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Cerebral blood-flow in polycythaemia

D J Thomas, G H du Boulay, J Marshall

    Lancet (London, England)
    |July 23, 1977
    PubMed
    Summary

    Patients with polycythaemia have significantly reduced cerebral blood-flow (CBF). Lowering haematocrit levels through venesection substantially increased CBF and reduced blood viscosity, suggesting current management targets may be too high.

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    Area of Science:

    • Neurology
    • Hematology
    • Physiology

    Background:

    • Polycythaemia is a condition characterized by an abnormally high concentration of red blood cells.
    • This can lead to increased blood viscosity and potentially impair cerebral blood-flow (CBF).
    • Current management strategies for polycythaemia aim to reduce haematocrit levels.

    Purpose of the Study:

    • To investigate the relationship between polycythaemia severity and cerebral blood-flow (CBF).
    • To assess the impact of venesection and subsequent reduction in haematocrit on CBF and blood viscosity.

    Main Methods:

    • Cerebral blood-flow (CBF) was measured in 16 patients with varying degrees of polycythaemia.
    • CBF was re-measured in 15 patients after venesection to lower haematocrit.

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  • Whole-blood viscosity was also assessed.

    • Main Results:

    • Mean CBF in polycythaemia patients was significantly lower (37.9 ml/100 g/min) than normal levels (69.1 ml/100 g/min).
    • Following venesection, a reduction in mean haematocrit from 0.536 to 0.455 was associated with a 73% increase in mean CBF and a 30% decrease in blood viscosity.
    • Low CBF was observed at haematocrit levels between 0.46 and 0.52.

    Conclusions:

    • Cerebral blood-flow is significantly impaired in patients with polycythaemia.
    • Reducing haematocrit levels through venesection improves CBF and reduces blood viscosity.
    • Current acceptable haematocrit levels in polycythaemia management may be too high, potentially compromising cerebral perfusion.