Investigation of intravascular haemolysis during treatment of acute stroke with intravenous glycerol.
1. In patients with acute strokes entering a large ongoing randomised double-blind controlled trial of intravenous glycerol therapy, the extent and pathogenesis of any ensuing haemolysis were evaluated using standard clinical investigations and in vitro techniques. 2. Twenty patients received 10% glycerol in saline (500 ml over 4 h on 6 consecutive days) and 15 received corresponding control treatment with saline. 3. Intravascular haemolysis was evident after the first infusion; compared with the controls the glycerol group had i) a greater mean reduction in serum haptoglobin concentration (P less than .05), and ii) a greater proportion exhibiting haemoglobinaemia (P = 0.03). 4. After 6 days of glycerol treatment, the mean reduction in haemoglobin concentration was only 0.8 g more than in controls; this difference being neither clinically nor statistically significant. 5. Glycerol therapy was not associated with haemoglobinuria, renal insufficiency or disseminated intravascular coagulation. 6. Exposure of red blood cells to 1-10% glycerol in vitro did not induce haemolysis per se; on re-exposure to lower concentrations lysis ensued provided a minimum osmotic gradient was present. 7. Whilst taking standard dosage regimes of glycerol, the stroke patients we studied manifested a degree of intravascular haemolysis but its consequences were not clinically significant; lysis probably ensued after venous blood acquiring high glycerol concentrations mixed with blood containing little or no glycerol.
Kumana
C R
CR
Department of Medicine, University of Hong Kong.
Chan
G T
GT
Yu
Y L
YL
Lauder
I J
IJ
Chan
T K
TK
Kou
M
M
D000208:Acute Disease; D000368:Aged; D001777:Blood Coagulation / Q000187:drug effects; D002561:Cerebrovascular Disorders / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D005990:Glycerol / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006242:Haptoglobins / Q000378:metabolism; D006454:Hemoglobins / Q000378:metabolism; D006461:Hemolysis / Q000187:drug effects*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D011517:Prothrombin Time; D011897:Random Allocation
D006242:Haptoglobins; D006454:Hemoglobins; D005990:Glycerol