Comparative characteristics of therapeutic methods to eliminate hemoconcentration in patients with cerebrovascular diseases

Yu.I. Malankevich, O.V. Sayko, B.S. Porodko, A.I. Bohdan


Background. Blood dilution (hemodilution) has been long used in practical medicine in the form of fluid intake regimen (intense water consumption) and parenteral administration of crystalloid solutions and plasma substitutes. Hemodilution improves blood rheological properties, thus, it enhances the delivery of oxygen and nutrients to the brain, so neurons, which are at risk of death, have a chance to survive. Hemodilution can be attained with bloodletting (removing of blood), with infusion of solutions or with combination of both methods. Crystalloid and colloid solutions are used for hemodilution. Colloid solutions are more effective agents, due to the fact that they consist mostly of insoluble molecules and their purpose is to maintain an intravascular liquid. In many countries, hemodilution is used in clinical treatment of patients with stroke since 1970s. Materials and methods. The retrospective analysis of the most effective method of hemoconcentration treatment has been conducted among patients with cerebrovascular diseases and other pathologies, who had been treated at the angioneurological department of neurosurgery and neurology clinic of Military Medical Clinical Center of Western Region from January to June 2018. Results. 212 patients aged 20–80 years with cerebrovascular diseases and other pathologies were included in the study. The average age of patients was 50 years. The number of men was 164 (73 %), women — 48 (23 %). Hemoconcentration was observed in 32 cases (15 %). Blood rheology disorders were presented in 28 men (17 %) and 7 women (14 %). Blood rheology impairment took place in 10 (24 %) cases of strokes, in 12 (24 %) patients with post-stroke condition, in 8 (8 %) persons with dyscirculatory encephalopathy, in 1 (20 %) patient with Kimmerle anomaly, in 1 (3 %) case of vegetovascular dystonia against the background of acute period of closed head injury, concussion of the brain. Fluid intake regimen was effective in 3 cases of dyscirculatory encephalopathy, vegetovascular dystonia against the background of acute period of closed head injury, concussion of the brain and Kimmerle anomaly. The positive effect of hypervolemic hemodilution was observed in 17 patients, isovolemic hemodilution — in 12 patients with stroke, post-stroke condition and dyscirculatory encephalopathy. With intense fluid consumption, hypervolemic hemodilution and isovolemic hemodilution, the level of hemoglobin and hematocrit was normalized; the mean prothrombin concentration decreased by 10 points. The level of fibrinogen, electrolytes and platelets didn’t change much when applying more intense fluid intake regimen. The number of platelets increased insignificantly after both hypervolemic and isovolemic hemodilution. Side effects did not occur. Conclusions. According to our findings hemoconcentration is common mostly among male patient aged 40–50 years, is associated with stroke and post-stoke condition. The least effective method of blood dilution is fluid intake regimen; otherwise, more effective measure is hypervolemic hemodilution. Fluid intake regimen is insignificant, while managing such pathologies as stroke and post-stroke condition. Hypervolemic or isovolemic hemodilution is indicated in such cases. If hypervolemic hemodilution is ineffective, it is preferred to use isovolemic hemodilution, which is applied one time. These methods are safe.


hemodilution; fluid intake regimen; vascular di­seases


Zhiburt E. B., Kaleko, S. P., Et Danilchenko, V. V., Sidorkevich S. V., Chechetkin A. V. Autogemotransfuzii is in clinical practice / E. В. Zhiburt, P. C., Kaleko, V. V. Danil'chenko, S. V. Sidorkevich, A.V. Chechetkin // Transfuziologiya. - 2001. - №3.- P. 32-52

Morgan D. E., M. S. Michaelis Clinical anaesthesiology, 2 book / D. E. Morgan , N. S. Michael // Trudged. with angl. of M.: there is Binomial, P. - P.: Nevskiy Dialect, 2000. – P. 430.

Brainin M. V. Conduct of sharp stroke in the conditions of the specialized separation of / M. V. Brainin // Zhurn. to neurology and psychiatry the name of S.S. Korsakova. - 2003. - Vyp. 9. - Р. 49-51 (Stroke: appendix to zhurn.).

Vascular pathology of the nervous system / А. А. Voznyuk, М. М. Op, А. І. Kuznetsov // - SPb, 1998. - Р. 167-172.

Voloshin Р. R., Yavorskaya V. A., Floman Y. Y., Alternis N. K. and other Modern organization of insul'tnoy help: educational programs, active tactic in a sharp period and valuable rehabilitation of/ Р. R. Voloshin, V. A. Yavorskaya, Y. Y. Floman, N. K. Alternis // medications of Ukraine - 2005. - № 5 (94). - Р. 1-19.

Stroke / Е. І. Gusev, V. I. Skvortsova // – 2002. - № 5. - Р. 3-16

Evidential medicine. Annual short-story reference book. Issue 3: Trudged. with angl. / Under red. S.E. Baku // - M.: of Medias Sphere, 2004. - Р. 687.

Ragimov A. A. «Transfuziologicheskaya gemokorrekciya» / A. A. Ragimov // - Practical medicine - 2008.- P. 577.

Daimon S., Saga T., Nakayama M. et al. Dextran sulphate cellulose columns for the treatment of nephrotic syndrome due to inactive lupus nephritis / S. Daimon, T. Saga, M. Nakayama // Nephrol. Dial. Transplant. — 2000. — V. 15, № 2. — P. 235-238.

Berezina T.L., Zaets S.B., Morgan С. et al. Influence of sto-rage on red cell rheological properties / T.L. Berezina, S.B. Zaets, С. Morgan // J. Surg. Res. — 2002. — V. 102, № 6. — P. 12.

Jauch E., Saver J., Adams H. et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association / E. Jauch, J. Saver, H. Adams // Stroke. — 2013. — Р. 870-947.

Diener H.C. Stroke Prevention. Antiplatelet and thrombolytic therapy / H.C. Diener // Stroke. — 2000. — V. 19, № 2. — P. 343-335.

European Stroke Initiative Recommendations for Stroke Management-Udate 2003 // Cerebrovasc. Dis. — 2003. — № 16. — P. 311-337.

Implementation strategies for emergency medical services within stroke systems of care: a policy statement from the American Heart Association / J.E. Acker III, A.M. Pancioli, T.J. Crocco et al. American Stroke Association Expert Panel on Emergency Medical Services Systems and the Stroke Council // Stroke. — 2007. — Vol. 38. — P. 3097-3115.

Rummler S., Althaus K., Maak B., Barz D. A case report of successful treatment with immunoadsorption onto protein A in mixed connective tissue disease in childhood / S. Rummler, K. Althaus, B. Maak, D. Barz // Ther. Apher. Dial. — 2008. — V. 12, № 4. — P. 33-42.

Suzuki K. The role of immunoadsorption using dextran-sulphate cellulose columns in the treatment of systemic lupus erythematosus / K. Suzuki // Ther. Apher. — 2000. — V. 4, № 3. — P. 239-243.

Yield of diffusion-weighted MRI for detection of potentially relevant findings in stroke patients / G.W. Albers, M.G. Lansberg, M.D. Norbash et al. // Neurology. — 2000. — V. 54. — P. 1562-1567.

Рагимов А.А. Трансфузиологическая гемокоррекция / А.А. Рагимов // Практическая медицина. — 2008. — С. 577.

Esnault V.L., Besnier D., Testa A. et al. Effect of protein A immunoadsorption in nephrotic syndrome of various etiologies / V.L. Esnault, D. Besnier, A. Testa // J. Am. Soc. Nephrol. — 1999. — V. 10, № 9. — P. 2014.

Jacob L., Heming N., Guidet B. Hydroxyethyl starch and renal dysfunction / L. Jacob, N. Heming, B. Guidet // Transfusion Alternatives in Transfusion Medicine. — 2007. — V 9, № 3 — Р. 182-188.


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2018


   Seo анализ сайта