score than group 1 did (p = 0.0068). Only group 1 and 2 animals showed histologic damage. CONCLUSIONS: Both higher hematocrit and higher colloid oncotic pressure with pentafraction improve cerebral recovery after deep hypothermic circulatory arrest. The higher hematocrit improves cerebral oxygen delivery but does not reduce total body edema. Modified ultrafiltration after cardiopulmonary bypass is less effective than having a higher initial prime hematocrit or colloid oncotic pressure.

Animals↗

Routine hematocrit after elective gynecologic surgery.

OBJECTIVE: To determine the clinical use and associated costs of routine postoperative hematocrit after elective gynecologic surgery. METHODS: We reviewed the charts of all women who had elective gynecologic surgery over 12 months at a community hospital. Demographic data, estimated blood loss at surgery, pre- and postoperative hematocrits, postoperative symptoms suggesting anemia, and incidence of transfusion were tabulated. Laboratory charges for hematocrit at the hospital were used to develop an economic assessment. Statistical analysis was done with Student t test, Mann-Whitney U test, and Fisher exact test. RESULTS: Among 1105 women who had elective surgery, a single postoperative hematocrit was done in 761 (69%) and two or more postoperative hematocrits (mean 2.4, range 2-6) were done in 201 (18%). The overall incidence of blood transfusion related to elective gynecologic surgery was 1.9% (21 of 1105). Five of those women needed preoperative transfusions, eight needed intraoperative transfusions, and the remaining eight had postoperative transfusions. All women who needed postoperative transfusion showed some sign or symptom of anemia. None received transfusions based solely on hematocrit. Risk factors for postoperative transfusion included low preoperative hematocrit and increased intraoperative blood loss. CONCLUSION: Routine postoperative hematocrit in asymptomatic women after uncomplicated elective gynecologic surgery did not improve outcome.

Adult↗

Lack of value of routine postpartum hematocrit determination after vaginal delivery.

OBJECTIVE: To identify risk factors associated with low postpartum hematocrits after vaginal delivery and to define lower risk categories of patients for whom routine determination of hematocrit may not be necessary. METHODS: This case-control study was designed to identify risk factors for discharge hematocrit below 27% in nonanemic patients after a vaginal delivery using the University of California, San Francisco, Perinatal Database. Multivariate statistics were used to determine the most significant risk factors. Lower risk subpopulations were analyzed to determine their rate of low discharge hematocrits. RESULTS: Risk factors associated with odds ratios greater than 1.5 for discharge hematocrit less than 27% included estimated blood loss greater than 500 mL, placenta previa, abruption, prolonged third stage, preeclampsia, prior postpartum hemorrhage, and prior cesarean delivery. Estimated blood loss > 500 mL was the most significant risk factor for discharge hematocrit less than 27% (odds ratio 4.5, 95% confidence interval 3.8, 5.4). A population without statistically significant risk factors was identified; this group had a 1.4% risk of discharge hematocrit less than 27%. CONCLUSION: Routine postpartum hematocrits are unnecessary in clinically stable patients with an estimated blood loss of less than 500 mL.

Adolescent↗

Effect of crystalloid infusion on hematocrit in nonbleeding patients, with applications to clinical traumatology.

A prospective study was undertaken to evaluate the change in hematocrit produced by infusion of crystalloid solution. Twenty healthy, nonbleeding subjects were randomized into two groups. Each group had an initial, baseline hematocrit. Group A then received an infusion of 20 mL/kg normal saline over 45 minutes and had a second hematocrit drawn, after which an additional 15 mL/kg was infused over one hour and a third hematocrit was drawn. Group B also had an initial 20 mL/kg infusion over 45 minutes followed by a second hematocrit determination, but this was followed by an additional 15 mL/kg over three hours, again followed by a final hematocrit. Multiple methodologic factors were included to stimulate, as closely as possible, an actual trauma treatment protocol. In each group, a significant decrease in hematocrit was produced by the first infusion, specifically, 4.8 points in group A and 4.1 points in group B, with more than 50% of the subjects demonstrating a drop of 5 points or more. The second infusion produced no further significant change in either group. There was no difference in the magnitude of the change between the two groups. The study demonstrates that a significant drop in hematocrit may be expected in nonbleeding patients who receive crystalloid infusions during trauma evaluation protocols.

Adult↗

Reducing symptoms during hemodialysis by continuously monitoring the hematocrit.

Previous studies have demonstrated that patients on hemodialysis develop intradialytic symptoms when the blood volume decreases to a critical level. Using a continuous monitor (CRIT-LINE; In-Line Diagnostics, Riverdale, UT) to determine the instantaneous hematocrit and blood volume, we observed that certain intradialytic symptoms occurred at a patient-specific hematocrit. In the present study, we exploited this hematocrit threshold concept to decrease the occurrence of lightheadedness, cramping, and nausea, regardless of blood pressure changes. In the first phase of the study, hematocrit threshold was established in six hypotension-prone patients. Five patients entered into the second phase in which ultrafiltration rates were increased 25 percent above prescribed values at the beginning of the experimental sessions. Subsequently during the experimental sessions, ultrafiltration rates were manipulated to maintain the instantaneous hematocrit value 2 units below the established hematocrit threshold. Sessions without ultrafiltration rate adjustments based on hematocrit served as controls. There were no differences between experimental (n = 27) and control (n = 28) sessions with respect to treatment time (230 minutes v 229 minutes), fluid volume removed (3,351 mL v 3,383 mL), and maximum percentage change in systemic blood pressure (-26 percent v -24 percent). However, there were less symptoms during the experimental sessions (26 percent v 57 percent; P = 0.038). These data suggest that a twofold reduction in intradialytic symptoms can be achieved using continuous hematocrit monitoring without altering treatment times or volume removed in hypotension-prone patients.

Blood Volume↗

Influence of hematocrit on the measurement of lipoproteins demonstrated by the example of lipoprotein(a).

BACKGROUND: The measurement of many parameters of human blood is usually performed in plasma or serum. Since lipoproteins or apolipoproteins, for example, are found almost exclusively in the plasma fraction after low-speed centrifugation, these parameters can be expected to be distributed in a different plasma volume depending on the hematocrit value. Therefore, the measured plasma levels might be relatively too low or too high in comparison to the whole blood concentrations in the case of abnormal hematocrit levels. The aim of our experiments was to evaluate the extent of differences between whole blood and plasma concentrations, taking as an example lipoprotein(a) [Lp(a)] in hemodialysis patients with documented decreased hematocrit values. METHODS: Lp(a) was measured in plasma as well as whole blood of 15 hemodialysis patients with low hematocrit values (0.29 +/- 0.02) in comparison to 11 control subjects (0.45 +/- 0.04). RESULTS: Plasma concentrations were 27% higher in patients than in controls (19.7 vs. 15.5 mg/dl). The relative difference was twice as high (59%) when measured in whole blood (13.5 vs. 8.5 mg/dl). Similar relative differences were observed when whole blood concentrations of 125 hemodialysis patients and 256 controls were calculated with the formula [Lp(a)plasma * (1-hematocrit)]. CONCLUSIONS: Our findings clearly demonstrate that hematocrit is a strong confounding variable of lipoprotein measurement in epidemiological studies when concentrations are measured in plasma, especially in cases of abnormal hematocrit values. Furthermore, studies investigating the longitudinal changes of lipoproteins should consider potential hematocrit changes.

Blood Chemical Analysis↗

Effects of exercise training plus normalization of hematocrit on exercise capacity and health-related quality of life.

The limitation to exercise capacity in hemodialysis patients has been attributed to anemia. We report the effects of normalization of hematocrit levels by using r-hu-recombinant erythropoietin and exercise training on exercise capacity and self-reported physical functioning in hemodialysis patients. Sixty-five patients were randomized into 1 of 4 groups: usual hematocrit (30%-33%) with no exercise training (UH); usual hematocrit (30%-33%) plus exercise training (UHX); normalized hematocrit (40%-42%) with no exercise training (NH); and normalized hematocrit (40%-42%) plus exercise training (NHX). Treadmill exercise testing was conducted at baseline and at 5 months after the initiation of the interventions. Analysis was performed on the data collapsed for 48 patients who met the criteria for hematocrit and exercise adherence and completed both baseline and post intervention (5.6 +/- 1.6 months) testing. Significant effects of exercise were found in peak oxygen uptake measurements (P = 0.03) and in self-reported physical functioning as measured by the Short Form-36 questionnaire (P = 0.01). There was a significant effect of hematocrit on the General Health scale on the SF-36 (P = 0.03). The changes in peak oxygen uptake with exercise training were small and levels remained lower than age-predicted values at the end of the study. These results indicate that there are other physiologic limitations to exercise capacity that are not overcome by exercise training or normalization of hematocrit. The effects of exercise training on self-reported physical functioning may be of clinical importance because these scores have been shown to be highly predictive of outcomes such as hospitalizations and mortality in hemodialysis patients.

Adult↗

The clinical efficacy of higher hematocrit levels in children with chronic renal insufficiency and those undergoing dialysis.

The optimal hematocrit target range in children with end-stage renal disease, who are receiving recombinant human erythropoietin, is ambiguous due to the lack of compelling, age-appropriate studies. There are a large number of adult and pediatric studies which show that physical performance as well as morbidity and mortality are positively influenced by partial normalization of the hematocrit to 30 vol% to 36 vol%. Cognition studies performed in adults similarly show improvement with partial correction of hematocrit. Normalization of hematocrit studies show lower mortality rates, incremental further improvement in cognition, and greater resolution of cardiac anomalies when compared with patients with partial correction of anemia. Conversely, cardiac death rates may increase in adult patients receiving hemodialysis with preexisting cardiac disease, and there are concerns about the effect of recombinant human erythropoietin on catheter/shunt/fistula patency and on blood pressure. The high cost of recombinant human erythropoietin and established Medicare and Dialysis Outcomes Quality Initiative target hematocrit ranges have also influenced pediatric nephrologists in their assessment of the risk-benefit ratios, despite new adult data suggesting that maintenance of higher hematocrits may be cost-effective. The rationale of using adult-derived hematocrits in children with end-stage renal disease needs to be re-examined in the context of the unique growth and developmental requirements of children. A prospective, multicenter study which determines the relative benefits and risks of age-adjusted hematocrit normalization in children with renal failure is warranted.

Anemia↗

Increased hematocrit mitigates ischemic renal damage in the splenectomized dog.

Splenectomy (SPLX) prevents ischemic acute tubular necrosis (ATN) and peritubular capillary (PTC) congestion. This study attempts to reverse the protective effect of splenectomy in the ischemic model of ATN by increasing hematocrit before inducing ATN. Sham-SPLX, SPLX, and SPLX dogs given packed red cells to elevate hematocrit by 30% (SPLX-high hematocrit) received bilateral renal artery obstruction (RAO) for 120 minutes. Renal function was tested for 6 days post-RAO. Hematocrit in the SPLX-high hematocrit group was greater (p less than .05) than the SPLX-RAO group but did not differ from the non-SPLX group. All groups had different (p less than .05) serum creatinine levels for 48 hours post-RAO, and untreated animals differed from all the others at 144 hours. Serum creatinine was highest in untreated, lowest in SPLX-high hematocrit, and intermediate in noninfused SPLX animals. The same pattern was observed in blood urea nitrogen, creatinine clearance and renal histopathology. Fractional excretion of sodium in the SPLX groups was six times that in the intact animals (p less than .05), irrespective of hematocrit level. We conclude that increased hematocrit is protective in ischemic ATN, and does not promote PTC congestion or ATN in the SPLX animal. In addition, the protective effect of splenectomy may be mediated, in part, by mechanism(s) that alter sodium transport or osmolar excretion.

Acute Kidney Injury↗

The severely anemic and hydropic isoimmune fetus: changes in fetal hematocrit associated with intrauterine death.

Hydrops caused by isoimmune hemolytic anemia is frequently associated with fetal death following intrauterine intravascular transfusion. To identify possible predictors of procedure-related fetal death, we examined changes in fetal blood volume and hematocrit resulting from the initial transfusion performed on 19 severely anemic, hydropic fetuses. Seven fetuses (36.8%) died at 24-72 hours after transfusion, but in no case was the procedure associated with fetal distress. There were no significant differences between fetuses who died and those who survived in terms of total volume of blood transfused, volume transfused as a percentage of total fetoplacental blood volume, hematocrit of transfused blood, post-transfusion hematocrit, umbilical vein pH, or gestational age at transfusion. Significant differences were noted between hydropic fetuses who died compared with those who survived in the mean pretransfusion hematocrit, 6.7% (+/- 2.0) versus 8.7% (+/- 1.6) (P = .03), and the relative increase in post- over pre-transfusion hematocrit, 5.5-fold (+/- 1.4) versus 3.5-fold (+/- 0.8) (P = .001). Stepwise logistic regression analysis confirmed that only the relative increase in hematocrit was predictive of fetal loss. Moreover, six of seven fetal deaths occurred when the relative increase in hematocrit was greater than fourfold, whereas ten of 12 surviving fetuses had relative increases of less than fourfold. We conclude that large, acute increases in fetal hematocrit following intrauterine transfusion are associated with substantial mortality in hydropic fetuses.

Anemia↗

Hematocrit is associated with carotid atherosclerosis in men but not in women.

BACKGROUND: It is known that blood and plasma viscosities are associated with clinical manifestations of atherosclerosis, though evidence is not conclusive particularly in women. OBJECTIVE: To verify whether hematocrit and blood and plasma viscosities are independently associated with carotid atherosclerosis and whether their measurement can improve the definition of the global coronary heart disease (CHD) risk. METHOD: Eight hundred and ninety-two participants in a cardiovascular disease prevention campaign were examined with regard to conventional CHD risk factors (age, blood pressure, lipids, glucose, body mass index, waist/hip ratio, cigarette smoking and diabetes), hematocrit and blood and plasma viscosities. According to the degree of carotid atherosclerosis, investigated by echo-Doppler, participants were divided in three groups: those without atherosclerosis, those with a low degree of atherosclerosis and those with a high degree of atherosclerosis. RESULTS: In men, age, blood pressure, intima-media thickness (IMT), hematocrit (47.4+/-3.7%, 47.8+/-3.7%, 48.4+/-3.7%, P<0.05) and blood viscosity (4.69+/-0.51 cP, 4.77+/-0.55 cP, 4.82+/-0.51 cP, P=0.05) increased with increasing degree of carotid atherosclerosis. In women, age, blood pressure, total cholesterol and low-density lipoprotein-cholesterol, IMT and plasma viscosity (1.42+/-0.12 cP, 1.44+/-0.11 cP, 1.46+/-0.13 cP, P<0.05) increased with increasing carotid score. Analysis of covariance (ANCOVA) showed that after adjusting for hematocrit, blood viscosity was no longer different in the three groups. In discriminant analysis, hematocrit, among the hemorheological variables investigated, was independently associated with carotid score in men (F=3.66, P<0.05). Neither hematocrit nor blood and plasma viscosities were significantly associated with carotid score in women. CONCLUSION: These findings suggest that in men, both hematocrit and blood viscosity are related to carotid atherosclerosis but hematocrit would appear to have an independent effect over and above that mediated by viscosity.

Adult↗

Posttransfusion equilibration of hematocrit in hemodynamically stable neonates.

OBJECTIVE: To determine whether hematocrit obtained 15 mins after blood transfusion in hemodynamically stable neonates is significantly different from that obtained after 6 hrs. We hypothesized that the hematocrit stabilizes within the first 15 mins that follow a 3-hr blood transfusion in preterm infants. DESIGN: We prospectively studied 24 consecutive infants who received blood transfusion. Hematocrit was measured immediately before the transfusion and 15 mins and 6 hrs after the transfusion of 10 mL/kg body weight of sedimented red blood cells administered over 3 hrs. Hematocrit was measured by centrifugation of a capillary. RESULTS: There was a significant increase in hematocrit from pretransfusion values both at 15 mins and 6 hrs. The increase in hematocrit from the pretransfusion value was identical (11%) at both 15 mins and 6 hrs. CONCLUSION: The hematocrit obtained 15 mins after the end of a 3-hr blood transfusion in hemodynamically stable, anemic infants is indistinguishable from that obtained after 6 hrs in the same infants. Thus, if the increase of hematocrit is deemed insufficient at 15 mins after the transfusion, it is possible to complete the transfusion without exposing the patient to an additional donor.

Anemia↗

Effects of hematocrit on oxygenation of the isolated perfused rat liver.

The isolated perfused rat liver is used ubiquitously for metabolic and endocrine studies of hepatic function, yet few data are available regarding the inadequacy of the oxygenation of such preparations. Moreover, the isolated rat liver is usually deprived of its arterial supply and perfused via the hepatic portal vein with low-hematocrit or cell-free solutions. To investigate the efficacy of the oxygen supply, we determined the effect of hematocrit on the relation between oxygen consumption and perfusate flow. We then attempted to define a hematocrit at which hepatic oxygenation was maximal. Livers of male rats anesthesized with pentobarbital sodium were perfused via the portal vein with fresh canine red blood cells suspended in Krebs-Ringer-bicarbonate buffer. Perfusions were carried out at various flow rates, and the relation between perfusate flow and oxygen uptake was determined. At flow rates above 100 ml X min-1 X 100 g liver-1, oxygen uptake was independent of flow but below that value was flow limited, regardless of whether the hematocrit was 10, 20, or 40%. To determine the optimal hematocrit for hepatic oxygen uptake, hepatic portal venous and hepatic venous pressures were held at 10 and 0 mmHg, respectively. The hematocrit was lowered in steps from 80 to 10%. Blood flow increased exponentially as hematocrit fell while oxygen uptake increased to a maximum at approximately 20%. It is concluded that an hematocrit of approximately 20% provides the optimal combination of blood flow and oxygen-carrying capacity while maintaining physiological perfusion pressures, e.g., 10 mmHg.

Animals↗

Blood viscosity in tube flow: dependence on diameter and hematocrit.

Since the original publications by Martini et al. (Dtsch. Arch. Klin. Med. 169: 212-222, 1930) and Fahraeus and Lindqvist (Am. J. Physiol. 96: 562-568, 1931), it has been known that the relative apparent viscosity of blood in tube flow depends on tube diameter. Quantitative descriptions of this effect and of the dependence of blood viscosity on hematocrit in the different diameter tubes are required for the development of hydrodynamic models of blood flow through the microcirculation. The present study provides a comprehensive data base for the description of relative apparent blood viscosity as a function of tube diameter and hematocrit. Data available from the literature are compiled, and new experimental data obtained in a capillary viscometer are presented. The combined data base comprises measurements at high shear rates (u > or = 50 s-1) in tubes with diameters ranging from 3.3 to 1,978 microns at hematocrits of up to 0.9. If corrected for differences in suspending medium viscosity and temperature, the data show remarkable agreement. Empirical fitting equations predicting relative apparent blood viscosity from tube diameter and hematocrit are presented. A pronounced change in the hematocrit dependence of relative viscosity is observed in a range of tube diameters in which viscosity is minimal. While a linear hematocrit-viscosity relationship is found in tubes of < or = 6 microns, an overproportional increase of viscosity with hematocrit prevails in tubes of > or = 9 microns. This is interpreted to reflect the hematocrit-dependent transition from single- to multifile arrangement of cells in flow.

Animals↗

Determination of capillary tube hematocrit during arteriolar microperfusion.

Intracapillary hematocrit is known to be substantially lower than arterial hematocrit. We hypothesized that capillary hematocrit might be influenced by interactions between plasma macromolecules and the endothelial cell surface. Microvessel perfusion pipettes were inserted in second- or third-order vessels, and capillaries were perfused with three different artificial bloods composed of 50% red cells plus the following suspension media: fetal calf serum (group I), serum albumin plus serum globulins (fractions II and III; group II), and bovine serum albumin plus dextran (group III). The mean hematocrits of the pipette-perfused capillaries averaged close to 50% of the systemic value with all perfusion fluids and were not different from the hematocrits of the capillaries perfused by the animal. These data suggest that bifurcations proximal to the pipette location did not contribute to the reduction in mean tube hematocrit normally seen in the animal. Furthermore, interactions between the plasma macromolecules and the endothelial cell surface do not appear to contribute to the low intracapillary hematocrit. Analysis of the data indicate that the capillary Fåhraeus effect, the network Fåhraeus effect in terminal vessels of the arterial tree, and intracapillary events all contribute to the reduction in intracapillary hematocrit.

Adenosine↗