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STUDIES OF THE BLOOD IN CONGESTIVE HEART FAILURE: WITH PARTICULAR REFERENCE TO RETICULOCYTOSIS, ERYTHROCYTE FRAGILITY, BILIRUBINEMIA, UROBILINOGEN EXCRETION AND CHANGES IN BLOOD VOLUME

STUDIES OF THE BLOOD IN CONGESTIVE HEART FAILURE: WITH PARTICULAR REFERENCE TO RETICULOCYTOSIS,... Abstract That the total circulating blood volume is increased during congestive heart failure1 and is decreased after recovery1b,c has been convincingly demonstrated. Knowledge is incomplete, however, in regard to the mechanisms involved in creating and in disposing of the increased circulating volume of erythrocytes and plasma during the different stages of congestive failure. In the present investigation the reticulocyte percentage, red cell fragility, serum bilirubin and urinary and fecal excretion of pigment were studied in a series of patients at intervals during the height of, and recovery from, congestive heart failure; these findings were related to the observed changes in blood volume and clinical status. METHODS The total blood volume, plasma and circulating red blood cell mass were ascertained by means of Evans blue dye and the photoelectric colorimeter, as described by Gibson and Evans2 and Gibson and Evelyn.3 Measurements were made soon after the patient's admission to the hospital and References 1. Rowntree, L. G., and Brown, G. E.: The Volume of the Blood and Plasma in Health and Disease , Philadelphia, W. B. Saunders Company, 1929. 2. Schurmeyer, A.: Ueber Blutmengenbestimmungen bei Herzfehlern , Verhandl. d. deutsch. Gesellsch. f. inn. Med. 40:388, 1928 3. Gibson, J. G., and Evans, W. A.: Clinical Studies of the Blood Volume: III. Changes in Blood Volume, Venous Pressure and Blood Velocity Rate in Chronic Congestive Heart Failure , J. Clin. Investigation 16:851, 1937.Crossref 4. Gibson, J. G., and Evans, W. A.: Clinical Studies of the Blood Volume: I. Clinical Application of a Method Employing the Azo Dye "Evans Blue" and the Spectro-Photometer , J. Clin. Investigation 16:301, 1937.Crossref 5. Gibson, J. G., and Evelyn, K. A.: Clinical Studies of the Blood Volume: IV. Adaptation of the Method to Photoelectric Microcolorimeter , J. Clin. Investigation 17:153, 1938.Crossref 6. Rourke, M. D., and Ernstene, A. C.: A Method for Correcting the Erythrocyte Sedimentation Rate for Variations in the Cell Volume Percentage of Blood , J. Clin. Investigation 8:545, 1930.Crossref 7. Daland, G. A., and Worthley, K.: The Resistance of Red Blood Cells to Hemolysis in Hypotonic Solutions of Sodium Chloride , J. Lab. & Clin. Med. 20:1122, 1935. 8. Moritz, F., and von Tabora, D.: Ueber eine Methode, beim Menschen den Druck in oberflächlichen Venen exakt zu bestimmen , Deutsches Arch. f. klin. Med. 98:475, 1910. 9. Malloy, H. T., and Evelyn, K. A.: The Determination of Bilirubin with the Photoelectric Colorimeter , J. Biol. Chem. 119:481, 1937. 10. Watson, C. J.: Studies of Urobilinogen: I. Improved Method of Quantitation , Am. J. Clin. Path. 6:458, 1936. 11. Gibson, J. G., and Evans, W. A.: Clinical Studies of the Blood Volume: II. The Relation of Plasma and Total Blood Volume to Venous Pressure, Blood Velocity Rate, Physical Measurements, Age and Sex in Ninety Normal Humans , J. Clin. Investigation 16:317, 1937. 12. Watson, C. J.: Studies of Urobilinogen: II. Urobilinogen in the Urine and Feces of Subjects Without Evidence of Disease of the Liver or Biliary Tract , Arch. Int. Med. 59:196 ( (Feb.) ) 1937. 13. Blumgart, H. L., and Weiss, S.: Studies on the Velocity of Blood Flow: V. The Physiological and Pathological Significance of the Velocity of Blood Flow , J. Clin. Investigation 4:199, 1927. 14. Watson 10 15. Watson, C. J.: Studies of Urobilinogen: III. The Per Diem Excretion of Urobilinogen in the Common Forms of Jaundice and Disease of the Liver , Arch. Int. Med. 59:206 ( (Feb.) ) 1937. 16. Ehrstrom, M. C.: Blutstoffwechsel und Urobilinurie bei Herzinsuffizienz , Acta med. Scandinav. 88:517, 1936. 17. Heilmeyer, L., and Oetzel, W.: Blutfarbstoffwechselstudien: II. Ergebnisse bei Gersunden, Diätversuche. Der Blutfarbstoffwechsel im Hunger , Deutsches Arch. f. klin. Med. 171:365, 1931. 18. Weiss, M.: Ueber Urobilin und seine diagnostische Verwertung , Wien. Arch. f. inn. Med. 20:38, 1930. 19. Ham, T. H.: Studies on Destruction of Red Blood Cells: I. Chronic Hemolytic Anemia with Paroxysmal Nocturnal Hemoglobinuria; an Investigation of the Mechanism of Hemolysis, with Observations on Five Cases , Arch. Int. Med. 64:1271 ( (Dec.) ) 1939. 20. Jolliffe, N.: Liver Function in Congestive Heart Failure , J. Clin. Investigation 8:419, 1930. 21. Watson.13 22. Weiss.16 23. Fishberg, A. M.: Heart Failure , Philadelphia, Lea & Febiger, 1937. 24. Keefer, C. S., and Resnick, W. H.: Jaundice Following Pulmonary Infarction in Patients with Myocardial Insufficiency: I. A Clinical Study , J. Clin. Investigation 2:375, 1926. 25. Francescon, M.: Comportamento della resistenza osmotica die globuli rossi e del ricambio emoglobinico nei cardiopazienti in fase acuta di scompenso e in fase compensatoria , Minerva med. 37:255, 1936. 26. Greenthal, R. M., and O'Donnell, W. S.: Studies on the Fragility of the Red Blood Cells , Am. J. Physiol. 58:271, 1921. 27. Waller, J. V.: Cause of Increased Fragility of Erythrocytes in Congestive Heart Failure , Proc. Soc. Exper. Biol. & Med. 42:64, 1939. 28. Szour, M., and Bergenbaum, C.: Retikulozytenuntersuchungen bei Lungentuberkulose , Wien. klin. Wchnschr. 47:1583, 1934. 29. Barcroft, J.; Binger, C. A.; Bock, A. V.; Boggart, J. H.; Forbes, H. S.; Harrop, G.; Meakins, J. C., and Redfield, A. C.: Report to the Peru High-Altitude Committee: VIII. Observations upon the Effect of High Altitude on the Physiological Processes of the Human Body, Carried Out in the Peruvian Andes, Chiefly Cerro de Pasco , Phil. Tr. Roy. Soc. London 211:350, 1923. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

STUDIES OF THE BLOOD IN CONGESTIVE HEART FAILURE: WITH PARTICULAR REFERENCE TO RETICULOCYTOSIS, ERYTHROCYTE FRAGILITY, BILIRUBINEMIA, UROBILINOGEN EXCRETION AND CHANGES IN BLOOD VOLUME

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Publisher
American Medical Association
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Copyright © 1940 American Medical Association. All Rights Reserved.
ISSN
0730-188X
DOI
10.1001/archinte.1940.00190180042004
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Abstract

Abstract That the total circulating blood volume is increased during congestive heart failure1 and is decreased after recovery1b,c has been convincingly demonstrated. Knowledge is incomplete, however, in regard to the mechanisms involved in creating and in disposing of the increased circulating volume of erythrocytes and plasma during the different stages of congestive failure. In the present investigation the reticulocyte percentage, red cell fragility, serum bilirubin and urinary and fecal excretion of pigment were studied in a series of patients at intervals during the height of, and recovery from, congestive heart failure; these findings were related to the observed changes in blood volume and clinical status. METHODS The total blood volume, plasma and circulating red blood cell mass were ascertained by means of Evans blue dye and the photoelectric colorimeter, as described by Gibson and Evans2 and Gibson and Evelyn.3 Measurements were made soon after the patient's admission to the hospital and References 1. Rowntree, L. G., and Brown, G. E.: The Volume of the Blood and Plasma in Health and Disease , Philadelphia, W. B. Saunders Company, 1929. 2. Schurmeyer, A.: Ueber Blutmengenbestimmungen bei Herzfehlern , Verhandl. d. deutsch. Gesellsch. f. inn. Med. 40:388, 1928 3. Gibson, J. G., and Evans, W. A.: Clinical Studies of the Blood Volume: III. Changes in Blood Volume, Venous Pressure and Blood Velocity Rate in Chronic Congestive Heart Failure , J. Clin. Investigation 16:851, 1937.Crossref 4. Gibson, J. G., and Evans, W. A.: Clinical Studies of the Blood Volume: I. Clinical Application of a Method Employing the Azo Dye "Evans Blue" and the Spectro-Photometer , J. Clin. Investigation 16:301, 1937.Crossref 5. Gibson, J. G., and Evelyn, K. A.: Clinical Studies of the Blood Volume: IV. Adaptation of the Method to Photoelectric Microcolorimeter , J. Clin. Investigation 17:153, 1938.Crossref 6. Rourke, M. D., and Ernstene, A. C.: A Method for Correcting the Erythrocyte Sedimentation Rate for Variations in the Cell Volume Percentage of Blood , J. Clin. Investigation 8:545, 1930.Crossref 7. Daland, G. A., and Worthley, K.: The Resistance of Red Blood Cells to Hemolysis in Hypotonic Solutions of Sodium Chloride , J. Lab. & Clin. Med. 20:1122, 1935. 8. Moritz, F., and von Tabora, D.: Ueber eine Methode, beim Menschen den Druck in oberflächlichen Venen exakt zu bestimmen , Deutsches Arch. f. klin. Med. 98:475, 1910. 9. Malloy, H. T., and Evelyn, K. A.: The Determination of Bilirubin with the Photoelectric Colorimeter , J. Biol. Chem. 119:481, 1937. 10. Watson, C. J.: Studies of Urobilinogen: I. Improved Method of Quantitation , Am. J. Clin. Path. 6:458, 1936. 11. Gibson, J. G., and Evans, W. A.: Clinical Studies of the Blood Volume: II. The Relation of Plasma and Total Blood Volume to Venous Pressure, Blood Velocity Rate, Physical Measurements, Age and Sex in Ninety Normal Humans , J. Clin. Investigation 16:317, 1937. 12. Watson, C. J.: Studies of Urobilinogen: II. Urobilinogen in the Urine and Feces of Subjects Without Evidence of Disease of the Liver or Biliary Tract , Arch. Int. Med. 59:196 ( (Feb.) ) 1937. 13. Blumgart, H. L., and Weiss, S.: Studies on the Velocity of Blood Flow: V. The Physiological and Pathological Significance of the Velocity of Blood Flow , J. Clin. Investigation 4:199, 1927. 14. Watson 10 15. Watson, C. J.: Studies of Urobilinogen: III. The Per Diem Excretion of Urobilinogen in the Common Forms of Jaundice and Disease of the Liver , Arch. Int. Med. 59:206 ( (Feb.) ) 1937. 16. Ehrstrom, M. C.: Blutstoffwechsel und Urobilinurie bei Herzinsuffizienz , Acta med. Scandinav. 88:517, 1936. 17. Heilmeyer, L., and Oetzel, W.: Blutfarbstoffwechselstudien: II. Ergebnisse bei Gersunden, Diätversuche. Der Blutfarbstoffwechsel im Hunger , Deutsches Arch. f. klin. Med. 171:365, 1931. 18. Weiss, M.: Ueber Urobilin und seine diagnostische Verwertung , Wien. Arch. f. inn. Med. 20:38, 1930. 19. Ham, T. H.: Studies on Destruction of Red Blood Cells: I. Chronic Hemolytic Anemia with Paroxysmal Nocturnal Hemoglobinuria; an Investigation of the Mechanism of Hemolysis, with Observations on Five Cases , Arch. Int. Med. 64:1271 ( (Dec.) ) 1939. 20. Jolliffe, N.: Liver Function in Congestive Heart Failure , J. Clin. Investigation 8:419, 1930. 21. Watson.13 22. Weiss.16 23. Fishberg, A. M.: Heart Failure , Philadelphia, Lea & Febiger, 1937. 24. Keefer, C. S., and Resnick, W. H.: Jaundice Following Pulmonary Infarction in Patients with Myocardial Insufficiency: I. A Clinical Study , J. Clin. Investigation 2:375, 1926. 25. Francescon, M.: Comportamento della resistenza osmotica die globuli rossi e del ricambio emoglobinico nei cardiopazienti in fase acuta di scompenso e in fase compensatoria , Minerva med. 37:255, 1936. 26. Greenthal, R. M., and O'Donnell, W. S.: Studies on the Fragility of the Red Blood Cells , Am. J. Physiol. 58:271, 1921. 27. Waller, J. V.: Cause of Increased Fragility of Erythrocytes in Congestive Heart Failure , Proc. Soc. Exper. Biol. & Med. 42:64, 1939. 28. Szour, M., and Bergenbaum, C.: Retikulozytenuntersuchungen bei Lungentuberkulose , Wien. klin. Wchnschr. 47:1583, 1934. 29. Barcroft, J.; Binger, C. A.; Bock, A. V.; Boggart, J. H.; Forbes, H. S.; Harrop, G.; Meakins, J. C., and Redfield, A. C.: Report to the Peru High-Altitude Committee: VIII. Observations upon the Effect of High Altitude on the Physiological Processes of the Human Body, Carried Out in the Peruvian Andes, Chiefly Cerro de Pasco , Phil. Tr. Roy. Soc. London 211:350, 1923.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Dec 1, 1940

References