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Clinically practical blood volume assessment with fluorescein-labeled HES
E J Massey1, Pamela de Souza, George Findlay
1National Blood Service, Bristol, UK. edwin.massey@nbs.nhs.uk
Background:
Standard techniques for measuring blood volume (BV) entail administering radioactivity and human albumin. This is laborious, expensive, and impractical in acute settings. An alternative method suitable for widespread routine application was assessed.
Study Design And Methods:
Seventy-nine ambulant outpatients and 18 intensive care unit (ICU) patients were prospectively recruited. Measurements of RBC volume (RCV) and plasma volume (PV) were performed with radiochromium-labeled RBCs (51Cr), radioiodinated albumin (125I), and fluorescein-labeled HES (FITC-HES). Small molecules overestimate PV because of vascular endothelial dysfunction (ED) and increased capillary permeability; a reference value for PV was therefore derived with the RCV and Hct.
Results:
Mean PV with 125I dilution was 230 mL (SD, 185 mL) greater than that with FITC-HES in outpatients. This difference was more exaggerated, 345 mL (SD, 371 mL), in ICU patients likely to have ED. Both the PV measured with FITC-HES and the 125I dilution correlated closely with the PV derived with RCV and Hct (r = 0.950 and 0.925, respectively) in the ICU patients.
Conclusion:
FITC-HES estimates PV more accurately than 125I. FITC-HES should replace radioactive tracers for assessing BV. Comparing the estimates of PV with molecules of differing molecular weights may have clinical utility as an indicator of ED.
