Fluid volume changes in sickle cell anaemia - abstract

ABSTRACT

The aetiology of acute painful episodes in patients with sickle cell anaemia is unclear. There is no agreement as to the role of acidosis, and though body fluid changes may be of importance, only plasma volume measurements have been reported. We have therefore measured plasma volume, total body water, and extracellular fluid spaces during painfull crises and after recovery. Patients were males with proven homozygous sickle cell (HbSS) disease, in the age group 16 to 25 years. "Steady state" patients were attending sickle cell clinic and had no other illness. Patients in painful crises had fever and generalized pains and were studied within 36 hours of the onset of crisis. They were regarded as having recovered when significant pain and fever had subsided. Controls were healthy young volunteers, whose sickle cell test was negative and who were not anaemic. Plasma volume, total body water (T.B.W.) and extracellular fluid (E.C.F.) space were measured with Evan,s Blue, tritiated water and insulin repectively. The T.B.W of 11 patients in the "steady state" was normal, 67.7ñ2.7 percent of body weight (meanñS.D.) compared with 66.6ñ2.6 percent in 7 normal controls The mean plasma volume of these "steady state" patients was increased - 78.3ñ3.9 ml/kg per Kg compared with 54.1ñ8.4 mls/Kg in 7 controls. T.B.W. was greater during painful crisis than after recovery in five patients showing increases ranging from 1-11 percent of body weight. The plasma volume of these five patients showed no consistent change. In four patients in the "steady state" the E.C.F. volume as a percent of body weight was 23.0ñ1.5 percent compared with 20.5ñ5 percent for four normal controls. During painful crises in two patients the E.C.F. was expanded (33 percent and 32 percent of body weight) as compared with recovery values. It is suggested that the major body fluid compartment change during painful sickle cell crisis in an increase in total body water, and that this probably due to an increase in extra-cellular fluid (AU)