High Haematocrit Blood Flow and Adsorption of Micro- and Nanoparticles on an Atherosclerotic Plaque: an in-silico study

Background: The continuing inflammatory response entailed by atherosclerosis is categorised by a pathological surface expression of certain proteins over the endothelium, namely, P-selectins. Thus, to boost the efficiency of drug carriers these proteins can be used as binding targets. Method: An in-silico patient-specific model of a Left Anterior Descending (LAD) artery considering the luminal unevenness was built and meshed using the finite element method. Objectives: Delivery of particles in a specific size range, from 200 to 3200 nm, covered by P-selectin aptamers (PSA), to an atherosclerotic plaque in a pathologically high haematocrit (Hct) blood flow was simulated. The surface of the plaque was assumed to possess a pathologically high expression of P-Selectins. Results: The distribution of deposited particles over the plaque, in high Hct blood, was significantly more homogenous compared to that of particles travelled in normal blood Hct. Moreover, in the high Hct, the increase in the particle size, from 800 nm forwards, had a trivial effect on the upsurge in the surface density of adhered particles (SDAs) over the targeted endothelium. Yet, in normal blood Hct (45% in this research) the increase in the particle diameter from 800 nm forwards resulted in a significant increase in the SDAs over the targeted plaque. Interestingly, unlike the adsorption pattern of particles in normal Hct, a significant distribution of deposited particles in the post-constriction region of the atherosclerotic plaque was observed. Conclusion: Our findings lend insights into designing optimum carriers of anti-thrombotic/inflammatory drugs specifically for high blood Hct conditions.

A Case Report on Post-Transplant Erythrocytosis

Post-transplant erythrocytosis is defined as persistently elevated haemoglobin and haematocrit levels that occur following renal transplantation and persist for more than six months in the absence of thrombocytosis, leukocytosis or other potential causes of erythrocytosis. Here, we report the case history of a 35-year-old male, who underwent live related kidney transplantation ten months ago, presented with high haemoglobin level and high haematocrit. It is an uncommon complication of kidney transplant recipient,whichprompted us to report the case Birdem Med J 2019; 9(2): 170-173

The JAK2V617F Mutation in Blood Donors with High Haematocrit.

By the introduction for routine tests of automated counters it has become easy and extremely common the finding of abnormal or near normal laboratory results. During blood donations haematocrit (Htc) and haemoglobin level (Hb) are regularly tested to avoid a blood donation in the case of anaemia as this is the most frequent cause of exclusion from the donation. However it is not rare to observe a level of Hb or Htc upper or close the normal highest limit. Starting from the 1st of January 2006 to the 31st December 2006, we have collected 11240 donations in total from 5636 regular blood donors (total donation index 1.99) and selected on the basis of Htc, limit upper 50% for man and 46% for women, 84 males and 19 females. In this cohort, during a 1846 years donation period, the average of donations for males was 22.2 while for females was 11.4. We collected randomly and used as control group 79 donors (59 males and 20 females) with normal Htc levels in the last blood donation. For the identification of the V617F (1848 G>T) mutation within JAK2 we used the method published by Jones ed al. in 2005 named amplification refractory mutation system (ARMS). Among the 84 men with high haematocrit level we have been able to identify 1 blood donor positive for this mutation. This blood donor had Htc equal to 50.6 in the last donation, while the average Htc in the last year was 51.7. These results account for a total prevalence of the JAK2 mutation in 1% of the blood donor population with elevated Ht (1 out of 103) while it is 0.6% (1 out of 183) of the entire population of blood donors in this study or 0.02% of the entire cohort appertaining to our transfusion service. Our results seem also in keeping with the few studies evaluating blood donors (Zanella et al., Transfusion 1987) or normal population (Ruggeri et al., Ann Int Med 2003). In both these studies the prevalence of MPD was around 3% which is not so far away from that found in our cohort (asymptomatic patients) but much higher than that supposed in hospital based cohorts in previous studies (100 fold increased). The hypothesis that the prolonged myeloid stimulus from phlebotomies can induce inhibition of the feed-back control as well as blood donations triggered the onset of a pre-existing latent primary myeloproliferative disease needs further studies to be confirmed.

The Effects of High Haematocrit Levels on Glucose Metabolism Disorders

There has been only limited research investigating the possible association between raised haematocrit levels, glucose intolerance and type 2 diabetes. In the present study, we explored the association between high haematocrit levels and impaired glucose tolerance by performing oral glucose tolerance tests in 46 patients with chronic obstructive pulmonary disease and no previous history of diabetes mellitus or glucose intolerance. A glucose metabolism disorder was observed in 12 (26%) patients (type 2 diabetes in six patients and impaired glucose tolerance in a further six). There was a significant association between high haematocrit levels and the presence of a glucose metabolism disorder, which was independent of other risk factors. High haematocrit levels may be an independent risk factor for type 2 diabetes and impaired glucose tolerance.