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Neonatology pp 593-598 | Cite as

Polycythemia and Hyperviscosity

  • Otwin Linderkamp

Abstract

The term hyperviscosity cannot be understood without some knowledge of how blood viscosity is defined and measured. Viscosity (V) is a flow property defined as resistance (R) to the movement of blood: R = VZ, where Z is the resistance resulting from the vessel geometry [1]. Blood viscosity is usually measured in flow devices with fixed geometry (e.g., in a rotational viscometer with a defined gap or in a tube viscometer with defined tube diameter and length). In these devices, the blood flow resistance increases linearly with the blood viscosity, and blood flow resistance is measured as pressure (P) or force required to achieve a defined blood flow (F) in the device (V ≈ R = P/F). Blood viscosity decreases with increasing shear forces due to red blood cell (RBC) aggregation at low shear rates and ellipsoidal deformation of RBCs at high shear. In tube viscometers with diameters below 300 μ, blood viscosity decreases linearly with decreasing tube diameter. Without this so called Fahraus-Lindqvist effect, blood with a hematocrit of 50% and higher could probably not pass through arterioles and capillaries with diameters below 50 µm.

Keywords

Blood Viscosity Necrotizing Enterocolitis Exchange Transfusion Plasma Viscosity Diabetic Mother 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Linderkamp O (2007) Hemorheology of the fetus and neonate. In: Baskurt OK, Hardeman MR, Rampling MW, Meiselman HJ (eds) Handbook of hemorheology and hemodynamics, Vol 69 Biomedical and Health Research. IOS Press, AmsterdamGoogle Scholar
  2. 2.
    Anwar MA, Rampling MW, Bignall S, Rivers RP (1994) The variation with gestational age of the rheological properties of the blood of the new-born. Br J Haematol 86: 163–168PubMedCrossRefGoogle Scholar
  3. 3.
    Linderkamp O (2004) Blood viscosity of the neonate. Neoreview 5: e406–e416CrossRefGoogle Scholar
  4. 4.
    Buonocore G, Bernie S, Gioia D et al (1991) Whole blood filterability in the neonate. Clin Hemorheol 11: 41–48Google Scholar
  5. 5.
    Linderkamp O, Kiau U, Ruef P (1997) Cellular and membrane deformability of red blood cells in preterm infants with and without growth retardation. Clin Hemorheol Microcirc 17: 279–283PubMedGoogle Scholar
  6. 6.
    Linderkamp O, Nash GB, Wu PYK, Meiselman HJ (1986) Deformability and intrinsic material properties of neonatal red blood cells. Blood 67: 1244–1250PubMedGoogle Scholar
  7. 7.
    Katoh S, Yamamoto K, Kitao M (1992) Fetal erythrocyte deformability in hypoxia during delivery. Clin Hemorheol 12: 297–308Google Scholar
  8. 8.
    Munoz A, Uberos J, Bonillo A et al (1994) Plasma and internal erythrocyte viscosity in umbilical artery and vein of premature infants with and without acute asphyxia. Clin Hemorheol 14: 75–82Google Scholar
  9. 9.
    Linderkamp O, Poeschl J, Ruef P (2006) Blood cell deformation in neonates who have sepsis. Neoreview 7: e517–e523CrossRefGoogle Scholar
  10. 10.
    Ruef P, Linderkamp O (1999) Deformability and geometry of neonatal erythrocytes with irregular shapes. Pediatr Res 45: 114–119PubMedCrossRefGoogle Scholar
  11. 11.
    Linderkamp O, Stadler AA, Zilow EP (1992) Blood viscosity and optimal hematocrit in preterm and full-term neonates in 50- to 500- μm tubes. Pediatr Res 32: 97–102PubMedCrossRefGoogle Scholar
  12. 12.
    Ramamurthy RS, Berlanga MB (1987) Postnatal alteration in hematocrit and viscosity in normal and polycythemic infants. J Pediatr 110: 929–934PubMedCrossRefGoogle Scholar
  13. 13.
    Carmi D, Wolach B, Dolfin T, Merlob P (1992) Polycythemia of the preterm and full-term newborn infant: relationship between hematocrit and gestational age, total blood solutes, reticulocyte count, and blood pH. Biol Neonate 61: 173–178PubMedCrossRefGoogle Scholar
  14. 14.
    Linderkamp O, Nelle M, Kraus M, Zilow EP (1992) The effect of early and late cord-clamping on blood viscosity and other hemorheological parameters in full-term neonates. Acta Paediatr 81: 745–750PubMedCrossRefGoogle Scholar
  15. 15.
    LeBlanc MH, Pate K (1986) Hyperviscosity in the newborn: the scope of the problem. Bull N Y Med 62: 324–335Google Scholar
  16. 16.
    Werner EJ (1995) Neonatal polycythemia and hyperviscosity. Clin Perinatol 22: 693–710PubMedGoogle Scholar
  17. 17.
    Rosenkrantz TS (2004) Polycythemia and hyperviscosity in the newborn. Semin Thromb Hemost 29: 515–527Google Scholar
  18. 18.
    Pappas A, Delaney-Black V (2004) Differential diagnosis and management of polycythemia. Pediatr Clin North Am 51: 1063–1086PubMedCrossRefGoogle Scholar
  19. 19.
    Linderkamp O (1982) Placental transfusion: determinants and effects. Clin Perinatol 9: 559–592PubMedGoogle Scholar
  20. 20.
    Philip AGS, Saigal S (2004) When should we clamp the umbilical cord? NeoReview 5: e142–e154CrossRefGoogle Scholar
  21. 21.
    Nelle M, Zilow EP, Kraus M et al (1993) The effect of Leboyer delivery on blood viscosity and other hemorheological parameters in term neonates. Am J Obstet Gynecol 169: 189–193PubMedGoogle Scholar
  22. 22.
    Hutton EK, Hassan ES (2007) Late vs early clamping of the umbilical cord in full-term neonates. Systematic review and metaanalysis of controlled trials. JAMA 297: 1241–1252PubMedCrossRefGoogle Scholar
  23. 23.
    Linderkamp O, Bauer J, Noecker-Ribaupierre M, Riegel KP (2004) Neonatal polycythemia resulting from late cord-clamping does not cause developmental or neurologic sequelae. Pediatr Res 56: 490Google Scholar
  24. 24.
    Capasso L, Raimondi F, Capasso A et al (2003) Early cord clamping protects at-risk neonates from polycythemia. Biol Neonate 83: 197–200PubMedCrossRefGoogle Scholar
  25. 25.
    Merlob P, Litmanovitch I, Mor N et al (1990) Necrotizing enterocolitis after intravenous immunoglobulin treatment for neonatal isoimmune thrombocytopenia. Eur J Pediatr 149: 432–433PubMedCrossRefGoogle Scholar
  26. 26.
    Linderkamp O, Versmold HT, Riegel KP, Betke K (1984) Contributions of red cells and plasma to blood viscosity in preterm and full-term infants and adults. Pediatrics 74: 45–51PubMedGoogle Scholar
  27. 27.
    Klipp M, Holzwarth AU, Poeschl J et al (2007) Effects of erythropoietin on erythrocyte deformability in non-transfused preterm infants. Acta Paediatr 96: 253–256PubMedCrossRefGoogle Scholar
  28. 28.
    Holzman IR, Tabata B, Edelstone DI (1986) Blood flow and oxygen delivery to the organs of the neonatal lamb as a function of hematocrit. Pediatr Res 20: 1274–1279PubMedCrossRefGoogle Scholar
  29. 29.
    Mandelbaum VHA, Guajardo CD, Nelle M, Linderkamp O (1994) Effects of polycythaemia and haemodilution on circulation in neonates. Arch Dis Childh 71: F53–F54Google Scholar
  30. 30.
    Liem KD, Hopman JC, Oeseburg B et al (1997) The effect of blood transfusion and haemodilution on cerebral oxygenation and haemodynamics in newborn infants investigated by near infrared spectrophotometry. Eur J Pediatr 156: 305–310PubMedCrossRefGoogle Scholar
  31. 31.
    Acunas B, Celtik C, Vatansever U, Karasalihoglu S (2000) Thrombocytopenia: an important indicator for the application of partial exchange transfusion in polycythemic newborn infants. Pediatr Int 42: 343–347PubMedCrossRefGoogle Scholar
  32. 32.
    Wiswell TE, Cornish JD, Northam RS (1986) Neonatal polycythemia: Frequency of clinical manifestations and other associated findings. Pediatrics 78: 26–30PubMedGoogle Scholar
  33. 33.
    Van der Elst CW, Molteno CD, Malan AF, Heese H (1980) The management of polycythaemia in the newborn infant. Early Hum Dev 4: 393–403CrossRefGoogle Scholar
  34. 34.
    Dempsey EM, Barrington K (2006) Short and long term outcomes following partial exchange transfusion in the polycythaemic newborn: a systematic review. Arch Dis Child Fetal Neonat Ed 91: F2–F6CrossRefGoogle Scholar
  35. 35.
    Goldberg K, Wirth FH, Hathaway WE et al (1982) Neonatal hyperviscosity II. Effect of partial plasma exchange transfusion. Pediatrics 69: 419–425PubMedGoogle Scholar
  36. 36.
    Black VD, Lubchenco LO, Koops BL et al (1985) Neonatal hyperviscosity: Randomized study of effect of partial plasma exchange transfusion on long-term outcome. Pediatrics 75: 1048–1053PubMedGoogle Scholar
  37. 37.
    Delaney-Black V, Camp BW, Lubchenco LO et al (1989) Neonatal hyperviscosity association with lower achievement and IQ scores at school age. Pediatrics 83: 662–667PubMedGoogle Scholar
  38. 38.
    Ratrisawada V, Plubrukarn R, Trachulchang K et al (1994) Developmental outcome of infants with neonatal polycythemia. J Med Assoc Thai 77: 76–80Google Scholar
  39. 39.
    Host A, Ulrich M (1982) Late prognosis in untreated neonatal polycythemia with minor or no symptoms. Acta Paediatr Scand 71: 629–633PubMedCrossRefGoogle Scholar
  40. 40.
    Bada HS, Korones SB, Pourcyrous M et al (1992) Asymptomatic syndrome of polycythemic hyperviscosity: effect of partial plasma exchange transfusion. J Pediatr 120: 579–585PubMedCrossRefGoogle Scholar
  41. 41.
    Drew JH, Guaran RL, Cichello M, Hobbs JB (1997) Neonatal whole blood hyperviscosity: the important factor influencing later neurologic function is the viscosity and not the polycythemia. Clin Hemorheol Microcirc 17: 67–72PubMedCrossRefGoogle Scholar
  42. 42.
    Scarcella A, Gambardella P (1986) Partial exchange transfusion using peripheral vessels in polycythaemic newborn infants. Eur J Pediatr 144: 545–546PubMedCrossRefGoogle Scholar
  43. 43.
    De Waal KA, Baerts W, Offringa M (2006) Systematic review of the optimal fluid for dilutional exchange transfusionin in neonatal poycythaemia. Arch Dis Child Fetal Neonat Ed 91: F7–F10CrossRefGoogle Scholar
  44. 44.
    Supapannachart S, Siripoonya P, Boonwattanasoontorn W, Kanjanavanit S (1999) Neonatal polycythemia: effects of partial exchange transfusion using fresh frozen plasma, Haemaccel and normal saline. J Med Asoc Thai 82 Suppl 1: S82–S86Google Scholar
  45. 45.
    Dollberg S, Marom R, Mimouni FB, Littner Y (2007) Increased energy expenditure after dilutional exchange transfusion for neonatal polycythemia. J Am Coll Nutr 26: 412–415PubMedGoogle Scholar
  46. 46.
    Sarkar S, Rosenkrantz TS (2008) Neonatal polycythemia and hyperviscosity. Semin Fetal Neonatal Med 13: 248–255PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • Otwin Linderkamp
    • 1
  1. 1.Division of Neonatology, Department of PediatricsUniversity of HeidelbergHeidelbergGermany

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