EFFECTS OF INCREASING BLOOD HEMOGLOBIN LEVELS ON SYSTEMIC HEMODYNAMICS OF ACUTELY ANEMIC CIRRHOTIC-PATIENTS

Background/Aims: In experimental portal hypertension, blood hemoglobin levels have been shown to influence the hyperdynamic circulatory stat e. The aim of this study was to assess the hemodynamic effects of incr easing hemoglobin concentration in human portal hypertension. Methods: Sixteen cirrhotic patients recovering from a variceal bleeding episod e were randomly assigned to receive two units of packed red cells or 5 00 ml of a protein solution, Systemic and portal hemodynamics, and rhe ological and hormonal parameters were measured at baseline and after e xpansion. Results: Both groups were similar with respect to the degree of liver failure, severity of the bleeding episode, activation of the endogenous vasopressor systems, and hemodynamic parameters. The admin istration of either erythrocytes or a protein solution prompted a simi lar increase in total blood volume and suppression of vasopressor syst ems, Both groups of patients experienced similar increases in wedged h epatic venous pressure. Hepatic venous pressure gradient was not signi ficantly modified but tended to increase in erythrocyte-transfused pat ients. Cardiopulmonary pressures increased, but this increment was sig nificant in the non-blood-trans-fused patients only Cardiac output dec reased in erythrocyte-transfused patients, while it increased in the g roup receiving a protein solution. Red blood cell transfusion resulted in an increase in systemic vascular hindrance (resistance/blood visco sity), whereas the administration of a protein solution prompted a dec rease in this parameter, thus reflecting true vasoconstriction and vas odilation, respectively. Conclusions: An increase in blood hemoglobin in acutely anemic cirrhotic patients attenuates their hyperdynamic cir culation beyond viscosity-dependent changes, an effect which might be counteracted by the effects on portal venous pressure gradient.