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This study analyzed blood volume composition in 395 chronic heart failure patients and found that a "normal" total blood volume often masks underlying abnormalities. Among patients classified as having normal blood volume, 60% actually had deficient red blood cell mass (true anemia) and only 30% had genuinely normal blood composition with both normal red blood cell mass and plasma volume. The findings reveal that standard blood volume assessments can be misleading because they fail to account for compensatory changes where low red blood cell mass is offset by increased plasma volume, or vice versa.
Why it matters
Current heart failure management may miss critical blood composition abnormalities when relying solely on total blood volume measurements. Detecting these hidden imbalances could improve treatment strategies, particularly for anemia management in heart failure patients, as 60% of those with apparently normal blood volume actually had unrecognized red blood cell deficits that would not be caught by standard hemoglobin testing alone.
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⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Background: Blood volume (BV) in patients with chronic heart failure (HF) is characterized by heterogeneity in volume profiles; one profile being "normal BV". While overall intravascular volume may be considered normal clinically, the relative contributions of red blood cell (RBC) mass and plasma volume (PV) may not be. Objective: Assess how normal is a "normal BV" based on quantitative measures of RBC mass and PV. Methods: Retrospective analysis was undertaken in 395 patients with Class II-III HF. BV was quantitated using indicator-dilution methodology. Cohort was stratified by normal and hypervolemic BV. Results: Of the cohort, 31% (123/395) demonstrated normal total BV and 62% (244/395) hypervolemic BV. Of patients with "normal BV", 36% (44/123) demonstrated normal RBC mass and 60% normal PV (74/123). Importantly, 60% (74/123) demonstrated a deficit in RBC mass (true anemia), while a low hemoglobin (<12 g/dL) was present in just 29% (36/123). An excess in RBC mass (erythrocytosis) in 4% (5/123). Notably, true normal BV (i.e., normal RBC mass and normal PV) was observed in only 30% (37/123) of patients with an overall "normal" intravascular volume. Conclusions: Findings reveal that "normal BV" can be misleading by concealing substantial variability in RBC mass (including unrecognized anemia and erythrocytosis) as well as different degrees of PV expansion and contraction. An actual normal BV was identified in a minority of "normal BV" patients. This underscores the importance of looking beyond overall "normal BV" to the contributing elements of RBC mass and PV with significant implications for patient management and outcomes.
Source: WHY A "NORMAL BLOOD VOLUME" IS NOT ALWAYS NORMAL – AN OVERLOOKED ISSUE IN HEART FAILURE MANAGEMENT