Increased red blood cell aggregation in patients with idiopathic intracranial hypertension

Summary

It was the objective of this study to explore the possibility that the aggregation of red blood cells is enhanced in individuals with increased intracranial hypertension (IIH). This is a prospective cross sectional examination in a cohort of patients with IIH and matched controls.The aggregation of red blood cells in the peripheral venous blood was determined by using a slide test and image analysis.We have presently included a group of 33 women with IIH and the same number of women matched for age, body mass index, vascular risk factors and medications. A significant (p=0.038) increment in fibrinogen concentrations was noted in the patients (341 ± 60.8 mg/dl) as opposed to the controls 307.9 ± 64.8).The same stands for the aggregation of red blood cells (aggregation parameter of 8.7 ± 4.9 in patients vs.5.9 ± 3.2 in the controls, p=0.001).We noted an increment in the aggregation of red blood cells in the peripheral blood of 33 women with IIH as opposed to matched controls. Being associated with capillary slow flow,these findings might be relevant to the ethiopathogenesis of this disease.

Keywords

Idiopathic intracranial hypertension - pseudo tumor cerebri - aggregation

• References

• 1 Soutani M, Suzuki Y, Tateishi N. et al. Quantitative evaluation of flow dynamics of erythrocytes in microvessels: influence of erythrocyte aggregation. Am J Physiol 1995; 268: H1959-H1965.
• 2 Schmid-Schonbein H. Blood rheology and physiology of microcirculation. Ric Clin Lab 1981; 11 (Suppl. 01) 13-33.
• 3 Bishop JJ, Nance PR, Popel AS. et al. Effect of erythrocyte aggregation on velocity profiles in venules. Am J Physiol Heart Circ Physiol 2001; 280: H222-H236.
• 4 Mchedlishvili G, Gobejishvili L, Mamaladze A. et al. Microcirculatory stasis induced by hemorheological disorders: further evidence. Microcirculation 1999; 06: 97-106.
• 5 Cabel M, Meiselman HJ, Popel AS. et al. Contribution of red blood cell aggregation to venous vascular resistance in skeletal muscle. Am J Physiol 1997; 272: H1020-H1032.
• 6 Mchedlishvili G, Varazashvili M, Gobejishvili L. Local RBC aggregation disturbing blood fluidity and causing stasis in microvessels. Clin Hemorheol Microcirc 2002; 26: 99-106.
• 7 Bishop JJ, Nance PR, Popel AS. et al. Relationship between erythrocyte aggregate size and flow rate in skeletal muscle venules. Am J Physiol Heart Circ Physiol 2004; 286: H113-H120.
• 8 Yalcin O, Uyuklu M, Armstrong JK. et al. Graded alterations of RBC aggregation influence in vivo blood flow resistance. Am J Physiol Heart Circ Physiol 2004; 287: H2644-H2650.
• 9 Kim S, Popel AS, Intaglietta M. et al. Aggregate formation of erythrocytes in postcapillary venules. Am J Physiol Heart Circ Physiol 2005; 288: H584-H590.
• 10 Radhakrishnan K, Ahlskog JE, Garrity JA. et al. Idiopathic intracranial hypertension. Mayo Clin Proc 1994; 69: 169-80.
• 11 Rogowski O, Vered Y, Shapira I. et al. Introducing the wide range C-reactive protein (wr-CRP) into clinical use for the detection of microinflammation. Clin Chim Acta 2005; 358: 151-8.
• 12 Berliner S, Rogowski O, Aharonov S. et al. Erythrocyte adhesiveness/aggregation. A novel biomarker for the detection of low grade internal inflammation in individuals with atherothrombotic risk factors and proven. vascular disease. Am HeartJ 2005; 149: 260-7.
• 13 Rogowski O, Toker S, Shapira I. et al. Values of high sensitivity C-reactive protein in each month of the year in apparently healthy individuals. Am J Cardiol 2005; 95: 152-5.
• 14 Zeltser D, Rogowski O, Mardi T. et al. Clinical and laboratory characteristics of patients with atherothrombotic risk factors presenting with low concentrations of highly sensitive C-reactive protein. Atherosclerosis 2004; 176: 297-301.
• 15 Zeltser D, Rogowski O, Berliner S. et al. Sex differences in the expression of haemorheological determinants in individuals with atherothrombotic risk factors and apparently health people. Heart 2004; 90: 277-81.
• 16 International committee for standardization in hematology. Recommendation of measurement of erythrocyte sedimentation rate of human blood. Immunochemistry 1965; 02: 235-54.
• 17 Clauss A. Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens. Acta Haematol Basel 1957; 17: 237-46.
• 18 Schechner V, Shapira I, Berliner S. et al. Significant dominance of fibrinogen over immunoglobulins, C-reactive protein, cholesterol and triglycerides in maintaining increased red blood cell adhesiveness/aggregation: a model in hypercholaesterolemic patients. Eur J Clin Invest 2003; 33: 955-61.
• 19 Gamzu R, Rotstein R, Fusman R. et al. Increased erythrocyte adhesiveness and aggregation in peripheral venous blood of women with pregnancy-induced hypertension. Obstet Gynecol 2001; 98: 307-12.
• 20 Samocha-Bonet D, Lichtenberg D, Tomer A. et al. Enhanced erythrocyte adhesiveness/aggregation in obesity corresponds to low-grade inflammation. Obes Res 2003; 11: 403-7.
• 21 Fusman G, Mardi T, Justo D. et al. Red blood cell adhesiveness/aggregation, C-reactive protein, fibrinogen and erythrocyte sedimentation rate in healthy adults and in those with atherosclerotic risk factors. Am J Cardiol 2002; 90: 561-3.
• 22 Berliner S, Shapira I, Rogowski O. et al. Combined leukocyte and erythrocyte aggregation in the peripheral venous blood during sepsis.A clue to the presence of a commonly shared adhesive protein(s). Int J Clin Lab Res 2000; 30: 27-31.
• 23 Rotstein R, Fusman R, Zeltser D. et al. The picture of inflammation: a new concept that combines the white blood cell count and erythrocyte sedimentation rate into a new hematologic diagnostic modality. Acta Haematol 2001; 106: 106-14.
• 24 Sharshun Y, Brill S, Mardi T. et al. Inflammation at a glance: erythrocyte adhesiveness/aggregation to reveal the presence of inflammation in individuals with atherothrombosis. Heart Dis 2003; 05: 182-3.
• 25 Owler BK, Parker G, Halmagyi GM. et al. Pseudotumor cerebri syndrome: venous sinus obstruction and its treatment with stent placement. J Neurosurg 2003; 98: 1045-55.
• 26 Glueck CJ, Iyengar S, Goldenberg N. et al. Idiopathic intracranial hypertension: associations with coagulation disorders and polycystic-ovary syndrome. J Lab Clin Med 2003; 142: 35-45.
• 27 Rotstein R, Landau T, Twig A. et al. The erythrocyte adhesiveness/aggregation test (EAAT). A new biomarker to reveal the low grade subclinical smoldering inflammation in individuals with atherosclerotic risk factors. Atherosclerosis 2002; 165: 343-51.
• 28 Maharshak N, Shapira I, Rotstein R. et al. The erythrocyte adhesiveness/aggregation test for the detection of an acute phase response and for the assessment of its intensity. Clin Lab Haematol 2002; 24: 205-10.
• 29 Ben Assayag E, Bornstein NM, Shapira I. et al. Inflammation sensitive proteins and erythrocyte aggregation in atherothrombosis. Int J Cardiol 2005; 98: 271-6.
• 30 Berliner S, Ben-Ami R, Samocha-Bonet D. et al. The degree of red blood cell aggregation on peripheral blood glass slides corresponds to inter-erythrocyte cohesive forces in laminar flow. Thromb Res 2004; 114: 37-44.
• 31 Zeltser D, Rotstein R, Rogowski O. et al. The erythrocyte adhesiveness/aggregation (EAAT) in the peripheral blood of patients with ischemic heart and brain disease with normal fibrinogen concentrations. Appl Rheol 2000; 10: 231-7.
• 32 Zeltser D, Bornstein NM, Rotstein R. et al. The erythrocyte adhesiveness/aggregation test in the peripheral blood of patients with ischemic brain events. Acta Neurol Scand 2001; 103: 316-9.
• 33 Marckmann P. Nutritional status of patients on hemodialysis and peritoneal dialysis. Clin Nephrol 1988; 29: 75-8.
• 34 Hankey CR, Rumley A, Lowe GD. et al. Moderate weight reduction improves red cell aggregation and factor VII activity in overweight subjects. Int J Obes Relat Metab Disord 1997; 21: 644-50.
• 35 Ditschuneit HH, Flechtner-Mors M, Adler G. Fibrinogen in obesity before and after weight reduction. Obes Res 1995; 03: 43-8.
• 36 Banyai S, Banyai M, Falger J. et al. Atorvastatin improves blood rheology in patients with familial hypercholesterolemia (FH) on long term LDL apheresis treatment. Atherosclerosis 2001; 159: 513-9.
• 37 Sugerman HJ, Felton III WL, Sismanis A. et al. Gastric surgery for pseudotumor cerebri associated with severe obesity. Ann Surg 1999; 229: 634-40.
• 38 Sugerman HJ, Felton III WL, Salvant Jr JB. et al. Effects of surgically induced weight loss on idiopathic intracranial hypertension in morbid obesity. Neurology 1995; 45: 1655-9.
• 39 Gabay C, Kushner I. Mechanisms of disease: acutephase proteins and other systemic responses to inflammation. N Engl J Med 1999; 340: 448-54.