Erythrocyte deformability in morbid obesity before bariatric surgery. Influence of abdominal obesity.

Although there are several studies dealing with erythrocyte deformability (ED) in obese patients, research on this topic in morbidly obese subjects is scarce. In these studies ED seems to be decreased, although the cause remains unknown. A case-control study in 76 morbid obese subjects (23 women and 53 men, aged 44 ± 13 years) and in 79 normal-weight controls (30 women and 49 men, aged 43 ± 13 years) was undertaken. ED has been determined by ektacytometric techniques in a Rheodyn SSD, by means of the elongation index (EI) at 12, 30 and 60 Pascals, along with anthropometric, lipidic, metabolic and inflammatory parameters. EI was statistically lower in morbidly obese subjects than in controls…

Influence of lipids and obesity on haemorheological parameters in patients with deep vein thrombosis.

It is not well established whether haemorheological alterations constitute independent risk factors for deep vein thrombosis (DVT).We have determined in 149 DVT patients and in 185 control subjects the body mass index (BMI), the haemorheological profile: blood viscosity (BV), plasma viscosity (PV), fibrinogen (Fg), erythrocyte aggregation (EA), erythrocyte deformability (ED) and plasma lipids. In the crude analysis BMI, Fg, PV, EA, triglycerides (TG) and ApoB were statistically higher and HDL cholesterol (HDL-Chol) statistically lower in DVT patients than in controls. No differences in BV and ED were observed.After BMI adjustment, Fg, PV and EA remained statistically higher in DVT cases tha…

Rheological blood behavior is not only influenced by cardiovascular risk factors but also by aging itself. Research into 927 healthy Spanish Mediterranean subjects.

It is not well-established whether the alterations that the hemorheological profile undergoes with aging are an effect of concomitant cardiovascular risk factors or are due to age itself. To clarify this issue, we investigated the effect of age on blood rheology in a population of 927 healthy subjects from eastern Spain aged between 16-85 years, divided into four age groups (<30, 30-44, 45-50, ≥60 years) with and without cardiovascular risk factors. We determined blood viscosity, corrected blood viscosity (BVc), plasma viscosity (PV), erythrocyte aggregation (EA), erythrocyte deformability (EEI60) and fibrinogen, along with glucose and plasma lipids. We found that corrected blood viscosity …

Thrombotic events in systemic lupus erythematosus. Its association with acquired and inherited thrombophilic defects.

Systemic lupus erythematosus (SLE) is characterised by increased venous and arterial thrombotic risk. Although antiphospholipid antibodies (APAs) have been shown to be related with thrombotic tendency in these patients, in more than 40% of them, thrombosis occurs without the presence of such antibodies. We analysed the association of venous and arterial thrombotic events with acquired (anticardiolipin antibodies (ACAs) and lupus anticoagulant (LA)) and inherited (antithrombin (AT), protein C (PC), protein S (PS) deficiencies, factor V Leiden and the prothrombin G20210A mutation), thrombophilic risk factors in 86 SLE patients and 89 healthy controls. Patients showed a higher significant perc…

Erythrocyte Membrane Phosphatidylserine Exposure in Obesity

It has been suggested that increased erythrocyte membrane phosphatidylserine (PS) exposure could contribute to hypercoagulability and hemorheological disturbances in obesity. The aim of our study was to evaluate PS exposure in obese patients and in a control group and to correlate this with hemorheological properties, i.e., erythrocyte aggregability (EA) and deformability, and to evaluate the effect of weight loss on these parameters. An anthropometric and analytical evaluation was performed at baseline and after 3 months on a diet (very low-calorie diet for 4 weeks and low-calorie diet for 2 months) on 49 severe or morbid obese patients (37 women, 12 men) and 55 healthy volunteers (39 wome…

Estudio prospectivo de los factores de riesgo y las características clínicas de la enfermedad tromboembólica en pacientes jóvenes

Fundamento y objetivo El objetivo del presente trabajo es el estudio de los factores de riesgo de la enfermedad tromboembolica en pacientes jovenes y la descripcion de sus caracteristicas clinicas segun la etiologia Pacientes y metodo Estudio prospectivo de 100 pacientes menores de 50 anos, no afectados de neoplasias ni enfermedades cronicas, que requirieron ingreso hospitalario por enfermedad tromboembolica. El diagnostico morfologico se realizo con eco-Doppler, flebografia, gammagrafia pulmonar o tomografia computarizada. Los factores de riesgo valorados fueron deficit de antitrombina, deficit de proteina C y S, factor V Leiden, protrombina G20210A, hiperhomocisteinemia, elevacion del inh…

α-Thalassemia Does Not Seem to Influence Erythrocyte Deformability in Sickle Cell Trait Carriers

Studies dealing with rheological red blood cell (RBC) behavior in sickle cell trait carriers are scarce. Moreover, the association with α-thalassemia (α-thal), which also modifies erythrocyte behavior, has not always been taken into account. We analyzed erythrocyte deformability by means of a shear stress diffractometer, along with hematological and biochemical parameters (glucose and plasma lipids), given their possible influence on erythrocyte deformability, in 14 sickle cell trait carriers and 23 healthy controls. Nine patients were also α-thal carriers and five were not. Among the thalassemia carriers, eight were heterozygous and one was homozygous. When compared with controls, sickle c…

Association of erythrocyte deformability with red blood cell distribution width in metabolic diseases and thalassemia trait.

Abstract Increased red blood distribution width (RDW) in anemia is related to disturbances in the cellular surface/volume ratio, usually accompanied by morphological alterations, while it has been shown in inflammatory diseases that the activity of pro-inflammatory cytokines disturbing erythropoiesis increases RDW. Recently it has been reported that higher RDW is related with decreased erythrocyte deformability, and that it could be related with the association of RDW and increased risk of cardiovascular diseases. In order to analyze the influence of morphological alterations and proinflammatory status on the relationship between RDW and erythrocyte deformability, we analyzed erythrocyte de…

Haemorheological parameters in young patients with acute myocardial infarction

The role played by hemorheological alterations on acute myocardial infarction (AMI) in young patients remains a question of debate. We have carried out a case-control study of 84 AMI patients aged45 years and 135 sex and age matched controls, in which blood viscosity (BV), plasma viscosity (PV), erythrocyte aggregation (EA) performed with the Myrenne (EA0, EA1) and the Sefam aggregometer (Ta, AI10, gammaD), erythrocyte deformability (ED) along with fibrinogen (Fbg), C-reactive protein (CRP) and plasmatic lipids i.e. total cholesterol (T-Chol) and triglycerides (TG) were determined. AMI patients showed higher, Fbg, TG, EA0, EA1, IA10, gammaD and lower Ta than controls (p=0.029, p0.001, p=0.0…

Erythrocyte deformability in macrocytosis determined by means of ektacytometry techniques

There is little information regarding the behaviour of red blood cell deformability in macrocytosis. We have determined in 114 patients with macrocytosis (MCV > 97 fL) and in 115 age and sex-matched subjects with normocytosis (VCM < 97 fL) erythrocyte deformability by means of ektacytometric techniques (Rheodyn SSD) measuring the erythrocyte elongation index (EEI) at 12, 30 and 60 Pa. Patients with macrocytosis showed statistically higher EEI at all the shear stresses tested when compared with controls (p < 0.001). When patients with macrocytosis were classified according to their main diagnosis as hepatic or renal disease, HIV and miscellaneous, 66.7%, 41.7%, 36.7% and 33.3% of patients, r…

Hyperhomocysteinemia and the methylene tetrahydrofolate reductase C677T mutation in splanchnic vein thrombosis

Introduction: The role that hyperhomocysteinemia (HH) and the C677T mutation in 5,10-methylenetetrahydrofolate reductase (MTHFR) play in splanchnic vein thrombosis (SVT) remains unclear due to this unusual thrombotic location. Objective: To analyse the possible association of HH with the C677T mutation in the MTHFR gene in SVT. Material and methods: We determined homocysteine levels and the C677T MTHFR mutation, along with classical cardiovascular risk factors, in 48 patients with SVT (18 Budd-Chiari syndrome, 11 mesenteric vein thrombosis, 19 portal vein thrombosis) and 84 controls. Results: In the univariate analysis, patients with SVT showed statistically higher homocysteine levels (P = …

Association of metabolic syndrome and its components with hyperuricemia in a Mediterranean population.

Several studies have found an association between hyperuricemia and metabolic syndrome (MS), although there are discrepancies as to which MS components play a pivotal role in this association. We aimed to investigate the association between serum uric acid (SUA) levels and MS in a Mediterranean population (eastern Spain). We performed a case-control study of 71 patients with MS and 122 healthy controls. MS was defined according to the revised National Cholesterol Education Program Adult Treatment Panel III modified criteria. Hyperuricemia was defined as SUA levels >6.55 mg/dL. We determined biochemical, lipidic and inflammatory parameters along with uric acid. Patients with MS showed a high…

The lipid composition of red blood cells and their hemorheological behavior in patients with primary hyperlipoproteinemia

Influence of lipids on blood and plasma viscosity.

Amparo Vayaa,∗, Cristina Gimeneza, Rafael Alisb,c, Julian Muradoa and Oscar Fustera aHemorheology and Haemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain bResearch Universitary Institute “Dr. Vina Giner”, Molecular and Mitochondrial Medicine, Catholic University of Valencia “San Vicente Martir”, Valencia, Spain cFaculty of Medicine, Catholic University of Valencia “San Vicente Martir”, Valencia, Spain

Red blood cell distribution width is not related with inflammatory parameters in morbidly obese patients

Red blood cell distribution width (RDW) is a hematological parameter that has been studied in several clinical settings and has been found to be related to both anemia and inflammatory status. As obesity is related to increased inflammatory pattern, we aimed to analyze the RDW in this setting.We determined hematological and inflammatory parameters in morbidly obese patients before bariatric surgery (n=142) and normo-weight controls (n=144).RDW was higher in patients than in controls (p0.001), along with C-reactive protein (p0.001) and fibrinogen, (p0.001) while hemoglobin (p=0.026), serum iron (p0.001), MCH (p=0.002) and MCHC (p0.001) were lower in morbidly obese patients. The logistic corr…

Influence of inflammatory and lipidic parameters on red blood cell distribution width in a healthy population

Red blood cell distribution width (RDW) is a routine red blood cell count parameter which has been shown to be associated with inflammatory parameters. Recently, some authors proposed that RDW seems to be a marker of an adverse lipidic profile. In order to clarify whether RDW is related to inflammation, plasma lipids, or both, we determined anthropometric, hematimetric, inflammatory and lipidic parameters in 1111 healthy subjects. RDW correlated directly with age, body mass index (BMI), inflammatory parameters (plasma viscosity, erythrocyte sedimentation rate (ESR), fibrinogen, leukocyte and neutrophil count), and inversely with iron and hematimetric parameters (P  0.05). When subjects were…

Homocysteine levels in morbidly obese patients: its association with waist circumference and insulin resistance.

The association between morbid obesity and hyperhomocysteinemia (HH) remains controversial and the nature of this relationship needs to be clarified as several metabolic, lipidic, inflammatory and anthropometric alterations that accompany morbid obesity may be involved. In 66 morbidly obese patients, 47 women and 19 men aged 41 ± 12 years and 66 normo-weight subjects, 43 women and 23 men, aged 45 ± 11 years, we determined homocysteine (Hcy) levels along with lipidic, anthropometric, inflammatory and insulin resistance markers. In addition, we investigated the effect of Metabolic Syndrome (MS) and its components on Hcy levels. Obese patients had statistically higher Hcy levels than controls:…

Plasma viscosity and related cardiovascular risk factors in a Spanish Mediterranean population

Plasma viscosity (PV) constitutes an independent important predictor of initial and recurrent cardiac events and mortality. It has been suggested that there is a geographical variation in PV values related to coronary event rates. Little information exists regarding PV in Spain. Therefore, our objective was to determine PV in a large sample of randomly selected subjects from the Spanish population and to study which demographic or cardiovascular risk factors (CVRF) influence levels of PV in this population.1277 subjects (503 males, 774 females) aged 43+/-14 years (range: 20-70) were randomly selected from an Eastern Spanish population. These subjects were free of cardiovascular diseases and…

Rheological blood behaviour is not related to gender in morbidly obese subjects.

To the Editor. We have read with interest the recently published article by Wiewiora et al. [7] regarding hemorheological differences related to gender in morbidly obese subjects. In this study authors found several hemorheological differences between male and female. In this sense, males showed higher blood viscosity and higher erythrocyte deformability than females and native blood viscosity correlated with several erythrocyte aggregation parameters evaluated with the Laser-Assisted Optical Rotational Cell Analyser (LORCA) [3]. In studies with small sample sizes (18 men and 20 women) there is always the risk that differences in certain variables may appear by chance or by imbalances in th…

Erythrocyte aggregation in homozygous sickle cell disease

Amparo Vayaa,∗, Susana Colladoa, Rafael Alisb,c and Maria-Angeles Dasid aHemorheology and Haemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain bResearch Universitary Institute “Dr. Vina Giner”, Molecular and Mitochondrial Medicine, Catholic University of Valencia, “San Vicente Martir”, Valencia, Spain cFaculty of Medicine, Catholic University of Valencia “San Vicente Martir”, Valencia, Spain dPediatry Service, La Fe University Hospital, Valencia, Spain

Hyperhomocysteinemia, obesity and cryptogenic stroke

BACKGROUND: The pathogenic role of hyperhomocysteinemia in cryptogenic stroke is not well established. We aimed to determine homocysteine levels in patients with cryptogenic stroke considering the possible variables that may act as confounders and analyze the influence of obesity on this association. PATIENTS AND METHODS: We conducted a case-control study in 123 patients with cryptogenic stroke aged 42 ± 12 years and in 153 control subjects aged 42 ± 13 years. Serum homocysteine was determined by fluorescence polarization immunoassay. RESULTS: Patients showed statistically higher levels of homocysteine, creatinine and higher BMI than controls (p = 0.045, p = 0.014, p = 0.013), respectively.…

Metabolic alterations in morbid obesity. Influence on the haemorheological profile.

There are few studies on haemorheological disturbances in morbidly obese patients. The role played by the metabolic syndrome on the rheological profile of morbidly obese subjects has not yet been established, and it is not clear whether morbidly obese, but "metabolically healthy", show rheological alterations. We aimed to determine the whole rheological profile in 136 morbidly obese patients and 136 normo-weight volunteers, along with plasma lipids, inflammatory and insulin resistance parameters. Patients had statistically higher glucose, triglycerides, HbA1c, leptin, insulin, HOMA, CRP, leucocytes, fibrinogen, plasma viscosity (p0.001, respectively), erythrocyte aggregation at 3 s-1 (p = 0…

Hemorheological profile in primary and secondary Raynaud's phenomenon. Influence of microangiopathy.

Raynaud's phenomenon (RP) is an episodic peripheral circulatory disorder characterized by local artery spams in subjects exposed to cold or emotional stress. It is not well-established whether RP patients show an altered rheological profile, mostly due to patient classification and clinical severity. We aimed to compare the hemorheological profile in patients with primary and secondary RP with a healthy control group. Eighteen primary RP, 22 secondary RP and 22 healthy controls, were included in the study. RP patients were also divided according to the presence of digital ulcers (7 with, 33 without). Biochemical and hemorheological variables were analyzed, including glucose, triglycerides, …

Reply to "The association of red blood cell distribution width and morbid obesity" by Aydin et al.

We thank Aydin & cols. for their comments about our recently published paper “Red blood cell distribution width is not related with inflammatory parameters in morbidly obese patients” in Clinical Biochemistry Journal [1]. The authors show their concern about the clinical interpretation of our findings since we did not report folate and B12 vitamin levels. Moreover, they state that we should demonstrate the elimination of thrombocytopenic diseases by showing platelet count data. Aswe state in the paper, exclusion criteria for obese patients included “organic, malignant, hematological, infectious or inflammatory disease”. Therefore, any case of thrombocytopenic disease was not included. Moreo…

RDW in patients with systemic lupus erythematosus. Influence of anaemia and inflammatory markers

Red blood cell distribution width (RDW) is a routine parameter that reflects size variations in erythrocytes. High RDW has been associated with cardiovascular events and inflammatory diseases. However, no studies evaluating the association of RDW with systemic lupus erythematosus (SLE) have been published. We aimed to explore the association of RDW with inflammatory markers in SLE. As SLE is often associated with anaemia, we considered this factor in order to know whether RDW is related with inflammation, anaemia or both in SLE. The study included 105 SLE patients (7 men, 98 women; aged 15-73 years) and 105 controls (9 men, 96 women; aged 18-71 years). Patients were divided according to ana…

Are abdominal obesity and body mass index independent predictors of hemorheological parameters?

There is an association between obesity and rheological blood behavior [2, 4–7]. In this sense we have read with interest the recently published article by Brun et al. [1] in this journal. The authors evaluate, in a population of 430 subjects, the relationship between abdominal obesity and body mass index (BMI) with blood viscosity, and conclude that both anthropometric parameters are associated with increased blood viscosity but by different mechanisms, where the waist to hip ratio is a better predictor for blood viscosity than BMI. It is striking that in this study the authors do not indicate the variables included in the stepwise multivariate regression model, where plasma lipids, glucos…

Homocysteine levels and the metabolic syndrome in a Mediterranean population: A case-control study

Hyperhomocysteinemia (HH) and metabolic syndrome (MS) are associated with increased cardiovascular risk. However, whether there is a link between MS or its components and homocysteine levels in a population without cardiovascular disease is not well established. We conducted a case-control study in 61 MS patients (41 males, 20 females, aged 51 ± 11 years) and in 98 controls without MS (59 males, 39 females, aged 50 ± 10 years) to ascertain the association between MS and HH, and with inflammatory markers. MS was classified according to the updated ATPIII criteria [17]. No differences in homocysteine levels were observed when comparing MS patients and controls (12.0 ± 3.18 μM vs. 11.9 ± 3.5 μ…

Homocysteine levels in patients with primary and secondary Raynaud's phenomenon. Its association with microangiopathy severity

The association between hyperhomocysteinemia (HHcy) and Raynaud's phenomenon (RP) remains a matter of debate. In 18 primary RP, 23 secondary RP and 41 controls, we investigated homocysteine (Hcy) levels along with biochemical and inflammatory parameters. The Hcy levels in both primary and secondary RP were elevated when compared with controls (p0.05 and p0.01, respectively). As age was higher in secondary RP as compared with controls (p0.01), both primary and secondary RP were age-matched with a corresponding control group, and with Hcy maintaining its statistical significance (p0.05). No differences in creatinine, B12 vitamin or folic acid were observed between groups (p0.05), or in the pr…

Lack of association between hemorheological alterations and upper-extremity deep vein thrombosis.

Introduction: There is an association between rheological alterations and lower extremity deep vein thrombosis, although no research has been carried out regarding the possible influence of rheological alterations in the development of venous thrombosis in the upper limbs. Materials and methods: We have determined in 54 patients (23 male, 31 female; aged 35 ± 11 years) with primary upper extremity deep vein thrombosis (UEDVT), and in a well matched control group of 87 subjects (41 male, 46 female; aged 36 ± 12 years) the rheological profile (blood viscosity, plasma viscosity, fibrinogen, erythrocyte aggregation, erythrocyte de- formability) along with plasma lipids (total cholesterol and tr…