Department of Anaesthesia, Akershus University Hospital, Lørenskog, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Physiol Rep. 2024 Jun;12(11):e16035. doi: 10.14814/phy2.16035.
Large-volume therapeutic phlebotomy is the mainstay of hemochromatosis treatment and offers an opportunity to investigate the hemodynamic changes during acute hypovolemia. An otherwise healthy 64-year-old male with hemochromatosis participated. On nine separate visits, 1000 mL therapeutic phlebotomy was performed. On one occasion, pre- and post-phlebotomy orthostatic challenge with 27° reverse Trendelenburg position was administered. Mean arterial pressure, heart rate, and stroke volume were measured continuously during the procedures. The patient's tolerance to the interventions was continuously evaluated. The procedures were well tolerated by the patient. Mean arterial pressure was maintained during hemorrhage and following phlebotomy in both supine and reverse Trendelenburg positions, primarily through an increase in heart rate and systemic vascular resistance. The present study found that 1000 mL therapeutic phlebotomy in a patient with hemochromatosis may be acceptably and safely used to model hemorrhage. The approach demonstrates high clinical applicability and ethically robustness in comparison with volunteer studies.
大体积治疗性放血是血色素沉着症治疗的主要方法，为研究急性血容量不足期间的血液动力学变化提供了机会。一位患有血色素沉着症的健康 64 岁男性参与了这项研究。在九次单独的就诊中，进行了 1000 毫升的治疗性放血。有一次，在进行放血前后，患者采取了 27°反向特伦德伦伯卧位的直立倾斜试验。在整个过程中，连续测量平均动脉压、心率和每搏量。持续评估患者对干预措施的耐受性。患者能够很好地耐受这些操作。在仰卧位和反向特伦德伦伯卧位下，平均动脉压在出血期间和放血后均得到维持，主要是通过增加心率和全身血管阻力。本研究发现，1000 毫升治疗性放血在血色素沉着症患者中可能被接受并安全地用于模拟出血。与志愿者研究相比，该方法在临床应用和伦理方面具有较高的稳健性。
