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From www.bloodjournal.org by guest on August 2, 2017. For personal use only. Effect of High Concentrations of Leukocytes Blood By Whole blood leukemic that of in viscosity of leukoeytosis cell with volume suspension found to erythrocytes. tween a We the a also found no of the leukocyte count been noted.’4 To on blood viscosity leukocyte be- Thirteen patients were E. CiiRf whole of blood anemia This, ability of the The patients with elevation as well blood that viscosity. in the prevented TPCV. by leukocyte as the viscosity could greater their van- obscured have viscosity of normal been of any produced massed leuko- cytes. OF RED CELLS and plasma viscosity are the the viscosity of normal blood at high flow effect because of their relatively small numbers. elevated, the effect measured patients with changes in viscosity of blood of high concentrations of leukothe viscosity of whole blood and myeloproliferative disorders and leukemia. AND MATERIALS leukemia and increase is greatly from lymphocytic count investigate we have concentrates chronic than relation the STANLEY leukemia and viscosity AND presence total studied greaten magnitude to Leukocytes HE CONCENTRATION major factors determining rates. Leukocytes have little have cytes with similar T When STEINBERG compared (TPCV). were have Viscosity patients was normals packed H. MARTIN on Whole with various studied. METHODS myeloproliferative Leukocyte counts, disorders packed cell and volumes, chronic and lymphocytic differential counts were determined using standard hematologic techniques. Blood was anticoagulated with dried heparin or balanced oxalate. Leukocytes were separated by aspiration of the huffy coat after centrifugation and resuspended in autologous plasma. Viscosity was measured at 25#{176}Cwith a Brookfield cone and plate viscometer (RVT 0.3) between shear rates of 5 and 1500 sec-1. Controls were obtained from a normal population with similar total packed cell volume (TPCV) and plasma viscosity but without leukocytosis. The data were plotted as the square root of shear and resulted in a straight line. The slope of the apparent viscosity of blood, K2, or the minimum at high flow From the Departments Mass. Submitted Supported and Metabolic line stress vs. K, when the square root shear rate minimum to have England Medical Center Hospitals, Tufts University School of Medicine, and the Boston, blood would was of the appear viscosity squared, rate. Blood Research of Medicine Laboratory, and Physiology, New February 25, 1971; revised April 6, 1971; accepted April 7, 1971. in part by USPHS Grant AM 12444 from the National Institute of Arthritis Diseases. MARTIN H. STEINBERG, M.D.: Jackson Veterans Administration Center, Jackson, Miss.; formerly Research Fellow, Blood Research Laboratory, New England Medical Center Hospitals, Fellow of the American Cancer Society, and Research Fellow in Medicine, Tufts University School of Medicine, Boston, Mass. STANLEY E. CHAlirsi, Sc.D.: Associate Professor of Biochemistry and Scientific Director of the New England Enzyme Center, Tufts University School of Medicine, Boston, Mass. BLOOD, VOL. 38, No. 3 (SEPTEMBER), 1971 299 From www.bloodjournal.org by guest on August 2, 2017. For personal use only. 300 STEINBERG AND CHARM .540 .520 .500#{149} 0 .480 0 A .460 A 0 Fig. .440 Ci .420 A ity vs. of plasma volume normal and sub- patients leukocytic 0 viscos- cell for jects .400 blood total fraction 0 ‘ 1.-Ratio to minimum 0 with disorders. .380 0 .360 0 A .340 3) 0 Normal A Patients 2 Control A A -6 .30C 30 32 34 36 38 plasma were viscosity by expressing them is the TPCV); and 44 (‘P) Cell normalized 42 Volume Pocked Data 40 Laboratory of the data data for Statistical difference exists ties or the ratio of plasma The viscosity cell volume leukocytes studies, blood of blood (TPCV) is sufficient patients with viscosities.1’2’4 of We viscosity kemia, the have in chronic j, (where is the are detailed in Table patients shows that viscosities viscosities. a complex or whole manner viscosity as should rise elevation of viscosi- total packed the if was mm and said to lymphocytic the be volume the number TPCV. of a feature In leukemia cells chronic because of earlier elevated until the white of 1. no blood leukocytosis were found to have that changes were not seen 50,000/cu viscosity studied leukemic a significant leukemia and It was suggested was granulo- of the larger granulocyte.4 found (Fig. insures no relationship 1). The that in greater than of less flexibility between variable degree most instances presence of marked leukocytosis. Leukocytes in suspension, siderably because patients and Thus, vs. DIscusSIoN plasma blood increases increases. to provide leukocyte count exceeded at least 3%4 Increased cytic leukemia and not size between to whole of js/K2 1. AND of the normals 48% as a plot see Fig. RESULTS Clinical and A comparison 46 the however, leukocyte of anemia, TPCV is were same volume of and greater internal count and whole blood usually a feature not elevated even found erythrocytes viscosity.3 to have (Table of leuin the a viscosity 2), con- probably From www.bloodjournal.org by guest on August 2, 2017. For personal use only. CONCENTRATIONS Table Total Patient 301 OF LEUKOCYTES Diagnosis 1.-Clinical Cell volume, 4’ CLL#{176} CLL CLL 39 48 4 CLL 39 5 6 7 CGL CGL AGL 8 9 10 11 12 13 f visOOsity, (centipoises) Plasma visity, K2 M/K’ (centipoises) 1.2 4.84 1.72 0.357 13.7 4.5 5.0 5.62 3.84 4.80 1.66 0.295 1.66 1.59 0.432 3.61 1.61 0.445 6.35 4.93 4.00 3.94 4.00 5.81 3.09 3.84 3.96 1.96 1.74 0.308 0.352 1.5 44 48 41 13.8 3.0 3.4 AGL 34 4.0 AGL 35 16.0 PV § CLL CLL AGL 55 3.5 35 35 40 21.0 21.0 4.0 lymphocytic Data BlOOd (%) 45 48 Normal 0 1 2 3 Laboratory and Leukocyte Packed Cell Volume Packed 0.331 1.69 0.422 1.85 0.469 1.66 0.415 1.73 1.37 1.44 1.22 0.297 0.443 0.375 0.308 leukemia. I Chronic granulocytic leukemia. Acute granulocytic leukemia. § Polycythemia vera. The presence found of anemia in the and plasma that could Thus the normal viscosity, have patients due tended been results in the population, in to obscure caused the and to by the groups two the variability differences any in increase greater to be cell of whole viscosity appear of blood red of without viscosity concentration blood massed viscosity leukocytes. differences. REFERENCES 1. Austrian, in health and 22:9, C. R.: The disease. viscosity Johns of blood Hopkins Bull. 1911. Clinical diagnosis by of the blood and the with special reference to the viscosiof W. R. Hess. J. Lab. Clin. Med. 3. Dintenfass, L.: red and white 4:597, 1965. blood Viscosity cells. of Exp. the packed Molec. Path. 2. Bircher, M. C.: the aid of viscosimetry 4. Stephens, D. J.: Relation of viscosity of blood to leukocyte count, with particular serum meter 7:134, reference Soc. to chronic myelogenous Exp. Biol. Med. 35:251, leukemia. 1936. 1921. Table Group#{176} Total Packed Cell volume, A 2.-Viscosity 48 Lymphocytes 48 Whole Normal blood blood Lymphocytes blood Normal blood 28 35 28 a viscosity, Myeloblasts Whole Normal jz, was Suspension Percentage Whole 48 Plasm in of Leukocytes 48 C Leukocytes Sample 48 B of 4’ 48 0 Proc. co nstant in each blood blood group. 100.0 13.7 1.3 94.0 Blood vis,sity, (centipoises) 21.6 5.62 4.17 9.30 5.0 4.80 1.2 3.83 96.0 16.0 <1.0 4.28 4.00 3.08 K3 From www.bloodjournal.org by guest on August 2, 2017. For personal use only. 1971 38: 299-301 Effect of High Concentrations of Leukocytes on Whole Blood Viscosity MARTIN H. STEINBERG and STANLEY E. 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