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Erythropoietic Response in Chronic Pulmonary Disease

Erythropoietic Response in Chronic Pulmonary Disease Abstract Interest in the erythropoietic response in patients with chronic lung disease stems from the fact that, despite arterial hypoxia, the hemoglobin concentration is usually normal.1-6 Hypoxia under almost all other conditions is associated with a secondary polycythemia. In natives of the Peruvian Andes, Hurtado and co-workers clearly demonstrated that prolonged exposure to high altitudes will produce an increase in hemoglobin and hematocrit proportional to the degree of hypoxia.7 Similarly, it has been observed that patients with arterial hypoxemia due to cyanotic heart disease8,9 and occasionally due to chronic pulmonary disease have secondary polycythemia. The apparent lack of erythropoietic response in most patients with chronic pulmonary disease has not been explained adequately. Recently it has been emphasized that, if total red cell volume is measured rather than peripheral hemoglobin and hematocrit, patients with chronic pulmonary disease will demonstrate an adequate erythropoietic response.10 However, the reported data References 1. Lemon, W. S.: A Study of Effect of Chronic Pulmonary Disease on Volume and Composition of Blood , Ann Intern Med 3:430, 1929.Crossref 2. Kaltreider, N. L.; Hurtado, A.; and Brooks, W. D.: Study of Blood in Chronic Respiratory Diseases, With Special Reference to Volume of Blood , J Clin Invest 13:999, 1934.Crossref 3. Wilson, H. H.; Borden, C. W.; and Ebert, R. V.: Adaptation to Anoxia in Chronic Pulmonary Emphysema , AMA Arch Intern Med 88:581, 1951.Crossref 4. Ratto, O., et al: Anoxemia Secondary to Polycythemia and Polycythemia Secondary to Anoxia , Amer J Med 19:958, 1955.Crossref 5. Hammarsten, J. F., et al: The Hematologic Adaptation of Patients With Hypoxia Due to Pulmonary Emphysema , Amer Rev Tuberc 78:391, 1958. 6. Tura, S.; Pollycove, M.; and Gelpi, A. P.: Erythrocyte and Iron-Kinetics in Patients With Chronic Pulmonary Emphysema , J Nucl Med 3:110, 1962. 7. Hurtado, A.; Merino, C.; and Delgado, E.: Influence of Anoxemia on Hemopoietic Activity , Arch Intern Med 75:284, 1945.Crossref 8. Hallock, P.: Polycythemia of Morbus Caeruleus (Cyanotic Type of Congenital Heart Disease) , Proc Soc Exp Biol Med 44:11, 1940.Crossref 9. Bing, R. J., et al: Physiologic Studies in Congenital Heart Disease: VI. Adaptations to Anoxia in Congenital Heart Disease With Cyanosis , Bull Hopkins Hosp 83:439, 1948. 10. Lertzman, M.; Israels, L. G.; and Cherniack, R. M.: Erythropoiesis and Ferrokinetics in Chronic Respiratory Disease , Ann Intern Med 56:821, 1962.Crossref 11. Vanier, T., et al: Emphysema, Hypoxia and Polycythemic Response , New Eng J Med 269:169, 1963.Crossref 12. Fraimow, W., and Cathcart, R. T.: Clinical and Physiological Considerations in Pulmonary Muscular Hyperplasia , Ann Intern Med 56:752, 1962.Crossref 13. Wennesland, R., et al: Red Cells, Plasma and Blood Volume in Healthy Men Measured by Radiochromium (Cr51) Cell Tagging and Hematocrit: Influence of Age, Somatype and Habits of Physical Activity on Variance After Regression of Volumes to Height and Weight Combined , J Clin Invest 38:1065, 1959.Crossref 14. Brown, E., et al: Red Cell, Plasma, and Blood Volume in Healthy Women Measured by Radiochromium Cell-Labeling and Hematocrit , J Clin Invest 41:2182, 1962.Crossref 15. Lawrence, J. H.: Polycythemia: Physiology, Diagnosis and Treatment , New York: Grune & Stratton, Inc., 1955. 16. Gallagher, N. I., et al: Response of Starved Rats and Polycythemic Rats to Graded Doses of Erythropoietin , Proc Soc Exp Biol Med 106:127, 1961.Crossref 17. Borsook, H., et al: Polycythemic Response in Normal Adult Rats to Nonprotein Plasma Extract From Anemic Rabbits , Blood 9:734, 1954. 18. Read, R. C.; Wilson, G. W.; and Gradner, F.: Use of Radioactive Sodium Chromate to Evaluate Life Span of Red Blood Cells in Health and Certain Hemolytic Disorders , Amer J Med Sci 228:40, 1954.Crossref 19. Peterson, R. E.: Improved Spectrophotometric Procedure for Determination of Serum Iron Using 4,7-Diphenyl-1,10, Phenanthroline , Analyt Chem 25:1337, 1953.Crossref 20. Bothwell, T. H., et al: Erythrokinetics: IV. Plasma Iron Turnover as a Measure of Erythropoiesis , Blood 12:409, 1957. 21. Sack, J., and Erslev, A. J.: Unpublished data. 22. Shaw, D. B., and Simpson, T.: Polycythemia in Emphysema , Quart J Med 30:135, 1961. 23. Jacobson, L. O., et al: Role of Kidney in Erythropoiesis , Nature (London) 179:633, 1957.Crossref 24. Naets, J. P.: Role of Kidney in Erythropoiesis , J Clin Invest 39:120, 1960. 25. Stohlman, F., Jr.: Observations on Physiology of Erythropoietin and Its Role in Regulation of Red Cell Production , Ann NY Acad Sci 77:710, 1959.Crossref 26. VanDyke, D. C., et al: Relation Between Severity of Anemia and Erythropoietin Titer in Human Beings , Blood 18:187, 1961. 27. Lange, R. D.; McCarthy, J. M.; and Gallagher, N. I.: Plasma and Urinary Erythropoietin in Bone Marrow Failure , Arch Intern Med 108:850, 1961.Crossref 28. Merino, C. F.: Plasma Erythropoietic Factor in Polycythemia of High Altitudes, manual 56-103 , Air University, School of Aviation Medicine, USAF, Randolph AFB, Texas, November, 1956. 29. Whitcomb, W. H., et al: Erythropoietic Factor in Hypoxic Patients With Emphysema Without Secondary Polycythemia , AMA Arch Intern Med 103:871, 1959.Crossref 30. Haurani, F. I.; Young, J. K.; and Tocantins, L. M.: Reutilization of Iron in Anemia Complicating Malignant Neoplasms , Blood 22:73, 1963. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Erythropoietic Response in Chronic Pulmonary Disease

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References (35)

Publisher
American Medical Association
Copyright
Copyright © 1964 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1964.00280100067011
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Abstract

Abstract Interest in the erythropoietic response in patients with chronic lung disease stems from the fact that, despite arterial hypoxia, the hemoglobin concentration is usually normal.1-6 Hypoxia under almost all other conditions is associated with a secondary polycythemia. In natives of the Peruvian Andes, Hurtado and co-workers clearly demonstrated that prolonged exposure to high altitudes will produce an increase in hemoglobin and hematocrit proportional to the degree of hypoxia.7 Similarly, it has been observed that patients with arterial hypoxemia due to cyanotic heart disease8,9 and occasionally due to chronic pulmonary disease have secondary polycythemia. The apparent lack of erythropoietic response in most patients with chronic pulmonary disease has not been explained adequately. Recently it has been emphasized that, if total red cell volume is measured rather than peripheral hemoglobin and hematocrit, patients with chronic pulmonary disease will demonstrate an adequate erythropoietic response.10 However, the reported data References 1. Lemon, W. S.: A Study of Effect of Chronic Pulmonary Disease on Volume and Composition of Blood , Ann Intern Med 3:430, 1929.Crossref 2. Kaltreider, N. L.; Hurtado, A.; and Brooks, W. D.: Study of Blood in Chronic Respiratory Diseases, With Special Reference to Volume of Blood , J Clin Invest 13:999, 1934.Crossref 3. Wilson, H. H.; Borden, C. W.; and Ebert, R. V.: Adaptation to Anoxia in Chronic Pulmonary Emphysema , AMA Arch Intern Med 88:581, 1951.Crossref 4. Ratto, O., et al: Anoxemia Secondary to Polycythemia and Polycythemia Secondary to Anoxia , Amer J Med 19:958, 1955.Crossref 5. Hammarsten, J. F., et al: The Hematologic Adaptation of Patients With Hypoxia Due to Pulmonary Emphysema , Amer Rev Tuberc 78:391, 1958. 6. Tura, S.; Pollycove, M.; and Gelpi, A. P.: Erythrocyte and Iron-Kinetics in Patients With Chronic Pulmonary Emphysema , J Nucl Med 3:110, 1962. 7. Hurtado, A.; Merino, C.; and Delgado, E.: Influence of Anoxemia on Hemopoietic Activity , Arch Intern Med 75:284, 1945.Crossref 8. Hallock, P.: Polycythemia of Morbus Caeruleus (Cyanotic Type of Congenital Heart Disease) , Proc Soc Exp Biol Med 44:11, 1940.Crossref 9. Bing, R. J., et al: Physiologic Studies in Congenital Heart Disease: VI. Adaptations to Anoxia in Congenital Heart Disease With Cyanosis , Bull Hopkins Hosp 83:439, 1948. 10. Lertzman, M.; Israels, L. G.; and Cherniack, R. M.: Erythropoiesis and Ferrokinetics in Chronic Respiratory Disease , Ann Intern Med 56:821, 1962.Crossref 11. Vanier, T., et al: Emphysema, Hypoxia and Polycythemic Response , New Eng J Med 269:169, 1963.Crossref 12. Fraimow, W., and Cathcart, R. T.: Clinical and Physiological Considerations in Pulmonary Muscular Hyperplasia , Ann Intern Med 56:752, 1962.Crossref 13. Wennesland, R., et al: Red Cells, Plasma and Blood Volume in Healthy Men Measured by Radiochromium (Cr51) Cell Tagging and Hematocrit: Influence of Age, Somatype and Habits of Physical Activity on Variance After Regression of Volumes to Height and Weight Combined , J Clin Invest 38:1065, 1959.Crossref 14. Brown, E., et al: Red Cell, Plasma, and Blood Volume in Healthy Women Measured by Radiochromium Cell-Labeling and Hematocrit , J Clin Invest 41:2182, 1962.Crossref 15. Lawrence, J. H.: Polycythemia: Physiology, Diagnosis and Treatment , New York: Grune & Stratton, Inc., 1955. 16. Gallagher, N. I., et al: Response of Starved Rats and Polycythemic Rats to Graded Doses of Erythropoietin , Proc Soc Exp Biol Med 106:127, 1961.Crossref 17. Borsook, H., et al: Polycythemic Response in Normal Adult Rats to Nonprotein Plasma Extract From Anemic Rabbits , Blood 9:734, 1954. 18. Read, R. C.; Wilson, G. W.; and Gradner, F.: Use of Radioactive Sodium Chromate to Evaluate Life Span of Red Blood Cells in Health and Certain Hemolytic Disorders , Amer J Med Sci 228:40, 1954.Crossref 19. Peterson, R. E.: Improved Spectrophotometric Procedure for Determination of Serum Iron Using 4,7-Diphenyl-1,10, Phenanthroline , Analyt Chem 25:1337, 1953.Crossref 20. Bothwell, T. H., et al: Erythrokinetics: IV. Plasma Iron Turnover as a Measure of Erythropoiesis , Blood 12:409, 1957. 21. Sack, J., and Erslev, A. J.: Unpublished data. 22. Shaw, D. B., and Simpson, T.: Polycythemia in Emphysema , Quart J Med 30:135, 1961. 23. Jacobson, L. O., et al: Role of Kidney in Erythropoiesis , Nature (London) 179:633, 1957.Crossref 24. Naets, J. P.: Role of Kidney in Erythropoiesis , J Clin Invest 39:120, 1960. 25. Stohlman, F., Jr.: Observations on Physiology of Erythropoietin and Its Role in Regulation of Red Cell Production , Ann NY Acad Sci 77:710, 1959.Crossref 26. VanDyke, D. C., et al: Relation Between Severity of Anemia and Erythropoietin Titer in Human Beings , Blood 18:187, 1961. 27. Lange, R. D.; McCarthy, J. M.; and Gallagher, N. I.: Plasma and Urinary Erythropoietin in Bone Marrow Failure , Arch Intern Med 108:850, 1961.Crossref 28. Merino, C. F.: Plasma Erythropoietic Factor in Polycythemia of High Altitudes, manual 56-103 , Air University, School of Aviation Medicine, USAF, Randolph AFB, Texas, November, 1956. 29. Whitcomb, W. H., et al: Erythropoietic Factor in Hypoxic Patients With Emphysema Without Secondary Polycythemia , AMA Arch Intern Med 103:871, 1959.Crossref 30. Haurani, F. I.; Young, J. K.; and Tocantins, L. M.: Reutilization of Iron in Anemia Complicating Malignant Neoplasms , Blood 22:73, 1963.

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Archives of Internal Medicine – American Medical Association

Published: Apr 1, 1964

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