Lichtman M A
J Clin Invest. 1973 Feb;52(2):350-8. doi: 10.1172/JCI107191.
Suspensions of leukemic lymphocytes and myeloblasts and blood of leukemic patients were studied to examine (a) the effect of leukemic cells on blood viscosity and (b) the ability of leukemic cells to traverse channels of capillary diameter. The viscosity of suspensions of leukemic cells was dependent logarithmically on (a) shear strain rate and (b) cytocrit, although, suspensions of small lymphocytes and of myeloblasts had a similar viscosity at equivalent shear rates and cytocrit. The minimum apparent viscosity (MAV) of leukemic cells and red blood cells, measured over shear rates of 2.3-230 s(-1) was dependent logarithmically on cytocrit. However, MAV was slightly greater for leukemic cells than for red cells at cytocrits up to 20%. At cytocrits above 20%. MAV of leukemic cells increased more rapidly than that of erythrocytes. For example, at a 15% cytocrit MAV(WBC) (1.85 centipoise) was only slightly greater than MAV(RBC) (1.59); whereas, at 45% cytocrit MAV(WBC) (14.9) was markedly greater than MAV(RBC) (3.81). The blood of subjects with leukemia with marked elevation of leukocyte concentration (leukocrits of 6-32%) had 24% higher mean MAV (3.72) than blood with a similar total cytocrit composed of red cells (3.00). A negative correlation was present between leukocrit and erythrocrit in chronic lymphocytic (r = - 0.82) and chronic granulocytic (r = - 0.81) leukemia. Therefore, the modest increase in whole blood MAV in leukemia can be explained by (a) the negative association of leukocrit and erythrocrit and (b) the rarity of leukocrits over 20% and total cytocrits over 45%. However, the MAV of blood of leukemic patients was 71% greater than expected on the basis of their packed red cell volume. Hence, the ratio of hemoglobin concentration (O(2) carrying capacity) to MAV was abnormally low in the subjects with leukemia studied. Individual leukemic leukocytes were nearly rigid. The mean deformability index (DI) of leukemic myeloblasts (1.22; 1.18) and lymphocytes (1.22; 1.40) as measured by filtration and elastometry, respectively, at 50 mm H(2)O negative pressure, approached that of a rigid body (1.0) as compared to red cells studied by filtration (3.09) or elastometry (4.23). The ability of leukemic cells to traverse nucleopore filter or micropipette channels was related to cell diameter. The relevance of the rheology of leukemic cells to the interruption of blood flow and of tissue oxygen delivery and thereby to clinical manifestations of leukemia is considered.
对白血病患者的白血病淋巴细胞和原粒细胞悬液以及血液进行了研究，以检验：(a) 白血病细胞对血液粘度的影响；(b) 白血病细胞穿越毛细血管直径通道的能力。白血病细胞悬液的粘度对数依赖于：(a) 剪切应变率；(b) 血细胞比容，不过，小淋巴细胞和原粒细胞悬液在相同剪切率和血细胞比容下具有相似的粘度。在2.3 - 230 s⁻¹的剪切率范围内测量的白血病细胞和红细胞的最低表观粘度（MAV）对数依赖于血细胞比容。然而，在血细胞比容高达20%时，白血病细胞的MAV略高于红细胞。在血细胞比容高于20%时，白血病细胞的MAV比红细胞增加得更快。例如，在血细胞比容为15%时，MAV（白细胞）（1.85厘泊）仅略高于MAV（红细胞）（1.59）；而在血细胞比容为45%时，MAV（白细胞）（14.9）明显高于MAV（红细胞）（3.81）。白细胞浓度显著升高（血细胞比容为6 - 32%）的白血病患者的血液，其平均MAV（3.72）比由红细胞组成的具有相似总血细胞比容的血液（3.00）高24%。在慢性淋巴细胞白血病（r = - 0.82）和慢性粒细胞白血病（r = - 0.81）中，白细胞比容与红细胞比容呈负相关。因此，白血病患者全血MAV的适度增加可以解释为：(a) 白细胞比容与红细胞比容的负相关；(b) 白细胞比容超过20%和总血细胞比容超过45%的情况很少见。然而，白血病患者血液的MAV比根据其红细胞压积预期的值高71%。因此，在所研究的白血病患者中，血红蛋白浓度（携氧能力）与MAV的比值异常低。单个白血病白细胞几乎是刚性的。通过过滤和弹性测定法分别在50 mmHg₂O负压下测量的白血病原粒细胞（1.22；1.18）和淋巴细胞（1.22；1.40）的平均变形性指数（DI），与通过过滤（3.09）或弹性测定法（4.23）研究的红细胞相比，接近刚体的变形性指数（1.0）。白血病细胞穿越核孔滤膜或微量移液器通道的能力与细胞直径有关。文中考虑了白血病细胞流变学与血流中断、组织氧输送以及白血病临床表现之间的相关性。
