DOCSLIB.ORG

Hemoconcentration and Hemostasis During Acute Stress: Interacting and Independent Effects

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Hemoconcentration and Hemostasis During Acute Stress: Interacting and Independent Effects See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/51117803 Hemoconcentration and Hemostasis During Acute Stress: Interacting and Independent Effects Article in Annals of Behavioral Medicine · May 2011 DOI: 10.1007/s12160-011-9274-0 · Source: PubMed CITATIONS READS 31 264 3 authors: Anthony W Austin Stephen M Patterson Stockton University Ohio University 17 PUBLICATIONS 128 CITATIONS 41 PUBLICATIONS 1,007 CITATIONS SEE PROFILE SEE PROFILE Roland von Känel University Hospital Zurich 462 PUBLICATIONS 8,630 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: Guilt feelings, dysfunctional thoughts and cultural values: longitudinal and intervention study View project Leadership, work stress and workforce health View project All content following this page was uploaded by Anthony W Austin on 22 May 2014. The user has requested enhancement of the downloaded file. ann. behav. med. (2011) 42:153–173 DOI 10.1007/s12160-011-9274-0 ORIGINAL ARTICLE Hemoconcentration and Hemostasis During Acute Stress: Interacting and Independent Effects Anthony W. Austin, M.A. & Stephen M. Patterson, Ph.D. & Roland von Känel, M.D. Published online: 12 May 2011 # The Society of Behavioral Medicine 2011 Abstract Introduction Background Acute psychological stress can produce sig- nificant hemoconcentration as well as prothrombotic Cardiovascular disease is the underlying cause of 36% of changes in blood, both of which may have potentially all deaths in the USA, making it the nation’s number one harmful effects on the cardiovascular system. It is unclear killer, with coronary heart disease (CHD) being the primary whether these effects are independent or have influence on cause of death [1]. Several risk factors have been identified each other. for CHD, but five have been recognized as conferring the Purpose This review discusses research investigating the most risk: high blood pressure, elevated serum cholesterol, effects of acute psychological stress on hemoconcentration body mass index, diabetes, and smoking [2]. However, and hemostasis and explores future directions for psycho- these traditional risk factors do not fully explain CHD risk hematology research. Physiology, associations with cardio- [3]. Psychological stress is one factor purported to explain vascular disease, and relationships between acute additional CHD risk. For example, in the INTERHEART psychological stress are discussed independently for hemo- study [4], individuals with myocardial infarction reported concentration and hemostasis, followed by an examination more financial stress, more stress at home and at work, and of the effects of stress-hemoconcentration on hemostasis. a greater number of major life events in the previous year Conclusions Traditional methods of adjusting for stress- compared to controls. However, physiological mechanisms hemoconcentration effects (e.g., calculated plasma volume linking stress to CHD have yet to be delineated fully. One or hematocrit level corrections) may not be appropriate possible mechanism through which stress may be linked to when examining stress-induced changes in hemostasis. The CHD is through adverse effects on hemostasis, which is the effects of acute stress on hemostasis should be examined in arrest of bleeding by the physiological properties of conjunction with hemoconcentration. vasoconstriction and coagulation or the interruption of blood flow through any vessel or to any anatomical area, Keywords Hemostasis . Hemoconcentration . and hemostatic processes such as platelet function [5, 6], Cardiovascular disease . Psychological stress hemorheology [7–9], and coagulation [10, 11]. In fact, elevations in several factors involved in hemostasis, such as Electronic supplementary material The online version of this article fibrinogen, D-dimer, von Willebrand factor, and factor VII (doi:10.1007/s12160-011-9274-0) contains supplementary material, which is available to authorized users. (FVII), FVIII, FIX, FXI, and FXII, have been reported as heightened risk markers for CHD [12, 13]. * : A. W. Austin ( ) S. M. Patterson The initiation of acute coronary syndromes (especially Department of Psychology, Ohio University, Athens, OH, USA myocardial infarction) and acute atherothrombotic events in e-mail: [email protected] the coronary tree has been linked to acute psychosocial stress that can result from negative emotions, taxing social R. von Känel situations, and traumatic events [11]. Several pathophysio- Department of General Internal Medicine, Inselspital (University Hospital Berne), logical mechanisms have been suggested, including hemo- Berne, Switzerland concentration (i.e., when the ratio of blood cells to plasma 154 ann. behav. med. (2011) 42:153–173 increases), alterations in blood rheology [7], vascular hemostasis, blood coagulation, and cardiovascular disease. endothelial dysfunction coupled with vasoconstriction, Given that the focus of this review is on acute stress, articles proinflammatory cytokine release, autonomic imbalance were then examined to exclude those focusing on naturalistic (e.g., alterations in heart rate variability), and activation of stressors (e.g., earthquakes), chronic stress, vital exhaustion, or the coagulation cascade as well as indirectly through related concepts. Additionally, a wide variation in methodol- changes in health behaviors [14–16]. The disruption of the ogy existed among acute stress studies, making a systematic hemostatic balance (i.e., balance between clot formation and review difficult. Therefore, the review is narrative in nature. clot dissolution) is a critical factor in atherosclerotic develop- ment and initiation of acute coronary syndromes. After plaque rupture, a vessel occlusion is more likely if the ratio of Hemoconcentration prothrombotic activity (i.e., promoting clot formation) to fibrinolytic activity (i.e., promoting clot dissolution) is high. Hemoconcentration refers to conditions in which the ratio During acute psychological stress, both prothrombotic and of cellular components (principally red blood cells) of the fibrinolytic activities increase, but with the former to a greater blood to the plasma volume increases [7]. Hemoconcentra- extent than the latter [10]. In a healthy person, such a tion mainly occurs in two ways. First, plasma volume can response is physiologically normal. However, this type of remain constant while the number of red blood cells response could have life-threatening effects in a patient with increases. This condition is seen in polycythemia vera, a CHD because stress-hypercoagulability seems to be exag- rare tumorous condition in which red blood cells are gerated in these patients [17] and could add to hypercoag- produced to a greater extent than normal [20] and in ulability initiated after plaque rupture. Therefore, risk secondary polycythemia which is associated with altitude increases for the formation of a clot large enough to critically sickness [21]. Second, and more commonly, hemoconcen- occlude the coronary artery. The ensuing net hypercoagula- tration occurs when the number of red blood cells remains bility resulting from acute psychological stress may put an constant while plasma volume decreases. This condition individual at a greater risk for coronary thrombosis after has been variously referred to as ‘stress’ polycythemia, plaque disruption and thus contribute to acute coronary relative polycythemia, pseudopolycythemia, spurious poly- syndromes [10, 11]. Other crucial factors suggested to cythemia, or stress-hemoconcentration [7, 22, 23]. Figure 1 accompany hypercoagulation are stress-induced hemocon- depicts stress-hemoconcentration that occurs when plasma centration [18] and increased blood viscosity [9, 19], both of moves or shifts from the vascular compartment into which exacerbate the shear stresses imposed by atheroscle- interstitial spaces during acute psychological stress pro- rotic plaques and plaque ruptures [7]. Elucidation of how duced by various laboratory stressors (e.g., mental arith- these mechanisms occur is central to understanding the metic, Stroop color–word recognition test, cold pressor test, relationship between stress and CHD. and public speaking). Early studies of plasma volume shifts The purpose of this review is to provide an update on the demonstrated this phenomenon during various psycholog- state of the research investigating the effects of acute ical states such as emotional stress [24] and anxiety [25]. psychological stress on hemoconcentration and hemostasis Additionally, acute psychological stress reliably elicits and to explore future directions for psychohematology research. plasma volume losses from the vasculature [26]. This review has two main sections: “Hemoconcentration” and “Hemostasis”. The first section provides an overview of Hemoconcentration Assessments hemoconcentration with a discussion of physiology, association with cardiovascular disease, and relationships between hemo- Plasma Proteins concentration and acute psychological stress. The second section is organized similarly, providing an overview of One indicator of stress-hemoconcentration is an increase in hemostasis with a discussion of physiology, association with the concentration of plasma proteins, such as serum cardiovascular disease, and relationships between hemostasis albumin. Plasma passes easily into interstitial spaces and acute psychological stress, with particular emphasis on through minute openings or
Load more

Recommended publications
  • Section 8: Hematology CHAPTER 47: ANEMIA
    Section 8: Hematology CHAPTER 47: ANEMIA Q.1. A 56-year-old man presents with symptoms of severe dyspnea on exertion and fatigue. His laboratory values are as follows: Hemoglobin 6.0 g/dL (normal: 12–15 g/dL) Hematocrit 18% (normal: 36%–46%) RBC count 2 million/L (normal: 4–5.2 million/L) Reticulocyte count 3% (normal: 0.5%–1.5%) Which of the following caused this man’s anemia? A. Decreased red cell production B. Increased red cell destruction C. Acute blood loss (hemorrhage) D. There is insufficient information to make a determination Answer: A. This man presents with anemia and an elevated reticulocyte count which seems to suggest a hemolytic process. His reticulocyte count, however, has not been corrected for the degree of anemia he displays. This can be done by calculating his corrected reticulocyte count ([3% × (18%/45%)] = 1.2%), which is less than 2 and thus suggestive of a hypoproliferative process (decreased red cell production). Q.2. A 25-year-old man with pancytopenia undergoes bone marrow aspiration and biopsy, which reveals profound hypocellularity and virtual absence of hematopoietic cells. Cytogenetic analysis of the bone marrow does not reveal any abnormalities. Despite red blood cell and platelet transfusions, his pancytopenia worsens. Histocompatibility testing of his only sister fails to reveal a match. What would be the most appropriate course of therapy? A. Antithymocyte globulin, cyclosporine, and prednisone B. Prednisone alone C. Supportive therapy with chronic blood and platelet transfusions only D. Methotrexate and prednisone E. Bone marrow transplant Answer: A. Although supportive care with transfusions is necessary for treating this patient with aplastic anemia, most cases are not self-limited.
    [Show full text]
  • A Rapid and Quantitative D-Dimer Assay in Whole Blood and Plasma on the Point-Of-Care PATHFAST Analyzer ARTICLE in PRESS
    MODEL 6 TR-03106; No of Pages 7 ARTICLE IN PRESS Thrombosis Research (2007) xx, xxx–xxx intl.elsevierhealth.com/journals/thre REGULAR ARTICLE A rapid and quantitative D-Dimer assay in whole blood and plasma on the point-of-care PATHFAST analyzer Teruko Fukuda a,⁎, Hidetoshi Kasai b, Takeo Kusano b, Chisato Shimazu b, Kazuo Kawasugi c, Yukihisa Miyazawa b a Department of Clinical Laboratory Medicine, Teikyo University School of Medical Technology, 2-11-1 Kaga, Itabashi, Tokyo 173-8605, Japan b Department of Central Clinical Laboratory, Teikyo University Hospital, Japan c Department of Internal Medicine, Teikyo University School of Medicine, Japan Received 11 July 2006; received in revised form 7 December 2006; accepted 28 December 2006 KEYWORDS Abstract The objective of this study was to evaluate the accuracy indices of the new D-Dimer; rapid and quantitative PATHFAST D-Dimer assay in patients with clinically suspected Deep-vein thrombosis; deep-vein thrombosis (DVT). Eighty two consecutive patients (34% DVT, 66% non-DVT) Point-of-care testing; with suspected DVT of a lower limb were tested with the D-Dimer assay with a Chemiluminescent PATHFAST analyzer. The diagnostic value of the PATHFAST D-Dimer assay (which is immunoassay based on the principle of a chemiluminescent enzyme immunoassay) for DVT was evaluated with pre-test clinical probability, compression ultrasonography (CUS). Furthermore, each patient underwent contrast venography and computed tomogra- phy, if necessary. The sensitivity and specificity of the D-Dimer assay using 0.570 μg/ mL FEU as a clinical cut-off value was found to be 100% and 63.2%, respectively, for the diagnosis of DVT, with a positive predictive value (PPV) and negative predictive value (NPV) of 66.7% and 100%, respectively.
    [Show full text]
  • Introduction to Hematological Assessment (PDF)
    UPDATED 01/2021 Introduction to Hematological Assessment Objectives After completing this lesson, you will be able to: • State the main purposes of a hematological assessment. • Explain the procedures for collecting and processing a blood sample. • Understand the importance of hand washing. • Understand the importance of preventing blood borne pathogen transmission. • Describe and follow the hemoglobin test procedure using the Hemocue Hemoglobin Analyzer. Overview The most common form of nutritional deficiency is “iron deficiency”. It is observed more frequently among children and women of childbearing age (particularly pregnant women). Iron deficiency can result in developmental delays and behavioral disturbance in children, as well as increased risk for a preterm delivery in pregnant women. Iron status can be determined using several different types of laboratory tests. The two tests most commonly used to screen for iron deficiency are hemoglobin (Hgb) concentration and hematocrit (Hct). Proper screening for iron deficiency requires sound laboratory methods and procedures. Often, CPAs will hear the following questions: “Do you have to stick my finger? What does this have to do with my WIC foods anyway? Will it hurt?” For most of us, the thought of having blood taken, even from a finger, is not pleasant. However, evaluating the results of a blood test is a part of screening for nutritional risk. Why Does WIC Require Hematological Assessment? WIC requires that each applicant be screened for risk of a medical condition known as iron deficiency anemia. Anemia is a condition of the blood in which the amount of hemoglobin falls below a level considered desirable for good health.
    [Show full text]
  • Your Blood Cells
    Page 1 of 2 Original Date The Johns Hopkins Hospital Patient Information 12/00 Oncology ReviseD/ RevieweD 6/14 Your Blood Cells Where are Blood cells are made in the bone marrow. The bone marrow blood cells is a liquid that looks like blood. It is found in several places of made? the body, such as your hips, chest bone and the middle part of your arm and leg bones. What types of • The three main types of blood cells are the red blood cells, blood cells do the white blood cells and the platelets. I have? • Red blood cells carry oxygen to all parts of the body. The normal hematocrit (or percentage of red blood cells in the blood) is 41-53%. Anemia means low red blood cells. • White blood cells fight infection. The normal white blood cell count is 4.5-11 (K/cu mm). The most important white blood cell to fight infection is the neutrophil. Forty to seventy percent (40-70%) of your white blood cells should be neutrophils. Neutropenia means your neutrophils are low, or less than 40%. • Platelets help your blood to clot and stop bleeding. The normal platelet count is 150-350 (K/cu mm). Thrombocytopenia means low platelets. How do you Your blood cells are measured by a test called the Complete measure my Blood Count (CBC) or Heme 8/Diff. You may want to keep track blood cells? of your blood counts on the back of this sheet. What When your blood counts are low, you may become anemic, get happens infections and bleed or bruise easier.
    [Show full text]
  • Blood Donor Information
    Blood Donor Information Thank you for coming to donate blood. We are Did you know that some causes sorry that we cannot accept you as a donor today of anemia are invisible? because your hematocrit level was too low. You may not know you have bleeding from We care about your health and want to help you your digestive tract. This can be a result of: understand what having a low hematocrit level means.You are not alone, having a low hematocrit • Stomach ulcers level is the most frequent cause for not being able • Growths in intestines (polyps) to donate blood. You may return to donate when • Colon cancer your hematocrit level has increased and you can • Certain medications help immediately by asking your friends, family • Other diseases of the digestive tract and/or coworkers to donate. There are several Anemia is often the first symptom of these simple ways to improve your hematocrit level. conditions so it should be taken seriously. If you feel You may be eligible to donate another time. you don’t fit in any of the previous categories, What is Hematocrit? or just want to rule out these possibilities, make an appointment with your physician without delay. Blood is made up of red blood cells, white blood cells, platelets, and plasma. Hematocrit is the percentage of blood You should see your doctor if your volume that is red blood cells. Red blood cells contain hematocrit is low and you: hemoglobin which carries oxygen to all the cells in the body. • donate less than three times per year, Why do we test potential blood • are a non-menstruating woman of any donors for hematocrit levels? age with a hematocrit below 36%, Hematocrit is measured prior to each donation as part of • a man with a hematocrit less than 38%, and donor screening.
    [Show full text]
  • 116588NCJRS.Pdf
    If you have issues viewing or accessing this file contact us at NCJRS.gov. " "'- u.s. Department of Justice Federal Bureau of Investigation PROCEEDINGS OF THE INTERNATIONAL SYMPOSIUM ON FORENSIC IMMUNOLOGY FBI ACADEMY QUANTICO, VIRGINIA JUNE 23-26, 1986 Proceedings of the International Symposium on Forensic Immunology co 00 L() \0 u, r-l O§ r-l Ql C. If) 05~ Ql 0- 0 ~ o~ Ql E C/) Ql >. c:0 If) C/) ~ * ....,a: () a: z Ql '*02 Ql iii :5 ...... ....,::> a Ql {ij "...:0- Ql c: !!lc: °E ::>;: B 00 {ij c: 0 ~I::> z~ "e CD ~~ :5 .... ~o- S 1::C: Lt .~ Host Laboratory Division Federal Bureau of Investigation June 23-26, 1986 Forensic Science Research and Training Center FBI Academy Quantico, Virginia NOTICE This publication was prepared by the U. S. Government. Neither the U. S. Government nor the U. S. Department of Justice nor any of their employees makes any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness or usefulness of any information, apparatus, product or process disclosed, or represents that in use would not infringe privately owned rights. Reference herein to any specific commercial product, process or service by trade name, mark, manufacturer or otherwise does not necessarily constitute or imply its endorsement, recommendation or favoring by the U. S. Government or any agency thereof. The views and opinions of authors expressed herein do not necessarily state or reflect those of the U. S. Government or any agency thereof. Published by: The Laboratory Division Roger T. Castonguay Assistant Director in Charge Federal Bureau of Investigation U.
    [Show full text]
  • Understanding Blood Tests
    PATIENT EDUCATION patienteducation.osumc.edu Understanding Blood Tests Your heart pumps the blood in your body through a system of blood vessels. Blood delivers oxygen and nutrients to all parts of the body. It also carries away waste products. Blood is made up of red blood cells, white blood cells, platelets and a clear fluid called plasma. There are also other parts in the blood such as electrolytes, proteins, fats, sugar, and hormones. Your doctor can check for certain diseases and conditions by doing blood tests. A small sample of blood is taken and sent to the lab. The test results help your doctor: • Check your general health • See how well your body organs are working • Find health problems, diseases and disorders • Watch the body’s response to medicines and treatments Common blood tests include a Complete Blood Count (CBC) with differential, and a Comprehensive Metabolic Panel (CMP). Note: Some health problems may require ongoing monitoring or repeat testing. It is important to know that normal range values can vary from laboratory to laboratory. Talk with your doctor if you have questions about your test results. Complete Blood Count (CBC) A CBC shows the number of white and red blood cells, hematocrit, hemoglobin and platelets in your blood. This test helps your doctor look for signs of anemia, infection, bleeding problems or certain diseases and disorders. This handout is for informational purposes only. Talk with your doctor or health care team if you have any questions about your care. © January 9, 2018. The Ohio State University Comprehensive Cancer Center – Arthur G.
    [Show full text]
  • TITLE: Complete Blood Count (CBC) Basics PRESENTER: Sarah Drawz and Michael Linden
    TITLE: Complete Blood Count (CBC) Basics PRESENTER: Sarah Drawz and Michael Linden Slide 1: Good afternoon, my name is Dr. Michael Linden. I am the Director of Hematopathology at the University of Minnesota in Minneapolis, MN. With me is Dr. Sarah Drawz, who is a Hematopathology Fellow, also at the University of Minnesota. I would like to introduce Dr. Sarah Drawz, who will be beginning our presentation as part of this AACC Pearl of Laboratory Medicine on “Complete Blood Count (CBC) Basics.” Slide 2: The complete blood count (CBC) is an important initial test in the evaluation of a patient’s hematologic function. The CBC is performed on whole blood, which is composed of two primary components: plasma and cells. The plasma fraction contains mostly water, numerous proteins, electrolytes, and clotting factors. The cellular component of blood is comprised of the three major categories of blood cells: red blood cells (RBCs), white blood cells (WBCs), and platelets. The CBC test yields numbers of these main types of cells, but also additional information, such as the volume of red blood cells, or hematocrit, and quantity of different types of white blood cells, the differential. Slide 3: CBCs are collected from patients in both inpatient and outpatient settings. Generally, 3 to 10 ml of whole blood are drawn from a peripheral vein directly into a tube. The tube must contain anticoagulant to prevent clots from obscuring the CBC analysis. Various types of anticoagulants are used including ethylenediaminetetraacetic acid (EDTA), heparin, and citrate. The most common anticoagulant used for the CBC is EDTA.
    [Show full text]
  • Blood and Immunity
    Chapter Ten BLOOD AND IMMUNITY Chapter Contents 10 Pretest Clinical Aspects of Immunity Blood Chapter Review Immunity Case Studies Word Parts Pertaining to Blood and Immunity Crossword Puzzle Clinical Aspects of Blood Objectives After study of this chapter you should be able to: 1. Describe the composition of the blood plasma. 7. Identify and use roots pertaining to blood 2. Describe and give the functions of the three types of chemistry. blood cells. 8. List and describe the major disorders of the blood. 3. Label pictures of the blood cells. 9. List and describe the major disorders of the 4. Explain the basis of blood types. immune system. 5. Define immunity and list the possible sources of 10. Describe the major tests used to study blood. immunity. 11. Interpret abbreviations used in blood studies. 6. Identify and use roots and suffixes pertaining to the 12. Analyse several case studies involving the blood. blood and immunity. Pretest 1. The scientific name for red blood cells 5. Substances produced by immune cells that is . counteract microorganisms and other foreign 2. The scientific name for white blood cells materials are called . is . 6. A deficiency of hemoglobin results in the disorder 3. Platelets, or thrombocytes, are involved in called . 7. A neoplasm involving overgrowth of white blood 4. The white blood cells active in adaptive immunity cells is called . are the . 225 226 ♦ PART THREE / Body Systems Other 1% Proteins 8% Plasma 55% Water 91% Whole blood Leukocytes and platelets Formed 0.9% elements 45% Erythrocytes 10 99.1% Figure 10-1 Composition of whole blood.
    [Show full text]
  • Stress Polycythemia; the Influence of Stress on the Hematocrit Ralph Jay Falkenstein Yale University
    Yale University EliScholar – A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine 1969 Stress polycythemia; the influence of stress on the hematocrit Ralph Jay Falkenstein Yale University Follow this and additional works at: http://elischolar.library.yale.edu/ymtdl Recommended Citation Falkenstein, Ralph Jay, "Stress polycythemia; the influence of stress on the hematocrit" (1969). Yale Medicine Thesis Digital Library. 2569. http://elischolar.library.yale.edu/ymtdl/2569 This Open Access Thesis is brought to you for free and open access by the School of Medicine at EliScholar – A Digital Platform for Scholarly Publishing at Yale. It has been accepted for inclusion in Yale Medicine Thesis Digital Library by an authorized administrator of EliScholar – A Digital Platform for Scholarly Publishing at Yale. For more information, please contact [email protected]. TI13 YALE UNIVERSITY LIBRARY +yT5] 2963 3 9002 06584 7981 «v-»fI rib *e-* INrt.fes.p jjujf >i OF STRESS ON T HEMAT OCR IT MUDD LIBRARY Medical YALE MEDICAL LIBRARY Digitized by the Internet Archive in 2017 with funding from The National Endowment for the Humanities and the Arcadia Fund https://archive.org/details/stresspolycythemOOfalk STRESS POLYCYTHEMIA The Influence of Stress on the Hematocrit Ralph Jay Fallenstein A.B., Columbia College A Thesis Presented to the Department of Medicine, Yale University In Partial Fulfillment of the Requirements for the Degree of Doctor of Medicine New Haven, Connecticut April 1, 1969 JUN 1969 tlBRAH'' DEDICATION For My Wife and Parents ACKNOWLEDGEMENTS The author would, like to express his gratitude to: Dr. Stuart Finch, whose helpful suggestions, thoughtful criticism and constant interest helped nourish this thesis to its realization.
    [Show full text]
  • Blood Work: a Complete Guide for Monitoring
    BLOOD WORK: A COMPLETE GUIDE FOR MONITORING HIV PUBLISHED BY JANUARY 2011 Lab tests, or blood work, can give im­ Nearly all lab reports make it portant clues about your overall health simpler to understand test results and HIV disease. Many of these tests by including a “normal” range, should be done shortly after learning or high and low values. The results that you’re HIV-positive. This will establish that fall outside normal ranges are likely a “baseline” measure of your immune health and show the most important ones. Those that are above or below how active HIV is. Knowing this information will help normal are often highlighted on your lab report by you watch for changes in your health over time as well being bolded, printed in a different color or printed in as check the impact of any treatments that you take. a different column. Factors such as age, gender, stress, medicines, active It is your right to have and keep copies of all of your infections and others can all affect these test results. Lab medical records. You can then keep track of your results results should be considered with these factors in mind. to look for overall trends. Ask for and keep copies of your Understanding your test results may seem difficult lab reports, and make a chart or table of them to note at first. However, they can help you take charge of your trends or changes. For examples of these charts, read health and understand why your doctor prescribes Project Inform’s publication, Personal Tracking Charts, certain tests and medicines.
    [Show full text]
  • Polycythemia Vera BRIAN J
    PRACTICAL THERAPEUTICS Polycythemia Vera BRIAN J. STUART, LT, MC, USNR, and ANTHONY J. VIERA, LCDR, MC, USNR Naval Hospital Jacksonville, Jacksonville, Florida Polycythemia vera is a chronic myeloproliferative disorder characterized by increased red blood cell mass. The resultant hyperviscosity of the blood predisposes such patients to thrombosis. Poly- O A patient informa- cythemia vera should be suspected in patients with elevated hemoglobin or hematocrit levels, tion handout on poly- splenomegaly, or portal venous thrombosis. Secondary causes of increased red blood cell mass (e.g., cythemia vera, written by the authors of this heavy smoking, chronic pulmonary disease, renal disease) are more common than polycythemia article, is provided on vera and must be excluded. Diagnosis is made using criteria developed by the Polycythemia Vera page 2146. Study Group; major criteria include elevated red blood cell mass, normal oxygen saturation, and palpable splenomegaly. Untreated patients may survive for six to 18 months, whereas adequate treatment may extend life expectancy to more than 10 years. Treatment includes phlebotomy with the possible addition of myelosuppressive agents based on a risk-stratified approach. Agents under investigation include interferon alfa-2b, anagrelide, and aspirin. Consultation with a hematologist is recommended. (Am Fam Physician 2004: 69;2139-44,2146. Copyright© 2004 American Academy of Family Physicians.) Members of various olycythemia vera (PV) is a chronic family medicine depart- myeloproliferative disorder char- Diagnosis ments develop articles for “Practical Therapeu- acterized by an increased red blood PV should be suspected when hemoglo- tics.” This article is one in cell mass (RCM), or erythrocytosis, bin and/or hematocrit levels are elevated a series coordinated by which leads to hyperviscosity and (i.e., hemoglobin level greater than 18 g per the Department of Fam- an increased risk of thrombosis.
    [Show full text]