Effect of obesity on red cell mass results

Measurement of red cell mass with isotope dilution remains an important diagnostic test in the evaluation of patients with suspected polycythemia vera (PCV). Results and reference ranges are typically expressed in units normalized for body weight (mL/kg). Obesity is common in polycythemic patients, and it is important to know how the various published normative ranges compare across a wide range of body weights.

We retrospectively reviewed 51 consecutive patients referred for red cell mass determination with 51Cr red blood cell dilution. Results were expressed in milliliters per kilogram (mL/kg) by using the actual patient weight and after adiposity adjustments using ideal body weight, body mass index (BMI) and combinations of height-weight, including body surface area. Results were classified as normal, elevated or PCV.

There was a high prevalence of obesity in our population (28/51 [55%] with BMI > 27 kg/m2, BMI range 16.0-54.8 kg/m2). The method used to compensate for obesity had a dramatic effect on the derived red cell mass, the fraction of patients with elevated measurements and the fraction of patients meeting criteria for PCV. Concordance for categorization as normal, elevated or PCV by all methods was only 47.1%.

Obesity is a common confounding factor in the interpretation of red cell mass measurements. Currently published reference ranges generate inconsistent results when extrapolated to obese patients. Further normative data on obese subjects are needed to determine which method (if any) is optimal.