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Breenfeldt Andersen A, Bonne TC, Nordsborg NB, Holm-Sørensen H, Bejder J. Duplicate measures of hemoglobin mass within an hour: feasibility, reliability, and comparison of three devices in supine position. Scand J Clin Lab Invest 2024; 84:1-10. [PMID: 38265850 DOI: 10.1080/00365513.2024.2303711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/17/2023] [Indexed: 01/25/2024]
Abstract
Duplicate measure of hemoglobin mass by carbon monoxide (CO)-rebreathing is a logistical challenge as recommendations prompt several hours between measures to minimize CO-accumulation. This study investigated the feasibility and reliability of performing duplicate CO-rebreathing procedures immediately following one another. Additionally, it was evaluated whether the obtained hemoglobin mass from three different CO-rebreathing devices is comparable. Fifty-five healthy participants (22 males, 23 females) performed 222 duplicate CO-rebreathing procedures in total. Additionally, in a randomized cross-over design 10 participants completed three experimental trials, each including three CO-rebreathing procedures, with the first and second separated by 24 h and the second and third separated by 5-10 min. Each trial was separated by >48 h and conducted using either a glass-spirometer, a semi-automated electromechanical device, or a standard three-way plastic valve designed for pulmonary measurements. Hemoglobin mass was 3 ± 22 g lower (p < 0.05) at the second measure when performed immediately after the first with a typical error of 1.1%. Carboxyhemoglobin levels reached 10.9 ± 1.3%. In the randomized trial, hemoglobin mass was similar between the glass-spirometer and three-way valve, but ∼6% (∼50 g) higher for the semi-automated device. Notably, differences in hemoglobin mass were up to ∼13% (∼100 g) when device-specific recommendations for correction of CO loss to myoglobin and exhalation was followed. In conclusion, it is feasible and reliable to perform two immediate CO-rebreathing procedures. Hemoglobin mass is comparable between the glass-spirometer and the three-way plastic valve, but higher for the semi-automated device. The differences are amplified if the device-specific recommendations of CO-loss corrections are followed.
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Affiliation(s)
| | - Thomas Christian Bonne
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
| | | | - Henrik Holm-Sørensen
- Department of Anaesthesiology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Bejder
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
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2
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Papin M, Latour C, Leclère B, Javaudin F. Accuracy of pulse CO-oximetry to evaluate blood carboxyhemoglobin level: a systematic review and meta-analysis of diagnostic test accuracy studies. Eur J Emerg Med 2023; 30:233-243. [PMID: 37171830 PMCID: PMC10306338 DOI: 10.1097/mej.0000000000001043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Abstract
Carbon monoxide (CO) poisoning is one of the most common causes of poisoning death and its diagnosis requires an elevated carboxyhemoglobin (COHb) level. Noninvasive CO saturation by pulse oximetry (SpCO) has been available since 2005 and has the advantage of being portable and easy to use, but its accuracy in determining blood COHb level is controversial. To evaluate the accuracy of SpCO (index test) to estimate COHb (reference test). Systematic review and meta-analysis of diagnostic test accuracy (DTA) studies. Four electronic databases were searched (Medline, Embase, Cochrane Central Register of Controlled Trials, and OpenGrey) on 2 August 2022. All studies of all designs published since the 2000s evaluating the accuracy and reliability of SpCO measurement compared to blood COHb levels in human volunteers or ill patients, including children, were included. The primary outcome was to assess the diagnostic accuracy of SpCO for estimating COHb by blood sampling by modeling receiver operating characteristic (ROC) curves and calculating sensitivity and specificity (primary measures). The secondary measures were to calculate the limits of agreement (LOA) and the mean bias. This systematic review was conducted according to the Preferred Reporting Items for a Systematic Review and Meta-analysis-DTA 2018 guidelines and has been registered on International Prospective Register of Systematic Reviews (PROSPERO, CRD42020177940). The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Twenty-one studies were eligible for the systematic review; 11 could be included for the quantitative analysis of the primary measures and 18 for the secondary measures. No publication bias was found. The area under the summary ROC curve was equal to 86%. The mean sensitivity and specificity were 0.77, 95% confidence interval (CI, 0.66-0.85) and 0.83, 95% CI (0.74-0.89), respectively (2089 subjects and 3381 observations). The mean bias was 0.75% and the LOA was -7.08% to 8.57%, 95% CI (-8.89 to 10.38) (2794 subjects and 4646 observations). Noninvasive measurement of COHb (SpCO) using current pulse CO oximeters do not seem to be highly accurate to estimate blood COHb (moderate sensitivity and specificity, large LOA). They should probably not be used to confirm (rule-in) or exclude (rule-out) CO poisoning with certainty.
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Affiliation(s)
- Mathilde Papin
- Emergency Department, Nantes University Hospital, Nantes
| | - Chloé Latour
- Department of Medicine, Hospital of Pontivy, Pontivy
| | - Brice Leclère
- Department of Medical Evaluation and Epidemiology, Nantes University Hospital
- Cibles et Médicaments des Infections et de l'Immunité, UR1155 IICiMed, Nantes University, Nantes, France
| | - François Javaudin
- Emergency Department, Nantes University Hospital, Nantes
- Cibles et Médicaments des Infections et de l'Immunité, UR1155 IICiMed, Nantes University, Nantes, France
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3
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Schmidt WFJ, Hoffmeister T, Wachsmuth NB, Byrnes WC. The effect of posture and exercise on blood CO kinetics during the optimized carbon monoxide rebreathing procedure. Scand J Clin Lab Invest 2023:1-8. [PMID: 37154842 DOI: 10.1080/00365513.2023.2204402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
An indispensable precondition for the determination of hemoglobin mass (Hbmass) and blood volume by CO rebreathing is complete mixing of CO in the blood. The aim of this study was to demonstrate the kinetics of CO in capillary and venous blood in different body positions and during moderate exercise. Six young subjects (4 male, 2 female) performed three 2-min CO rebreathing tests in seated (SEA) & supine (SUP) positions as well as during moderate exercise (EX) on a bicycle ergometer. Before, during, and until 15 min after CO rebreathing cubital venous and capillary blood samples were collected simultaneously and COHb% was determined. COHb% kinetics were significantly slower in SEA than in SUP or EX. Identical COHb% in capillary and venous blood were reached in SEA after 5.0 ± 2.3 min, in SUP after 3.2 ± 1.3 min and in EX after 1.9 ± 1.2 min (EX vs. SEA p < .01, SUP vs. SEA p < .05). After 7th min, Hbmass did not differ between the resting positions (capillary: SEA 766 ± 217 g, SUP 761 ± 227 g; venous: SEA 759 ± 224 g, SUP 744 ± 207 g). Under exercise, however, a higher Hbmass (p < .05) was determined (capillary: 823 ± 221 g, venous: 804 ± 226 g). In blood, the CO mixing time in the supine position is significantly shorter than in the seated position. By the 6th minute complete mixing is achieved in either position giving similar Hbmass determinations. CO-rebreathing under exercise conditions, however, leads to ∼7% higher Hbmass values.
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Affiliation(s)
- Walter F J Schmidt
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, Germany
- Division of Exercise Physiology & Metabolism, University of Bayreuth, Bayreuth, Germany
| | - Torben Hoffmeister
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, Germany
| | - Nadine B Wachsmuth
- Division of Exercise Physiology & Metabolism, University of Bayreuth, Bayreuth, Germany
| | - William C Byrnes
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
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4
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Breenfeldt Andersen A, Baungaard SB, Bejder J, Graae J, Hristovska AM, Agerskov M, Holm-Sørensen H, Foss NB. A semi-automated device rapidly determine circulating blood volume in healthy males and carbon monoxide uptake kinetics of arterial and venous blood. J Clin Monit Comput 2023; 37:437-447. [PMID: 36201093 DOI: 10.1007/s10877-022-00921-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022]
Abstract
We examined whether a semi-automated carbon monoxide (CO) rebreathing method accurately detect changes in blood volume (BV) and total hemoglobin mass (tHb). Furthermore, we investigated whether a supine position with legs raised reduced systemic CO dilution time, potentially allowing a shorter rebreathing period. Nineteen young healthy males participated. BV and tHb was quantified by a 10-min CO-rebreathing period in a supine position with legs raised before and immediately after a 900 ml phlebotomy and before and after a 900 ml autologous blood reinfusion on the same day in 16 subjects. During the first CO-rebreathing, arterial and venous blood samples were drawn every 2 min during the procedure to determine systemic CO equilibrium in all subjects. Phlebotomy decreased (P < 0.001) tHb and BV by 166 ± 24 g and 931 ± 247 ml, respectively, while reinfusion increased (P < 0.001) tHb and BV by 143 ± 21 g and 862 ± 250 ml compared to before reinfusion. After reinfusion BV did not differ from baseline levels while tHb was decreased (P < 0.001) by 36 ± 21 g. Complete CO mixing was achieved within 6 min in venous and arterial blood, respectively, when compared to the 10-min sample. On an individual level, the relative accuracy after donation for tHb and BV was 102-169% and 55-165%, respectively. The applied CO-rebreathing procedure precisely detect acute BV changes with a clinically insignificant margin of error. The 10-min CO-procedure may be reduced to 6 min with no clinical effects on BV and tHb calculation. Notwithstanding, individual differences may be of concern and should be investigated further.
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Affiliation(s)
- Andreas Breenfeldt Andersen
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark.
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus C, Denmark.
| | - Søren Brouw Baungaard
- Department of Anesthesiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Bejder
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
| | - Jonathan Graae
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
| | - Ana-Marija Hristovska
- Department of Anesthesiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Agerskov
- Department of Anesthesiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Holm-Sørensen
- Department of Anesthesiology, Abdominal Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai Bang Foss
- Department of Anesthesiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
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5
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Royal JT, Fisher JT, Mlinar T, Mekjavic IB, McDonnell AC. Validity and reliability of capillary vs. Venous blood for the assessment of haemoglobin mass and intravascular volumes. Front Physiol 2022; 13:1021588. [PMID: 36505074 PMCID: PMC9730879 DOI: 10.3389/fphys.2022.1021588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives: Haemoglobin mass (Hbmass) assessment with the carbon monoxide rebreathing method is a more accurate estimate than other measures of oxygen-carrying capacity. Blood may be collected by several means and differences in the measured variables may exist as a result. The present study assessed the validity and reliability of calculated Hbmass and intravascular volumes obtained from capillary blood (CAP) when compared to venous blood (VEN) draws. Methods: Twenty-two adults performed a carbon monoxide rebreathing procedure with paired VEN and CAP draws at baseline, pre-rebreathing and post-rebreathing (POST). Thirteen of these participants performed this protocol on two occasions to assess the data reliability from both blood sampling sites. In a second experiment, 14 adults performed a 20-min seated and a 20-min supine rest to assess for the effect of posture on haematological parameters. Results: Haemoglobin mass (CAP = 948.8 ± 156.8 g; VEN = 943.4 ± 157.3 g, p = 0.108) and intravascular volume (CAP = 6.5 ± 1 L; VEN = 6.5 ± 0.9 L, p = 0.752) were statistically indifferent, had low bias (Hbmass bias = 14.45 ± 40.42 g, LoA -64.78 g-93.67 g) and were highly correlated between sampling techniques. Reliability analysis demonstrated no difference in the mean change in variables calculated from both sampling sites and good to excellent intraclass correlation coefficients (>0.700), however, typical measurement error was larger in variables measured using CAP (VEN Hbmass TE% = 2.1%, CAP Hbmass TE% = 5.5%). The results indicate that a supine rest prior to the rebreathing protocol would have a significant effect on haemoglobin concentration and haematocrit values compared to a seated rest, with no effect on carboxyhaemoglobin %. Conclusion: The present study demonstrates that CAP and VEN were comparable for the calculation of Hbmass and intravascular volumes in terms of accuracy. However, reduced reliability and increased error in the CAP variables indicates that there are methodological considerations to address when deciding which blood drawing technique to utilise. To reduce this CAP error, increased replicate analyses are required.
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Affiliation(s)
- Joshua T. Royal
- Department of Automation, Biocybernetics, and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia,Jozef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Jason T. Fisher
- Department of Automation, Biocybernetics, and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia,Jozef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Tinkara Mlinar
- Department of Automation, Biocybernetics, and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia,Jozef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Igor B. Mekjavic
- Department of Automation, Biocybernetics, and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia,Department of Biomedical Physiology and Kinesiology, Simon Fraser University Burnaby, Burnaby, BC, Canada
| | - Adam C. McDonnell
- Department of Automation, Biocybernetics, and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia,*Correspondence: Adam C. McDonnell,
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Kellenberger K, Steiner T, Wehrlin JP. Comparison of the automatised and the optimised carbon monoxide rebreathing methods. Scandinavian Journal of Clinical and Laboratory Investigation 2022; 82:474-480. [PMID: 36129418 DOI: 10.1080/00365513.2022.2122078] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Recently, a new automated carbon monoxide (CO) rebreathing method (aCO) to estimate haemoglobin mass (Hbmass) was introduced. The aCO method uses the same CO dilution principle as the widely used optimised CO rebreathing method (oCO). The two methods differ in terms of CO administration, body position, and rebreathing time. Whereas with aCO, CO is administered automatically by the system in a supine position of the subject, with oCO, CO is administered manually by an experienced operator with the subject sitting. Therefore, the aim of this study was to quantify possible differences in Hbmass estimated with the two methods. Hbmass was estimated in 18 subjects (9 females, 9 males) with oCO using capillary blood samples (oCOc) and aCO taking simultaneously venous blood samples (aCOv) and capillary blood samples (aCOc). Overall, Hbmass was different between the three measurement procedures (F = 57.55, p < .001). Hbmass was lower (p < .001) for oCOc (737 g ± 179 g) than for both aCOv (825 g ± 189 g, -9.3%) and aCOc (835 g ± 189 g, -10.6%). There was no difference in Hbmass estimated with aCOv and aCOc procedures (p = .12). Three factors can likely explain the 10% difference in Hbmass: differences in calculations (including a factor for myoglobin flux), body position (distribution of CO in blood circulation) during rebreathing, and time of blood sampling. Moreover, the determination of Hbmass with aCO is possible with capillary blood sampling instead of venous blood sampling.
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Affiliation(s)
- Katja Kellenberger
- Section for Elite Sport, Swiss Federal Institute of Sport, Magglingen, Switzerland
| | - Thomas Steiner
- Section for Elite Sport, Swiss Federal Institute of Sport, Magglingen, Switzerland
| | - Jon Peter Wehrlin
- Section for Elite Sport, Swiss Federal Institute of Sport, Magglingen, Switzerland
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Yang X, Lu W, Hopper CP, Ke B, Wang B. Nature's marvels endowed in gaseous molecules I: Carbon monoxide and its physiological and therapeutic roles. Acta Pharm Sin B 2021; 11:1434-1445. [PMID: 34221861 PMCID: PMC8245769 DOI: 10.1016/j.apsb.2020.10.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/03/2020] [Accepted: 09/07/2020] [Indexed: 02/08/2023] Open
Abstract
Nature has endowed gaseous molecules such as O2, CO2, CO, NO, H2S, and N2 with critical and diverse roles in sustaining life, from supplying energy needed to power life and building blocks for life's physical structure to mediating and coordinating cellular functions. In this article, we give a brief introduction of the complex functions of the various gaseous molecules in life and then focus on carbon monoxide as a specific example of an endogenously produced signaling molecule to highlight the importance of this class of molecules. The past twenty years have seen much progress in understanding CO's mechanism(s) of action and pharmacological effects as well as in developing delivery methods for easy administration. One remarkable trait of CO is its pleiotropic effects that have few parallels, except perhaps its sister gaseous signaling molecules such as nitric oxide and hydrogen sulfide. This review will delve into the sophistication of CO-mediated signaling as well as its validated pharmacological functions and possible therapeutic applications.
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Affiliation(s)
- Xiaoxiao Yang
- Department of Chemistry and Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, GA 30303, USA
| | - Wen Lu
- Department of Chemistry and Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, GA 30303, USA
| | - Christopher P. Hopper
- Department of Chemistry and Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, GA 30303, USA
- Institut für Experimentelle Biomedizin, Universitätsklinikum Würzburg, Würzburg, Bavaria 97080, Germany
| | - Bowen Ke
- Department of Anesthesiology, West China Hospital, Chengdu 610041, China
| | - Binghe Wang
- Department of Chemistry and Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, GA 30303, USA
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8
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Culliton K, Louati H, Laneuville O, Ramsay T, Trudel G. Six degrees head-down tilt bed rest caused low-grade hemolysis: a prospective randomized clinical trial. NPJ Microgravity 2021; 7:4. [PMID: 33589644 PMCID: PMC7884785 DOI: 10.1038/s41526-021-00132-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 01/13/2021] [Indexed: 01/31/2023] Open
Abstract
This study aimed to measure hemolysis before, during and after 60 days of the ground-based spaceflight analog bed rest and the effect of a nutritional intervention through a prospective randomized clinical trial. Twenty male participants were hospitalized for 88 days comprised of 14 days of ambulatory baseline, 60 days of 6° head-down tilt bed rest and 14 days of reambulation. Ten participants each received a control diet or daily polyphenol associated with omega-3, vitamin E, and selenium supplements. The primary outcome was endogenous carbon monoxide (CO) elimination measured by gas chromatography. Hemolysis was also measured with serial bilirubin, iron, transferrin saturation blood levels and serial 3-day stool collections were used to measure urobilinoid excretion using photometry. Total hemoglobin mass (tHb) was measured using CO-rebreathing. CO elimination increased after 5, 11, 30, and 57 days of bed rest: +289 ppb (95% CI 101-477 ppb; p = 0.004), +253 ppb (78-427 ppb; p = 0.007), +193 ppb (89-298 ppb; p = 0.001) and +858 ppb (670-1046 ppb; p < 0.000), respectively, compared to baseline. Bilirubin increased after 20 and 49 days of bed rest +0.8 mg/l (p = 0.013) and +1.1 mg/l (p = 0.012), respectively; and iron increased after 20 days of bed rest +10.5 µg/dl (p = 0.032). The nutritional intervention did not change CO elimination. THb was lower after 60 days of bed rest -0.9 g/kg (p = 0.001). Bed rest enhanced hemolysis as measured through all three by-products of heme oxygenase. Ongoing enhanced hemolysis over 60 days contributed to a 10% decrease in tHb mass. Modulation of red blood cell control towards increased hemolysis may be an important mechanism causing anemia in astronauts.
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Affiliation(s)
- Kathryn Culliton
- grid.412687.e0000 0000 9606 5108Department of Medicine, Division of Physical Medicine and Rehabilitation, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Hakim Louati
- grid.412687.e0000 0000 9606 5108Department of Medicine, Division of Physical Medicine and Rehabilitation, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Odette Laneuville
- grid.28046.380000 0001 2182 2255Department of Biology, Faculty of Science, University of Ottawa, Ottawa, ON Canada
| | - Tim Ramsay
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
| | - Guy Trudel
- grid.412687.e0000 0000 9606 5108Department of Medicine, Division of Physical Medicine and Rehabilitation, Ottawa Hospital Research Institute, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON Canada
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9
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Krehl LM, Plumb JOM, Wachsmuth NB, Haupt S, Kumar SB, Otto JM, Schierbauer J, Grocott MPW, Montgomery HE, Schmidt WFJ. A carbon monoxide 'single breath' method to measure total haemoglobin mass: a feasibility study. Exp Physiol 2020; 106:567-575. [PMID: 33369791 DOI: 10.1113/ep089076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/14/2020] [Indexed: 12/20/2022]
Abstract
NEW FINDINGS What is the central question of this study? Is it possible to modify the CO-rebreathing method to acquire reliable measurements of haemoglobin mass in ventilated patients? What is the main finding and its importance? A 'single breath' of CO with a subsequent 30 s breath hold provides almost as exact a measure of haemoglobin mass as the established optimized CO-rebreathing method when applied to healthy subjects. The modified method has now to be checked in ventilated patients before it can be used to quantify the contributions of blood loss and of dilution to the severity of anaemia. ABSTRACT Anaemia is defined by the concentration of haemoglobin (Hb). However, this value is dependent upon both the total circulating haemoglobin mass (tHb-mass) and the plasma volume (PV) - neither of which is routinely measured. Carbon monoxide (CO)-rebreathing methods have been successfully used to determine both PV and tHb-mass in various populations. However, these methods are not yet suitable for ventilated patients. This study aimed to modify the CO-rebreathing procedure such that a single inhalation of a CO bolus would enable its use in ventilated patients. Eleven healthy volunteers performed four CO-rebreathing tests in a randomized order, inhaling an identical CO volume. In two tests, CO was rebreathed for 2 min (optimized CO rebreathing; oCOR), and in the other two tests, a single inhalation of a CO bolus was conducted with a subsequent breath hold of 15 s (Procnew 15s) or 30 s (Procnew 30s). Subsequently, the CO volume in the exhaled air was continuously determined for 20 min. The amount of CO exhaled after 7 and 20 min was respectively 3.1 ± 0.3 and 5.9 ± 1.1 ml for oCOR, 8.7 ± 3.6 and 12.0 ± 4.4 ml for Procnew 15s and 5.1 ± 2.0 and 8.4 ±2.6 ml for Procnew 30s. tHb-mass was 843 ± 293 g determined by oCOR, 821 ± 288 g determined by Procnew 15s (difference: P < 0.05) and 849 ± 311 g determined by Procnew 30s. Bland-Altman plots demonstrated slightly lower tHb-mass values for Procnew 15s compared with oCOR (-21.8 ± 15.3 g) and similar values for Procnew 30s. In healthy volunteers, a single inhalation of a CO bolus, preferably followed by a 30 s breath hold, can be used to determine tHb-mass. These results must now be validated for ventilated patients.
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Affiliation(s)
- Lisa-Marie Krehl
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, 95440, Germany
| | - James O M Plumb
- Respiratory and Critical Care Research Area, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of Southampton, Southampton, UK
| | - Nadine B Wachsmuth
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, 95440, Germany
| | - Sandra Haupt
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, 95440, Germany
| | - Shriya B Kumar
- Centre for Human Integrative Physiology, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James M Otto
- Respiratory and Critical Care Research Area, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of Southampton, Southampton, UK
| | - Janis Schierbauer
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, 95440, Germany
| | - Michael P W Grocott
- Respiratory and Critical Care Research Area, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of Southampton, Southampton, UK
| | - Hugh E Montgomery
- Centre for Human Health and Performance/ Institute of Sport, Exercise and Health, University College London, and NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Walter F J Schmidt
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, 95440, Germany
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10
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Oberholzer L, Bonne TC, Breenfeldt Andersen A, Bejder J, Højgaard Christensen R, Baastrup Nordsborg N, Lundby C. Reproducibility of the CO rebreathing technique with a lower CO dose and a shorter rebreathing duration at sea level and at 2320 m of altitude. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 80:590-599. [PMID: 32955368 DOI: 10.1080/00365513.2020.1818282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Total hemoglobin mass (Hbmass) is routinely assessed in studies by the carbon monoxide (CO) rebreathing. Its clinical application is often hindered due to the consequent rise in carboxyhemoglobin (%HbCO) and the concern of CO toxicity. We tested the reproducibility of the CO rebreathing with a CO dose of 0.5 mL/kg body mass (CO0.5) compared to 1.5 mL/kg (CO1.5) and when shortening the CO rebreathing protocol. Therefore, CO rebreathing was performed 1×/day in eight healthy individuals on four consecutive days. On each day, either CO0.5 (CO0.5-1 and CO0.5-2) or CO1.5 (CO1.5-1 and CO1.5-2) was administered. Venous blood samples to determine %HbCO and quantify Hbmass were obtained prior to, and at 6 (T6), 8 (T8) and 10 min (T10) of CO rebreathing. This protocol was tested at sea level and at 2320 m to investigate the altitude-related measurement error. At sea level, the mean difference (95% limits of agreement) in Hbmass between CO0.5-1 and CO0.5-2 was 26 g (-26; 79 g) and between CO1.5-1 and CO1.5-2, it was 17 g (-18; 52 g). The respective typical error (TE) corresponded to 2.4% (CO0.5) and 1.5% (CO1.5), while it was 6.5% and 3.0% at 2320 m. With CO0.5, shortening the CO rebreathing resulted in a TE for Hbmass of 4.4% (T8 vs. T10) and 14.1% (T6 vs T10) and with CO1.5, TE was 1.6% and 5.8%. In conclusion, the CO dose and rebreathing time for the CO rebreathing procedure can be decreased at the cost of a measurement error ranging from 1.5-14.1%.
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Affiliation(s)
- Laura Oberholzer
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Christian Bonne
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Nutrition, Exercise and Sport Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Jacob Bejder
- Department of Nutrition, Exercise and Sport Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Carsten Lundby
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Innland University of Applied Sciences, Lillehammer, Norway
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11
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Plumb JO, Otto JM, Kumar SB, Wright M, Schmidt W, Grocott MP, Montgomery HE. Application of the optimized carbon monoxide rebreathing method for the measurement of total haemoglobin mass in chronic liver disease. Physiol Rep 2020; 8:e14402. [PMID: 32207243 PMCID: PMC7090373 DOI: 10.14814/phy2.14402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/20/2020] [Accepted: 02/23/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Anemia is common in liver cirrhosis. This generally infers a fall in total hemoglobin mass (tHb-mass). However, hemoglobin concentration ([Hb]) may fall due to an expansion in plasma volume (PV). The "optimized carbon monoxide rebreathing method" (oCOR) measures tHb-mass directly and PV (indirectly using hematocrit). It relies upon carboxyhemoglobin (COHb) distribution throughout the entire circulation. In healthy subjects, such distribution is complete within 6-8 min. Given the altered circulatory dynamics in cirrhosis, we sought in this pilot study, to assess whether this was true in cirrhosis. The primary aim was to ascertain if the standard timings for the oCOR were applicable to patients with chronic liver disease and cirrhosis. The secondary aim was to explore the applicability of standard CO dosing methodologies to this patient population. METHODS Sixteen patients with chronic liver parenchymal disease were studied. However, tHb-mass was determined using the standard oCOR technique before elective paracentesis. Three subjects had an inadequate COHb% rise. In the remaining 13 (11 male), mean ± standard deviation (SD) age was 52 ± 13.8 years, body mass 79.1 ± 11.4 kg, height 175 ± 6.8 cm. To these, mean ± SD dose of carbon monoxide (CO) gas administered was 0.73 ± 0.13 ml/kg COHb values at baseline, 6 and 8 min (and "7-min value") were compared to those at 10, 12, 15 and 20 min after CO rebreathing. RESULTS The "7-min value" for median COHb% (IQR) of 6.30% (6.21%-7.47%) did not differ significantly from those at subsequent time points (8 min: 6.30% (6.21%-7.47%), 10 min: 6.33% (6.00%-7.50%), 12 min: 6.33% (5.90%-7.40%), 15 min: 6.37% (5.80%-7.33%), 20 min: 6.27% (5.70%-7.20%)). Mean difference in calculated tHb-mass between minute 7 and minute 20 was only 4.1 g, or 0.6%, p = .68. No subjects reported any adverse effects. CONCLUSIONS The oCOR method can be safely used to measure tHb-mass in patients with chronic liver disease and ascites, without adjustment of blood sample timings. Further work might refine and validate appropriate dosing regimens.
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Affiliation(s)
- James O.M. Plumb
- Respiratory and Critical Care Research AreaNIHR Biomedical Research CentreUniversity Hospital Southampton NHS Foundation Trust / University of SouthamptonSouthamptonUK
- Centre for Human Integrative PhysiologyFaculty of MedicineUniversity of SouthamptonSouthamptonUK
- Anaesthesia, Perioperative Medicine and Critical Care Research UnitUniversity Hospital Southampton NHSFTSouthamptonUK
- Shackleton Department of AnaesthesiaUniversity Hospital Southampton NHSFTSouthamptonUK
| | - James M. Otto
- Respiratory and Critical Care Research AreaNIHR Biomedical Research CentreUniversity Hospital Southampton NHS Foundation Trust / University of SouthamptonSouthamptonUK
- Centre for Human Integrative PhysiologyFaculty of MedicineUniversity of SouthamptonSouthamptonUK
- Anaesthesia, Perioperative Medicine and Critical Care Research UnitUniversity Hospital Southampton NHSFTSouthamptonUK
- Shackleton Department of AnaesthesiaUniversity Hospital Southampton NHSFTSouthamptonUK
- University of Southampton Medical SchoolSouthamptonUK
| | - Shriya B. Kumar
- Centre for Human Integrative PhysiologyFaculty of MedicineUniversity of SouthamptonSouthamptonUK
- University of Southampton Medical SchoolSouthamptonUK
| | - Mark Wright
- Department of HepatologyUniversity Hospital SouthamptonSouthamptonUK
| | - Walter Schmidt
- Department of Sports Medicine/Sports PhysiologyUniversity of BayreuthBayreuthGermany
| | - Michael P.W. Grocott
- Respiratory and Critical Care Research AreaNIHR Biomedical Research CentreUniversity Hospital Southampton NHS Foundation Trust / University of SouthamptonSouthamptonUK
- Centre for Human Integrative PhysiologyFaculty of MedicineUniversity of SouthamptonSouthamptonUK
- Anaesthesia, Perioperative Medicine and Critical Care Research UnitUniversity Hospital Southampton NHSFTSouthamptonUK
- Shackleton Department of AnaesthesiaUniversity Hospital Southampton NHSFTSouthamptonUK
- Department of AnesthesiologyDuke University School of MedicineDurhamNCUSA
| | - Hugh E. Montgomery
- Centre for Human Health and Performance/ Institute of Sport, Exercise and HealthUniversity College London, and NIHR University College London Hospitals Biomedical Research CentreLondonUK
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12
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Wachsmuth N, Soria R, Jimenez J, Schmidt W. Modification of the CO‐rebreathing method to determine haemoglobin mass and blood volume in patients suffering from chronic mountain sickness. Exp Physiol 2019; 104:1819-1828. [DOI: 10.1113/ep087870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/26/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Nadine Wachsmuth
- Department of Sports Medicine & Sports PhysiologyUniversity of Bayreuth Bayreuth Germany
| | - Rudy Soria
- Instituto Boliviano de Biologia de AlturaUniversidad Mayor de San Andres La Paz Bolivia
| | - Jesus Jimenez
- Instituto Boliviano de Biologia de AlturaUniversidad Mayor de San Andres La Paz Bolivia
| | - Walter Schmidt
- Department of Sports Medicine & Sports PhysiologyUniversity of Bayreuth Bayreuth Germany
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13
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Otto JM, Plumb JOM, Wakeham D, Clissold E, Loughney L, Schmidt W, Montgomery HE, Grocott MPW, Richards T. Total haemoglobin mass, but not haemoglobin concentration, is associated with preoperative cardiopulmonary exercise testing-derived oxygen-consumption variables. Br J Anaesth 2018; 118:747-754. [PMID: 28510737 DOI: 10.1093/bja/aew445] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2016] [Indexed: 01/22/2023] Open
Abstract
Background Cardiopulmonary exercise testing (CPET) measures peak exertional oxygen consumption ( V˙O2peak ) and that at the anaerobic threshold ( V˙O2 at AT, i.e. the point at which anaerobic metabolism contributes substantially to overall metabolism). Lower values are associated with excess postoperative morbidity and mortality. A reduced haemoglobin concentration ([Hb]) results from a reduction in total haemoglobin mass (tHb-mass) or an increase in plasma volume. Thus, tHb-mass might be a more useful measure of oxygen-carrying capacity and might correlate better with CPET-derived fitness measures in preoperative patients than does circulating [Hb]. Methods Before major elective surgery, CPET was performed, and both tHb-mass (optimized carbon monoxide rebreathing method) and circulating [Hb] were determined. Results In 42 patients (83% male), [Hb] was unrelated to V˙O2 at AT and V˙O2peak ( r =0.02, P =0.89 and r =0.04, P =0.80, respectively) and explained none of the variance in either measure. In contrast, tHb-mass was related to both ( r =0.661, P <0.0001 and r =0.483, P =0.001 for V˙O2 at AT and V˙O2peak , respectively). The tHb-mass explained 44% of variance in V˙O2 at AT ( P <0.0001) and 23% in V˙O2peak ( P =0.001). Conclusions In contrast to [Hb], tHb-mass is an important determinant of physical fitness before major elective surgery. Further studies should determine whether low tHb-mass is predictive of poor outcome and whether targeted increases in tHb-mass might thus improve outcome.
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Affiliation(s)
- J M Otto
- Division of Surgery and Interventional Science, University College London, London, UK
| | - J O M Plumb
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, UK.,Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK
| | - D Wakeham
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK.,Centre for Human Health and Performance/Institute for Sport, Exercise and Health, University College London, UK
| | - E Clissold
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, UK.,Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK
| | - L Loughney
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, UK.,Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK
| | - W Schmidt
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, Germany
| | - H E Montgomery
- Centre for Human Health and Performance/Institute for Sport, Exercise and Health, University College London, UK.,NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - M P W Grocott
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, UK.,Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK
| | - T Richards
- Division of Surgery and Interventional Science, University College London, London, UK
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14
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Ahlgrim C, Birkner P, Seiler F, Grundmann S, Baumstark MW, Bode C, Pottgiesser T. Applying the Optimized CO Rebreathing Method for Measuring Blood Volumes and Hemoglobin Mass in Heart Failure Patients. Front Physiol 2018; 9:1603. [PMID: 30483155 PMCID: PMC6240604 DOI: 10.3389/fphys.2018.01603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 10/25/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Determination of blood volume, red cell volume, and plasma volume contributes to the understanding of the pathophysiology in heart failure, especially concerning anemia and volume load. The optimized carbon monoxide (CO)-rebreathing method (oCORM) is used to determine these parameters and hemoglobin mass (Hbmass) in exercise physiology. The applicability of oCORM to determine the intravascular volumes and Hbmass in heart failure patients is currently undetermined because assumptions concerning CO kinetics with oCORM rely on healthy subjects with a normal ejection fraction. Therefore, the aim of the present study is to determine the applicability and the systematic error of oCORM arising from a reduced EF when oCORM is used for measurement of intravascular volumes and Hbmass in heart failure patients. Methods: oCORM was performed in 21 patients with heart failure and a reduced ejection fraction (EF) of < 30% (EFsev) and 25 controls (CONT). CO kinetics in capillary blood was studied 3-15 min after commencement of CO rebreathing. Differences in CO kinetics between the groups were assessed using a generalized linear model. The systematic error for determination of Hbmass with oCORM arising from differences in CO kinetics was assessed using the Monte Carlo method. Results: The CO kinetics was significantly different between EFsev and CONT. In both groups, exposure to CO led to a COHb increase to 6.0 ± 1.0% 3 min after CO rebreathing. There were no CO related side effects or any clinical symptoms. Monte Carlo simulation quantifies the systematic error for determination of Hbmass arising from an impaired ejection fraction to be -0.88%. Conclusion: Our results indicate an impaired vascular mixing of CO when EF is severely reduced. When Hbmass is determined using the original oCORM protocol in heart failure patients with a reduced EF, the systematic underestimation of about 1% should be considered. However, the error arising from this impaired vascular mixing appears small and clinically negligible. Furthermore, application of oCORM was safe and not related to any side effects resulting from CO exposure. In conclusion, oCORM can be used for assessing intravascular volumes and Hbmass in patients with a reduced EF.
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Affiliation(s)
- Christoph Ahlgrim
- Center for Medicine, Institute for Exercise and Occupational Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp Birkner
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Seiler
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Grundmann
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Manfred W Baumstark
- Center for Medicine, Institute for Exercise and Occupational Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Torben Pottgiesser
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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15
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Ramasawmy R, Rogers T, Alcantar MA, McGuirt DR, Khan JM, Kellman P, Xue H, Faranesh AZ, Campbell-Washburn AE, Lederman RJ, Herzka DA. Blood volume measurement using cardiovascular magnetic resonance and ferumoxytol: preclinical validation. J Cardiovasc Magn Reson 2018; 20:62. [PMID: 30201013 PMCID: PMC6131893 DOI: 10.1186/s12968-018-0486-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/20/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The hallmark of heart failure is increased blood volume. Quantitative blood volume measures are not conveniently available and are not tested in heart failure management. We assess ferumoxytol, a marketed parenteral iron supplement having a long intravascular half-life, to measure the blood volume with cardiovascular magnetic resonance (CMR). METHODS Swine were administered 0.7 mg/kg ferumoxytol and blood pool T1 was measured repeatedly for an hour to characterize contrast agent extraction and subsequent effect on Vblood estimates. We compared CMR blood volume with a standard carbon monoxide rebreathing method. We then evaluated three abbreviated acquisition protocols for bias and precision. RESULTS Mean plasma volume estimated by ferumoxytol was 61.9 ± 4.3 ml/kg. After adjustment for hematocrit the resultant mean blood volume was 88.1 ± 9.4 ml/kg, which agreed with carbon monoxide measures (91.1 ± 18.9 ml/kg). Repeated measurements yielded a coefficient of variation of 6.9%, and Bland-Altman repeatability coefficient of 14%. The blood volume estimates with abbreviated protocols yielded small biases (mean differences between 0.01-0.06 L) and strong correlations (r2 between 0.97-0.99) to the reference values indicating clinical feasibility. CONCLUSIONS In this swine model, ferumoxytol CMR accurately measures plasma volume, and with correction for hematocrit, blood volume. Abbreviated protocols can be added to diagnostic CMR examination for heart failure within 8 min.
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Affiliation(s)
- Rajiv Ramasawmy
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Toby Rogers
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Miguel A. Alcantar
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Delaney R. McGuirt
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Jaffar M. Khan
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Peter Kellman
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Hui Xue
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Anthony Z. Faranesh
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Adrienne E. Campbell-Washburn
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Robert J. Lederman
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Daniel A. Herzka
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
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16
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Plumb JOM, Kumar S, Otto J, Schmidt W, Richards T, Montgomery HE, Grocott MPW. Replicating measurements of total hemoglobin mass (tHb-mass) within a single day: precision of measurement; feasibility and safety of using oxygen to expedite carbon monoxide clearance. Physiol Rep 2018; 6:e13829. [PMID: 30203465 PMCID: PMC6131726 DOI: 10.14814/phy2.13829] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 07/21/2018] [Indexed: 11/24/2022] Open
Abstract
Hemoglobin concentration ([Hb]) is a function of total hemoglobin mass (tHb-mass) and plasma volume. [Hb] may fall by dilution due to plasma volume expansion and changes in the perioperative period may therefore correlate poorly with blood loss. A simple, reliable, repeatable way to measure plasma volume and tHb-mass would have substantial clinical utility. The "optimized carbon monoxide re-breathing method" (oCOR) meets these criteria. However, it is recommended that a minimum of 12 h (when breathing room air) is left between repeat measurements. Twenty-four subjects underwent 3 days of testing. Two oCOR tests were performed (T1 and T2), 3 h apart, with a different CO clearance method employed between tests aiming to keep the carboxyhemoglobin level below 10%. The primary aim was to ascertain whether tHb-mass testing could be safely repeated within 3 h if carboxyhemoglobin levels were actively reduced by breathing supplemental oxygen (PROCA ). Secondary aims were to compare two other clearance methods; moderate exercise (PROCB ), or a combination of the two (PROCC ). Finally, the reliability of the oCOR method was assessed. Mean (SD) tHb-mass was 807.9 ± (189.7 g) (for T1 on day 1). PROCA lowered the carboxyhemoglobin level from the end of T1 (mean 6.64%) to the start of T2 (mean 2.95%) by a mean absolute value of 3.69%. For PROCB and PROCC the mean absolute decreases in carboxyhemoglobin were 4.00% and 4.31%, respectively. The fall in carboxyhemoglobin between T1 and T2 was greatest in PROCC ; this was statistically significantly lower than that of PROCA (P = 0.0039) and PROCB (P = 0.0289). The test-retest reliability for the measurement of total hemoglobin mass was good with a mean typical error (TE) of 2.0%. The oCOR method is safe and can be repeated within 3 h when carbon monoxide is suitably cleared between tests. Using oxygen therapy alone adequately achieves this.
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Affiliation(s)
- James O. M. Plumb
- Respiratory and Critical Care Research AreaNIHR Biomedical Research CentreUniversity Hospital Southampton NHS Foundation TrustUniversity of SouthamptonSouthamptonUnited Kingdom
- Centre for Human Integrative PhysiologyFaculty of MedicineUniversity of SouthamptonSouthamptonUnited Kingdom
- Anaesthesia and Critical Care Research UnitUniversity Hospital Southampton NHSFTSouthamptonUnited Kingdom
- Shackleton Department of AnaesthesiaUniversity Hospital Southampton NHSFTSouthamptonUnited Kingdom
| | - Shriya Kumar
- Anaesthesia and Critical Care Research UnitUniversity Hospital Southampton NHSFTSouthamptonUnited Kingdom
- University of Southampton Medical SchoolSouthamptonUnited Kingdom
| | - James Otto
- Shackleton Department of AnaesthesiaUniversity Hospital Southampton NHSFTSouthamptonUnited Kingdom
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUnited Kingdom
| | - Walter Schmidt
- Department of Sports Medicine/Sports PhysiologyUniversity of BayreuthBayreuthGermany
| | - Toby Richards
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUnited Kingdom
| | - Hugh E. Montgomery
- Centre for Human Health and PerformanceInstitute of Sport, Exercise and HealthUniversity College LondonNIHR University College London Hospitals Biomedical Research CentreLondonUnited Kingdom
| | - Mike P. W. Grocott
- Respiratory and Critical Care Research AreaNIHR Biomedical Research CentreUniversity Hospital Southampton NHS Foundation TrustUniversity of SouthamptonSouthamptonUnited Kingdom
- Centre for Human Integrative PhysiologyFaculty of MedicineUniversity of SouthamptonSouthamptonUnited Kingdom
- Anaesthesia and Critical Care Research UnitUniversity Hospital Southampton NHSFTSouthamptonUnited Kingdom
- Shackleton Department of AnaesthesiaUniversity Hospital Southampton NHSFTSouthamptonUnited Kingdom
- Department of AnesthesiologyDuke University School of MedicineDurhamNorth Carolina
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17
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Falz R, Busse M. Determination of hemoglobin mass in humans by measurement of CO uptake during inhalation of a CO-air mixture: a proof of concept study. Physiol Rep 2018; 6:e13849. [PMID: 30178548 PMCID: PMC6121115 DOI: 10.14814/phy2.13849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 11/25/2022] Open
Abstract
Measuring hemoglobin mass (Hbmass) using the carbon monoxide (CO) bolus rebreathing method is frequently used in research but has yet to be widely used in the clinical practice. The estimation of an adequate CO bolus may be difficult in patients with unknown Hbmass. In the present pilot study, a progressive inhalation technique for CO that leads to a linear individual adjusted COHb increase was evaluated. Sixteen healthy test subjects participated in the study (preliminary investigation: six; main study: ten). The reliability and validity of the new method were evaluated using multiple measurements of Hbmass with and without a defined blood donation and compared to a CO bolus method. The participants inhaled a CO-air mixture (CO concentration: 1500 ppm) for a specific breathing duration. The CO uptake and COHb change were determined simultaneously. The typical error (reliability) in the repeated measurements was 2.4% (CI ± 4.7). The mean difference between the new method and the bolus method was 34 g (±41; P = 0.026). The measured hemoglobin loss in 490 mL of blood was 74 g (±35), and the calculated hemoglobin loss was 77 g (±4) (mean difference 3 g ± 34; P = 0.820). The new method was reliable and valid in a proof of concept study with healthy subjects. The total amount of CO and as a result the COHb increase is individually adjustable. Future studies in clinical settings are needed to determine if the method could be used in disease-specific pathologies associated with changes in Hbmass.
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Affiliation(s)
- Roberto Falz
- Institute of Sport Medicine and PreventionUniversity of LeipzigGermany
| | - Martin Busse
- Institute of Sport Medicine and PreventionUniversity of LeipzigGermany
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18
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Prommer N, Wachsmuth N, Thieme I, Wachsmuth C, Mancera-Soto EM, Hohmann A, Schmidt WFJ. Influence of Endurance Training During Childhood on Total Hemoglobin Mass. Front Physiol 2018; 9:251. [PMID: 29618981 PMCID: PMC5871736 DOI: 10.3389/fphys.2018.00251] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 03/06/2018] [Indexed: 11/18/2022] Open
Abstract
Elite endurance athletes are characterized by markedly increased hemoglobin mass (Hbmass). It has been hypothesized that this adaptation may occur as a response to training at a very young age. Therefore, the aim of this study was to monitor changes in Hbmass in children aged 8–14 years following systematic endurance training. In the first study, Hbmass, VO2max, and lean body mass (LBM) were measured in 17 endurance-trained children (13 boys and 4 girls; aged 9.7 ± 1.3 years; training history 1.5±1.8 years; training volume 3.5 ± 1.6 h) twice a year for up to 3.5 years. The same parameters were measured once in a control group of 18 age-matched untrained children. Hbmass and blood volume (BV) were measured using the optimized CO-rebreathing technique, VO2max by an incremental test on a treadmill, and LBM by skin-fold measurements. In the second pilot study, the same parameters were measured in 9 young soccer athletes (aged 7.8 ± 0.2 years), and results were assessed in relation to soccer performance 2.5 years later. The increase in mean Hbmass during the period of study was 50% which was closely related to changes in LBM (r = 0.959). A significant impact of endurance training on Hbmass was observed in athletes exercising more than 4 h/week [+25.4 g compared to the group with low training volume (<2 h/week)]. The greatest effects were related to LBM (11.4 g·kg−1 LBM) and overlapped with the effects of age. A strong relationship was present between absolute Hbmass and VO2max (r = 0.939), showing that an increase of 1 g hemoglobin increases VO2max by 3.6 ml·min−1. Study 2 showed a positive correlation between Hbmass and soccer performance 2.5 years later at age 10.3 ± 0.3 years (r = 0.627, p = 0.035). In conclusion, children with a weekly training volume of more than 4 h show a 7% higher Hbmass than untrained children. Although this training effect is significant and independent of changes in LBM, the major factor driving the increase in Hbmass is still LBM.
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Affiliation(s)
- Nicole Prommer
- Department of Sports Medicine/Sports Physiology, Sports Science, University of Bayreuth, Universitaetsstrasse, Bayreuth, Germany
| | - Nadine Wachsmuth
- Department of Sports Medicine/Sports Physiology, Sports Science, University of Bayreuth, Universitaetsstrasse, Bayreuth, Germany
| | - Ina Thieme
- Department of Sports Medicine/Sports Physiology, Sports Science, University of Bayreuth, Universitaetsstrasse, Bayreuth, Germany
| | - Christian Wachsmuth
- Department of Sports Medicine/Sports Physiology, Sports Science, University of Bayreuth, Universitaetsstrasse, Bayreuth, Germany
| | - Erica M Mancera-Soto
- Department of Physiology, Biological Sciences, Universidad Nacional de Colombia, Bogota, Colombia
| | - Andreas Hohmann
- Department of Training Sciences, Sports Science, University of Bayreuth, Universitaetsstrasse, Bayreuth, Germany
| | - Walter F J Schmidt
- Department of Sports Medicine/Sports Physiology, Sports Science, University of Bayreuth, Universitaetsstrasse, Bayreuth, Germany
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19
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Millet GP, Chapman RF, Girard O, Brocherie F. Is live high -train low altitude training relevant for elite athletes? Flawed analysis from inaccurate data. Br J Sports Med 2017; 53:923-925. [PMID: 29247024 DOI: 10.1136/bjsports-2017-098083] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Gregoire P Millet
- Institute of Sport Sciences, Faculty of Biology and Medicine, ISSUL, University of Lausanne, Lausanne, Switzerland
| | - Robert F Chapman
- Department of Kinesiology, HH Morris Human Performance Laboratory, Indiana University, Bloomington, Indiana, USA
| | - Olivier Girard
- Aspetar Orthopaedic and Sports Medicine Hospital, Athlete Health and Performance Research Centre, Doha, Qatar
| | - Franck Brocherie
- Research Department, Laboratory Sport, Expertise and Performance, French Institute of Sport (INSEP), Paris, France
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20
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Siebenmann C, Keiser S, Robach P, Lundby C. CORP: The assessment of total hemoglobin mass by carbon monoxide rebreathing. J Appl Physiol (1985) 2017; 123:645-654. [DOI: 10.1152/japplphysiol.00185.2017] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/14/2017] [Accepted: 06/26/2017] [Indexed: 11/22/2022] Open
Abstract
In this Cores of Reproducibility in Physiology (CORP) article, we present the theory and practical aspects of the carbon monoxide (CO) rebreathing method for the determination of total hemoglobin mass in humans. With CO rebreathing, a small quantity of CO is diluted in O2and rebreathed for a specified time period, during which most of the CO is absorbed and bound to circulating hemoglobin. The dilution principle then allows calculation of the total number of circulating hemoglobin molecules based on the number of absorbed CO molecules and the resulting changes in the fraction of carboxyhemoglobin in blood. Total hemoglobin mass is derived by multiplication with the molar weight of hemoglobin. CO rebreathing has been used for >100 yr and has undergone steady improvement so that today excellent values in terms of accuracy and precision can be achieved if the methodological precautions are carefully followed.
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Affiliation(s)
- Christoph Siebenmann
- The Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Stefanie Keiser
- Center for Integrative Human Physiology, Institute of Physiology, University of Zürich, Zürich, Switzerland; and
| | - Paul Robach
- National School for Mountain Sports, Site of the National School for Skiing and Mountaineering (ENSA), Chamonix, France
| | - Carsten Lundby
- The Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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21
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Otto JM, Plumb JOM, Clissold E, Kumar SB, Wakeham DJ, Schmidt W, Grocott MPW, Richards T, Montgomery HE. Hemoglobin concentration, total hemoglobin mass and plasma volume in patients: implications for anemia. Haematologica 2017; 102:1477-1485. [PMID: 28596281 PMCID: PMC5685237 DOI: 10.3324/haematol.2017.169680] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/06/2017] [Indexed: 11/09/2022] Open
Abstract
In practice, clinicians generally consider anemia (circulating hemoglobin concentration < 120 g.l-1 in non-pregnant females and < 130 g.l-1 in males) as due to impaired hemoglobin synthesis or increased erythrocyte loss or destruction. Rarely is a rise in plasma volume relative to circulating total hemoglobin mass considered as a cause. But does this matter? We explored this issue in patients, measuring hemoglobin concentration, total hemoglobin mass (optimized carbon monoxide rebreathing method) and thereby calculating plasma volume in healthy volunteers, surgical patients, and those with inflammatory bowel disease, chronic liver disease or heart failure. We studied 109 participants. Hemoglobin mass correlated well with its concentration in the healthy, surgical and inflammatory bowel disease groups (r=0.687-0.871, P<0.001). However, they were poorly related in liver disease (r=0.410, P=0.11) and heart failure patients (r=0.312, P=0.16). Here, hemoglobin mass explained little of the variance in its concentration (adjusted R2=0.109 and 0.052; P=0.11 and 0.16), whilst plasma volume did (R2 change 0.724 and 0.805 in heart and liver disease respectively, P<0.0001). Exemplar patients with identical (normal or raised) total hemoglobin masses were diagnosed as profoundly anemic (or not) depending on differences in plasma volume that had not been measured or even considered as a cause. The traditional inference that anemia generally reflects hemoglobin deficiency may be misleading, potentially resulting in inappropriate tests and therapeutic interventions to address 'hemoglobin deficiency' not 'plasma volume excess'. Measurement of total hemoglobin mass and plasma volume is now simple, cheap and safe, and its more routine use is advocated.
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Affiliation(s)
- James M Otto
- Division of Surgery and Interventional Science, University College London, UK
| | - James O M Plumb
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK.,Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK
| | - Eleri Clissold
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK.,Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK
| | - Shriya B Kumar
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK.,Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK
| | - Denis J Wakeham
- School of Sport, Physiology and Health Group, Cardiff Metropolitan University, UK
| | - Walter Schmidt
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, Germany
| | - Michael P W Grocott
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK.,Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK
| | - Toby Richards
- Division of Surgery and Interventional Science, University College London, UK
| | - Hugh E Montgomery
- Centre for Human Health and Performance/Institute of Sport, Exercise and Health, University College London, and NIHR University College London Hospitals Biomedical Research Centre, UK
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22
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Keiser S, Meinild-Lundby AK, Steiner T, Trösch S, Rauber S, Krafft A, Burkhardt T, Hilty MP, Siebenmann C, Wehrlin JP, Lundby C. Detection of blood volumes and haemoglobin mass by means of CO re-breathing and indocyanine green and sodium fluorescein injections. Scandinavian Journal of Clinical and Laboratory Investigation 2017; 77:164-174. [PMID: 28276723 DOI: 10.1080/00365513.2016.1271908] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The main aim of the present study was to quantify the magnitude of differences introduced when estimating a given blood volume compartment (e.g. plasma volume) through the direct determination of another compartment (e.g. red cell volume) by multiplication of venous haematocrit and/or haemoglobin concentration. However, since whole body haematocrit is higher than venous haematocrit such an approach might comprise certain errors. To test this experimentally, four different methods for detecting blood volumes and haemoglobin mass (Hbmass) were compared, namely the carbon monoxide (CO) re-breathing (for Hbmass), the indocyanine green (ICG; for plasma volume [PV]) and the sodium fluorescein (SoF; for red blood cell volume [RBCV]) methods. No difference between ICG and CO re-breathing derived PV could be established when a whole body/venous haematocrit correction factor of 0.91 was applied (p = 0.11, r = 0.43, mean difference -340 ± 612 mL). In contrast, when comparing RBCV derived by the CO re-breathing and the SoF method, the SoF method revealed lower RBCV values as compared to the CO re-breathing method (p < 0.05, r = 0.95, mean difference -728 ± 184 mL). However, compared to the ICG and the SoF methods, the typical error (%TE) and hence reliability of the CO re-breathing method was lower for all measured parameters. Therefore, estimating blood volume compartments by the direct assessment of another compartment can be considered a suitable approach. The CO re-breathing method proved accurate in determining the induced phlebotomy and is at the same time judged easier to perform than any of the other methods.
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Affiliation(s)
- Stefanie Keiser
- a Zurich Center for Integrative Human Physiology , Institute of Physiology, University of Zurich , Zurich , Switzerland
| | - Anne-Kristine Meinild-Lundby
- a Zurich Center for Integrative Human Physiology , Institute of Physiology, University of Zurich , Zurich , Switzerland
| | - Thomas Steiner
- b Swiss Federal Institute of Sports , Magglingen , Switzerland
| | - Severin Trösch
- b Swiss Federal Institute of Sports , Magglingen , Switzerland
| | - Sven Rauber
- a Zurich Center for Integrative Human Physiology , Institute of Physiology, University of Zurich , Zurich , Switzerland
| | - Alexander Krafft
- c Foeto-Maternal Haematology Group, Department of Obstetrics , University Hospital of Zurich , Zurich , Switzerland
| | - Tilo Burkhardt
- c Foeto-Maternal Haematology Group, Department of Obstetrics , University Hospital of Zurich , Zurich , Switzerland
| | | | - Christoph Siebenmann
- e Department of Environmental Physiology, School of Technology and Health , Royal Institute of Technology , Solna , Sweden
| | | | - Carsten Lundby
- a Zurich Center for Integrative Human Physiology , Institute of Physiology, University of Zurich , Zurich , Switzerland
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23
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Fagoni N, Breenfeldt Andersen A, Oberholzer L, Haider T, Meinild Lundby AK, Lundby C. Reliability and validity of non-invasive determined haemoglobin mass and blood volumes. Clin Physiol Funct Imaging 2017; 38:240-245. [DOI: 10.1111/cpf.12406] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/07/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Nazzareno Fagoni
- Zurich Center of Integrative Human Physiology; Institute of Physiology; University of Zürich; Zürich Switzerland
- Department of Molecular and Translational Medicine; University of Brescia; Brescia Italy
| | - Andreas Breenfeldt Andersen
- Zurich Center of Integrative Human Physiology; Institute of Physiology; University of Zürich; Zürich Switzerland
- Department of Nutrition, Exercise and Sports (NEXS); University of Copenhagen; Copenhagen Denmark
| | - Laura Oberholzer
- Zurich Center of Integrative Human Physiology; Institute of Physiology; University of Zürich; Zürich Switzerland
| | - Thomas Haider
- Zurich Center of Integrative Human Physiology; Institute of Physiology; University of Zürich; Zürich Switzerland
| | - Anne-Kristine Meinild Lundby
- Zurich Center of Integrative Human Physiology; Institute of Physiology; University of Zürich; Zürich Switzerland
| | - Carsten Lundby
- Zurich Center of Integrative Human Physiology; Institute of Physiology; University of Zürich; Zürich Switzerland
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24
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Ryan BJ, Goodrich JA, Schmidt WF, Stothard ER, Wright KP, Byrnes WC. Haemoglobin mass alterations in healthy humans following four-day head-down tilt bed rest. Exp Physiol 2016; 101:628-40. [PMID: 26914389 PMCID: PMC4851582 DOI: 10.1113/ep085665] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/19/2016] [Indexed: 02/01/2023]
Abstract
NEW FINDINGS What is the central question of this study? Is haemoglobin mass (Hbmass) decreased following 4 days of head-down tilt bed rest (HDTBR), and does increased red blood cell (RBC) destruction mediate this adaptation? What is the main finding and its importance? Haemoglobin mass was increased immediately following HDTBR, before decreasing below baseline 5 days after return to normal living conditions. The transient increase in Hbmass might be the result of decreased RBC destruction, but it is also possible that spleen contraction after HDTBR contributed to this adaptation. Our data suggest that the decreased Hbmass 5 days following HDTBR resulted from decreased RBC production, not increased RBC destruction. Rapid decreases in haemoglobin mass (Hbmass) have been reported in healthy humans following spaceflight and descent from high altitude. It has been proposed that a selective increase in the destruction of young red blood cells (RBCs) mediates these decreases, but conclusive evidence demonstrating neocytolysis in humans is lacking. Based on the proposed triggers and time course of adaptation during spaceflight, we hypothesized that Hbmass would be reduced after 4 days of -6 deg head-down tilt bed rest (HDTBR) and that this would be associated with evidence for increased RBC destruction. We assessed Hbmass in seven healthy, recreationally active men before (PRE), 5 h after (POST) and 5 days after (POST5) 4 days of HDTBR. The concentration of erythropoietin decreased from 7.1 ± 1.8 mIU ml(-1) at PRE to 5.2 ± 2.8 mIU ml(-1) at POST (mean ± SD; P = 0.028). Contrary to our hypothesis, Hbmass was increased from 817 ± 135 g at PRE to 849 ± 141 g at POST (P = 0.014) before decreasing below PRE to 789 ± 139 g at POST5 (P = 0.027). From PRE to POST, the concentration of haptoglobin increased from 0.54 ± 0.32 to 0.68 ± 0.28 g l(-1) (P = 0.013) and the concentration of bilirubin decreased from 0.50 ± 0.24 to 0.32 ± 0.11 mg dl(-1) (P = 0.054), suggesting that decreased RBC destruction might have contributed to the increased Hbmass. However, it is possible that spleen contraction following HDTBR also played a role in the increase in Hbmass at POST, but as the transient increase in Hbmass was unexpected, we did not collect data that would provide direct evidence for or against spleen contraction. From PRE to POST5, the concentration of soluble transferrin receptor decreased from 20.7 ± 3.9 to 17.1 ± 3.3 nmol l(-1) (P = 0.018) but the concentrations of ferritin, haptoglobin and bilirubin were not significantly altered, suggesting that the decrease in Hbmass was mediated by decreased RBC production rather than increased RBC destruction. Peak oxygen uptake decreased by 0.31 ± 0.16 l min(-1) from PRE to POST (P = 2 × 10(-4) ) but was not significantly altered at POST5 compared with PRE. Overall, these findings indicate that 4 days of HDTBR does not increase RBC destruction and that re-examination of the time course and mechanisms of Hbmass alterations following short-term spaceflight and simulated microgravity is warranted.
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Affiliation(s)
- Benjamin J. Ryan
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Jesse A. Goodrich
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Walter F. Schmidt
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, Germany
| | - Ellen R. Stothard
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Kenneth P. Wright
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - William C. Byrnes
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
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25
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Govus AD, Peeling P, Abbiss CR, Lawler NG, Swinkels DW, Laarakkers CM, Thompson KG, Peiffer JJ, Gore CJ, Garvican-Lewis LA. Live high, train low - influence on resting and post-exercise hepcidin levels. Scand J Med Sci Sports 2016; 27:704-713. [PMID: 27038097 DOI: 10.1111/sms.12685] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 12/27/2022]
Abstract
The post-exercise hepcidin response during prolonged (>2 weeks) hypoxic exposure is not well understood. We compared plasma hepcidin levels 3 h after exercise [6 × 1000 m at 90% of maximal aerobic running velocity (vVO2max )] performed in normoxia and normobaric hypoxia (3000 m simulate altitude) 1 week before, and during 14 days of normobaric hypoxia [196.2 ± 25.6 h (median: 200.8 h; range: 154.3-234.8 h) at 3000 m simulated altitude] in 10 well-trained distance runners (six males, four females). Venous blood was also analyzed for hepcidin after 2 days of normobaric hypoxia. Hemoglobin mass (Hbmass ) was measured via CO rebreathing 1 week before and after 14 days of hypoxia. Hepcidin was suppressed after 2 (Cohen's d = -2.3, 95% confidence interval: [-2.9, -1.6]) and 14 days of normobaric hypoxia (d = -1.6 [-2.6, -0.6]). Hepcidin increased from baseline, 3 h post-exercise in normoxia (d = 0.8 [0.2, 1.3]) and hypoxia (d = 0.6 [0.3, 1.0]), both before and after exposure (normoxia: d = 0.7 [0.3, 1.2]; hypoxia: d = 1.3 [0.4, 2.3]). In conclusion, 2 weeks of normobaric hypoxia suppressed resting hepcidin levels, but did not alter the post-exercise response in either normoxia or hypoxia, compared with the pre-exposure response.
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Affiliation(s)
- A D Govus
- Institute for Sport & Physical Activity Research, University of Bedfordshire, Bedford, UK
| | - P Peeling
- School of Sport Science, Exercise & Health, University of Western Australia, Crawley, Western Australia, Australia
| | - C R Abbiss
- Centre for Exercise & Sports Science Research, School of Exercise and Health Science, Edith Cowan University, Joondalup, Western Australia, Australia
| | - N G Lawler
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
| | - D W Swinkels
- Department of Laboratory Medicine (TML 830), Radboud University Medical Centre, Nijmegen, The Netherlands.,Hepcidinanalysis.com, Radboudumc, Geert Grooteplein 10 (TML 830), Nijmegen, The Netherlands
| | - C M Laarakkers
- Department of Laboratory Medicine (TML 830), Radboud University Medical Centre, Nijmegen, The Netherlands.,Hepcidinanalysis.com, Radboudumc, Geert Grooteplein 10 (TML 830), Nijmegen, The Netherlands
| | - K G Thompson
- Research Institute for Sport & Exercise, University of Canberra, Belconnen, Australian Capital Territory, Australia
| | - J J Peiffer
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
| | - C J Gore
- Research Institute for Sport & Exercise, University of Canberra, Belconnen, Australian Capital Territory, Australia.,Department of Physiology, Australian Institute of Sport, Bruce, Australian Capital Territory, Australia.,Exercise Physiology Laboratory, Flinders University, Bedford Park, South Australia, Australia
| | - L A Garvican-Lewis
- Research Institute for Sport & Exercise, University of Canberra, Belconnen, Australian Capital Territory, Australia.,Department of Physiology, Australian Institute of Sport, Bruce, Australian Capital Territory, Australia
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26
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Siebenmann C, Cathomen A, Hug M, Keiser S, Lundby AK, Hilty MP, Goetze JP, Rasmussen P, Lundby C. Hemoglobin mass and intravascular volume kinetics during and after exposure to 3,454-m altitude. J Appl Physiol (1985) 2015; 119:1194-201. [DOI: 10.1152/japplphysiol.01121.2014] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 02/25/2015] [Indexed: 01/14/2023] Open
Abstract
High altitude (HA) exposure facilitates a rapid contraction of plasma volume (PV) and a slower occurring expansion of hemoglobin mass (Hbmass). The kinetics of the Hbmass expansion has never been examined by multiple repeated measurements, and this was our primary study aim. The second aim was to investigate the mechanisms mediating the PV contraction. Nine healthy, normally trained sea-level (SL) residents (8 males, 1 female) sojourned for 28 days at 3,454 m. Hbmass was measured and PV was estimated by carbon monoxide rebreathing at SL, on every 4th day at HA, and 1 and 2 wk upon return to SL. Four weeks at HA increased Hbmass by 5.26% (range 2.5-11.1%; P < 0.001). The individual Hbmass increases commenced with up to 12 days of delay and reached a maximal rate of 4.04 ± 1.02 g/day after 14.9 ± 5.2 days. The probability for Hbmass to plateau increased steeply after 20–24 days. Upon return to SL Hbmass decayed by −2.46 ± 2.3 g/day, reaching values similar to baseline after 2 wk. PV, aldosterone concentration, and renin activity were reduced at HA ( P < 0.001) while the total circulating protein mass remained unaffected. In summary, the Hbmass response to HA exposure followed a sigmoidal pattern with a delayed onset and a plateau after ∼3 wk. The decay rate of Hbmass upon descent to SL did not indicate major changes in the rate of erythrolysis. Moreover, our data support that PV contraction at HA is regulated by the renin-angiotensin-aldosterone axis and not by changes in oncotic pressure.
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Affiliation(s)
- C. Siebenmann
- Center for Integrative Human Physiology, Institute of Physiology, University of Zürich, Zürich, Switzerland
- Department of Environmental Physiology, School of Technology and Health, Royal Institute of Technology, Solna, Sweden
| | - A. Cathomen
- Institute of Human Movement Sciences and Sport, ETH Zürich, Zürich, Switzerland
| | - M. Hug
- Center for Integrative Human Physiology, Institute of Physiology, University of Zürich, Zürich, Switzerland
| | - S. Keiser
- Center for Integrative Human Physiology, Institute of Physiology, University of Zürich, Zürich, Switzerland
| | - A. K. Lundby
- Center for Integrative Human Physiology, Institute of Physiology, University of Zürich, Zürich, Switzerland
| | - M. P. Hilty
- Intensive Care Unit, University Hospital of Zürich, Zürich, Switzerland
| | - J. P. Goetze
- Department of Clinical Biochemistry, Copenhagen, and Aarhus University, Aarhus, Denmark
| | | | - C. Lundby
- Center for Integrative Human Physiology, Institute of Physiology, University of Zürich, Zürich, Switzerland
- Food and Nutrition and Sport Science, Gothenburg University, Gothenburg, Sweden
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27
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Govus AD, Garvican-Lewis LA, Abbiss CR, Peeling P, Gore CJ. Pre-Altitude Serum Ferritin Levels and Daily Oral Iron Supplement Dose Mediate Iron Parameter and Hemoglobin Mass Responses to Altitude Exposure. PLoS One 2015; 10:e0135120. [PMID: 26263553 PMCID: PMC4532405 DOI: 10.1371/journal.pone.0135120] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 07/17/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the influence of daily oral iron supplementation on changes in hemoglobin mass (Hbmass) and iron parameters after 2-4 weeks of moderate altitude exposure. METHODS Hematological data collected from 178 athletes (98 males, 80 females) exposed to moderate altitude (1,350-3,000 m) were analysed using linear regression to determine how altitude exposure combined with oral iron supplementation influenced Hbmass, total iron incorporation (TII) and blood iron parameters [ferritin and transferrin saturation (TSAT)]. RESULTS Altitude exposure (mean ± s: 21 ± 3 days) increased Hbmass by 1.1% [-0.4, 2.6], 3.3% [1.7, 4.8], and 4.0% [2.0, 6.1] from pre-altitude levels in athletes who ingested nil, 105 mg and 210 mg respectively, of oral iron supplement daily. Serum ferritin levels decreased by -33.2% [-46.9, -15.9] and 13.8% [-32.2, 9.7] from pre-altitude levels in athletes who supplemented with nil and 105 mg of oral iron supplement daily, but increased by 36.8% [1.3, 84.8] in athletes supplemented with 210 mg of oral iron daily. Finally, athletes who ingested either 105 mg or 210 mg of oral iron supplement daily had a greater TII compared with non-supplemented athletes (0 versus 105 mg: effect size (d) = -1.88 [-2.56, -1.17]; 0 versus 210 mg: effect size (d) = -2.87 [-3.88, -1.66]). CONCLUSION Oral iron supplementation during 2-4 weeks of moderate altitude exposure may enhance Hbmass production and assist the maintenance of iron balance in some athletes with low pre-altitude iron stores.
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Affiliation(s)
- Andrew D. Govus
- Centre for Exercise and Sports Science Research, School of Exercise and Health Science, Edith Cowan University, Joondalup, WA, Australia
- * E-mail:
| | - Laura A. Garvican-Lewis
- Department of Physiology, Australian Institute of Sport, Bruce, ACT, Australia
- Research Institute for Sport and Exercise, University of Canberra, Bruce, ACT, Australia
| | - Chris R. Abbiss
- Centre for Exercise and Sports Science Research, School of Exercise and Health Science, Edith Cowan University, Joondalup, WA, Australia
| | - Peter Peeling
- School of Sport Science, Exercise & Health, University of Western Australia, Crawley, WA, Australia
| | - Christopher J. Gore
- Department of Physiology, Australian Institute of Sport, Bruce, ACT, Australia
- Exercise Physiology Laboratory, Flinders University, Bedford Park, SA, Australia
- Research Institute for Sport and Exercise, University of Canberra, Bruce, ACT, Australia
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28
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Turner G, Richardson AJ, Maxwell NS, Pringle JSM. Comparison of total haemoglobin mass measured with the optimized carbon monoxide rebreathing method across different Radiometer™ ABL-80 and OSM-3 hemoximeters. Physiol Meas 2015; 35:N41-9. [PMID: 25420054 DOI: 10.1088/0967-3334/35/12/n41] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A new Radiometer™ hemoximeter (ABL-80) has recently become available to measure carboxyhaemoglobin concentration for the optimized CO-rebreathing method (oCOR-method). Within the English Institute of Sport (EIS), hemoximeters are used in three different laboratories; therefore, precision and agreement of total haemoglobin mass (tHbmass) determination across sites is essential, and comparison to the previous model OSM-3 is desirable. Six male and one female (age 30 ± 6 years, body mass 78.1 ± 10.6 kg) undertook the oCOR-method. Venous blood (~2 ml) was sampled immediately before and at 7 min during the oCOR-method; with seven replicates from each time point simultaneously analysed on five different Radiometer™ hemoximeters [OSM-3(1), OSM-3(2), ABL-80(1), ABL-80(2) and ABL-80(3)]. There were no differences (p > 0.05) between Δ%HbCO or mean tHbmass analysed with five different hemoximeters (OSM-3(1): 886 ± 167 g; OSM-3(2): 896 ± 160 g: ABL-80(1): 904 ± 157 g; ABL-80(2): 906 ± 163 g: ABL-80(3): 906 ± 162 g). However, the Bland-Altman plot revealed that there was closer agreement between ABL-80 machines for tHbmass than for the OSM-3. The variance (i.e. % error) across replicate samples decreased as the number of samples increased, with the error derived from the 'worse-case' scenario (single samples) being 1.2 to 1.6 fold greater in the OSM-3 than the ABL-80. Although there were no differences in the average tHbmass measured with five different hemoximeters, the new ABL-80 were in better agreement with each other compared to the old OSM-3. Previously, five replicates were required to achieve a low error using the OSM-3; however, three replicates are sufficient with the ABL-80 model to produce an error of ≤ 1% in tHbmass.
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Rasmussen P, Siebenmann C, Díaz V, Lundby C. Red cell volume expansion at altitude: a meta-analysis and Monte Carlo simulation. Med Sci Sports Exerc 2014; 45:1767-72. [PMID: 23502972 DOI: 10.1249/mss.0b013e31829047e5] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Altitude acclimatization is associated with a rapid increase in hematocrit. The time course and the contribution of the red cell volume expansion are not clear. The purpose of the present meta-analysis was to explore how much altitude exposure is required to induce polycythemia in healthy lowlanders. METHODS A systematic review was performed of 66 published articles (including 447 volunteers) identified through literature search. We performed a mixed-model random-effects meta-analysis and a Monte Carlo simulation on the extracted data. RESULTS The following results were obtained in this study: 1) the red cell volume expansion for a given duration of exposure is dependent on altitude (P < 0.0001), that is, that the increase in red cell volume was accelerated at higher altitudes; and 2) the extent of the erythropoietic response depends on the initial red cell volume (P < 0.0001). It seems that exposure time must exceed 2 wk at an altitude of more than 4000 m to exert a statistically significant effect. At lower altitudes, longer exposure times are needed with altitudes lower than 3000 m not yielding an increase within 4 wk. CONCLUSIONS Red cell volume response to hypoxia is generally slow, although it accelerates with increasing altitude. This, in combination with a dependency on initial red cell volume, suggests that, for example, athletes may need to spend more time at altitude to see an effect on red cell volume than commonly recommended.
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Affiliation(s)
- Peter Rasmussen
- Zurich Center of Integrative Human Physiology, Institute of Physiology, Zurich, Switzerland.
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30
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GARVICAN LAURAA, SAUNDERS PHILOU, CARDOSO TANUSHA, MACDOUGALL IAINC, LOBIGS LOUISAM, FAZAKERLEY RUTH, FALLON KIERANE, ANDERSON BEV, ANSON JUDITHM, THOMPSON KEVING, GORE CHRISTOPHERJ. Intravenous Iron Supplementation in Distance Runners with Low or Suboptimal Ferritin. Med Sci Sports Exerc 2014; 46:376-85. [DOI: 10.1249/mss.0b013e3182a53594] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Turner G, Pringle JSM, Ingham SA, Fudge BW, Richardson AJ, Maxwell NS. The influence of carbon monoxide bolus on the measurement of total haemoglobin mass using the optimized CO-rebreathing method. Physiol Meas 2014; 35:N11-9. [DOI: 10.1088/0967-3334/35/2/n11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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The carbon monoxide re-breathing method can underestimate Hbmass due to incomplete blood mixing. Eur J Appl Physiol 2013; 113:2425-30. [PMID: 23771574 DOI: 10.1007/s00421-013-2681-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 06/08/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Hemoglobin mass (Hbmass) is commonly assessed using the CO re-breathing method with the subject in the seated position. This may lead to an underestimation of Hbmass as blood in lower extremity veins while seated may not be tagged with carbon monoxide (CO) during the re-breathing period. METHODS To test this hypothesis, CO re-breathing was performed on four occasions in nine male subjects, twice in the seated position and twice in combination with light cycle ergometer exercise (1 W/kg body-weight) intending to accelerate blood circulation and thereby potentially allowing for a better distribution of CO throughout the circulation as compared to in the seated position. Blood samples were drawn from an antecubital vein and the saphenous magna vein following the re-breathing procedure. RESULTS In the seated position, CO re-breathing increased the percent carboxyhemoglobin (%HbCO) in the antecubital vein to 8.9 % (7.8-10.7) [median (min-max)], but less (P = 0.017) in the saphenous magna vein [7.8 % (5.0-9.9)]. With exercise, no differences in %HbCO were observed between sampling sites. As a result, CO re-breathing in combination with exercise revealed a ~3 % higher (P = 0.008) Hbmass, i.e., 936 g (757-1,018) as compared to 908 g (718-940) at seated rest. CONCLUSION This study suggests an uneven distribution of CO in the circulation if the CO re-breathing procedure is performed at rest in the seated position and therefore can underestimate Hbmass.
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Durussel J, Ross R, Kodi PR, Daskalaki E, Takas P, Wilson J, Kayser B, Pitsiladis Y. Precision of the optimized carbon monoxide rebreathing method to determine total haemoglobin mass and blood volume. Eur J Sport Sci 2013. [DOI: 10.1080/17461391.2011.606843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Garvican LA, Saunders PU, Pyne DB, Martin DT, Robertson EY, Gore CJ. Hemoglobin mass response to simulated hypoxia "blinded" by noisy measurement? J Appl Physiol (1985) 2012; 112:1797-8; author reply 1799. [PMID: 22589495 DOI: 10.1152/japplphysiol.00212.2012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Lundby C, Siebenmann C, Robach P. Reply to Garvican, Saunders, Pyne, Martin, Robertson, and Gore. J Appl Physiol (1985) 2012. [DOI: 10.1152/japplphysiol.00264.2012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Cartsen Lundby
- Center for Integrative Human Physiology, Institute of Physiology, University of Zürich, Switzerland, and
| | - Christoph Siebenmann
- Center for Integrative Human Physiology, Institute of Physiology, University of Zürich, Switzerland, and
| | - Paul Robach
- Ecole Nationale des Sports de Montagne (ENSA), Chamonix, France
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Chada KE, Bruce EN. Computational analyses of CO-rebreathing methods for estimating haemoglobin mass in humans. Exp Physiol 2011; 97:141-54. [PMID: 21948194 DOI: 10.1113/expphysiol.2011.059436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Measurement of haemoglobin mass (M(Hb)) is used to quantify alterations in oxygen delivery during exercise training or acclimatization to altitude. Uptake of carbon monoxide by haemoglobin is the basis of the common non-radioactive methods to determine M(Hb) in humans. This study used a validated mathematical model to simulate CO uptake during rebreathing protocols and to determine sources of errors in estimation of M(Hb). Our previously published model was validated using experimentally measured carboxyhaemoglobin levels (%HbCO) from arterial, capillary and venous blood sites of human subjects during CO-rebreathing protocols. This model was then used to simulate various CO-rebreathing protocols in 24 human subjects with known M(Hb). Using variables generated by the model, M(Hb) was estimated on the basis of assumptions typically made for calculating the volume of CO bound to myoglobin, the volume of CO exhaled and the volume of CO in the rebreathing system. It was found that inaccurate estimation of the volume of CO bound to myoglobin was the major source of error in determination of M(Hb). Additionally, the size of the error was found to depend on the site of blood sampling because of differences in %HbCO. Regression equations were developed to improve the estimation of volume of CO bound to myoglobin, and a new protocol that is less dependent on the site of blood sampling is proposed.
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Affiliation(s)
- Kinnera E Chada
- Center for Biomedical Engineering, University of Kentucky, Lexington, KY 40506-0070, USA
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Gough CE, Sharpe K, Ashenden MJ, Anson JM, Saunders PU, Garvican LA, Bonetti DL, Gore CJ, Prommer N. Quality control technique to reduce the variability of longitudinal measurement of hemoglobin mass. Scand J Med Sci Sports 2011; 21:e365-71. [DOI: 10.1111/j.1600-0838.2011.01316.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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