title: Impairment of blood rheology by cholestatic jaundice in human beings.
abstract: Bilirubin and bile acids may affect erythrocytes. We investigated blood viscosity and erythrocyte structure in patients with cholestatic jaundice ex vivo and studied the short-term effects of bilirubin and bile acids in vitro. Seventeen patients with cholestatic jaundice and controls were studied. Whole-blood viscosity (adjusted hematocrit 45%) at high (94.5 sec(-1)) and low (0.1 sec(-1)) shear rate and plasma viscosity were measured. Erythrocyte structure was assessed in wet preparations of fixed cells. In vitro whole blood was incubated with increasing concentrations of bilirubin (83% conjugated) and bile acids (cholic, lithocholic, deoxycholic, and chenodeoxycholic acid) and the abovementioned investigations were performed. In patients we observed increased whole-blood viscosity at high shear rate (5.82 +/- 0.69 vs 5.04+/- 0.27 mPa. sec, P =.0001), plasma viscosity (1.48 +/- 0.22 vs. 1.23 +/- 0.07 mPa. sec, P =.0004), and fibrinogen level (4.70 +/- 0.98 g/L vs 2.63 +/- 0.21 g/L, P < 0.001) were observed. The incubation of normal erythrocytes in patients' plasma confirmed an increase in blood viscosity at high shear rate. Erythrocytes from patients with jaundice demonstrated a slight degree of stomatocytic shape transformation (P <.0001). In vitro, bilirubin did not affect erythrocyte shape. Cholic and lithocholic acids caused a slight stomatocytic shape transformation, whereas deoxycholic acid and chenodeoxycholic acid influenced neither blood viscosity nor erythrocyte structure. Patients with cholestatic jaundice have increased whole-blood and plasma viscosity and slightly altered red blood cell shape, possibly the result of a combination of increased levels of bilirubin and bile acids plus an acute-phase reaction.
authors.affiliation: Department of Internal Medicine, Kantonsspital, Chur, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Mark
authors.forename: Roland
authors.initials: R
authors.lastname: Walter
authors.forename: John
authors.initials: J
authors.lastname: Contesse
authors.forename: Walter H
authors.initials: WH
authors.lastname: Reinhart
mesh_terms: D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D001809:Blood Viscosity; D004912:Erythrocytes / Q000473:pathology; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012709:Serum Albumin / Q000032:analysis
chemical_list: D012709:Serum Albumin; D001663:Bilirubin