Cardiol Rev. 2007 Jan-Feb;15(1):31-4. Links
Blood is thicker than water: the management of hyperviscosity in
adults with cyanotic heart disease.DeFilippis AP, Law K, Curtin S,
Eckman JR.
Department of Medicine, Division of General Medicine, Emory University
School of Medicine, Atlanta, Georgia 30303, USA. [email hidden]
Complications of chronic hypoxia, including erythrocytosis,
hyperviscosity, abnormalities of hemostasis, cerebral abscesses,
stroke, and endocarditis, are among the most common consequences of
cyanotic heart disease in adults. The compensatory erythrocytosis of
cyanotic heart disease can become pathologic by causing an increase in
blood viscosity, thereby decreasing perfusion and resulting in
decreased total oxygen delivery and increased risk of venoocclusive/
hyperviscosity syndrome. Treatment of hyperviscosity secondary to
erythrocytosis in cyanotic heart disease is controversial. Data is
limited but suggest that phlebotomy has the potential to increase
exercise capacity, reduce the symptoms of hyperviscosity, and reduce
the potential risk of vasoocclusive disease in selected patients with
polycythemia secondary to cyanotic heart disease. Unfortunately,
repeated phlebotomy can quickly lead to iron deficiency, resulting in
microcytic erythrocytes that induce higher viscosity than normocytic
erythrocytes, which may increase the risk for venoocclusive events.
There are limited data on the use of hydroxyurea to suppress
erythrocytosis in this patient population. The authors conclude that
until newer approaches to decreasing hematocrit without inducing iron
deficiency are shown to be safe and efficacious, phlebotomy should
only be used for the acute resolution of hyperviscosity symptoms. In
addition, the use of hydroxyurea should be limited to patients with
recurrent symptoms.
PMID: 17172881 [PubMed - indexed for MEDLINE]
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