CLINICAL AND HEMODYNAMIC-EFFECTS OF STEPWISE LOWERING OF HEMOGLOBIN CONCENTRATION IN PATIENTS WITH INTERMITTENT CLAUDICATION

This study evaluates the effect of stepwise lowering of the hemoglobin (Hb) concentration on maximal walking distance (MWD) and hemodynamics in patients with intermittent claudication. The results in a study gr oup (n = 6) were compared with those of a control group (n = 6) whose members were not subjected to venesections. An average decrease of Hb concentration from 151 +/- 4 to 121 +/- 3 g/L did not significantly in fluence MWD, the result being 282 +/- 62 meters before venesections an d 255 +/- 54 meters after three to five (mean four) repeated venesecti ons. Transcutaneous oxygen pressure was measured at the dorsum of the foot before and after exercise and did not change with a gradual decre ase of the Hb concentration. Maximal heart rate, painfree walking dist ance, ankle pressure, and blood lactate concentration were also unchan ged. An average venesection volume of about 1.4 liters whole blood wit hin fourteen days, without isovolemic replacement, did not change the blood volume, which was 5.1 +/- 0.4 liters before and 5.0 +/- 0.5 lite rs after venesections. In conclusion, hemodilution accomplished by ven esections did not have a clinically or physiologically beneficial effe ct in patients with severe intermittent claudication. However, hemodyn amics and clinical symptoms were not affected by a considerable decrea se in the arterial oxygen content within the normal Hb concentration r ange.