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Article
December 1940

STUDIES OF THE BLOOD IN CONGESTIVE HEART FAILURE: WITH PARTICULAR REFERENCE TO RETICULOCYTOSIS, ERYTHROCYTE FRAGILITY, BILIRUBINEMIA, UROBILINOGEN EXCRETION AND CHANGES IN BLOOD VOLUME

Author Affiliations

BOSTON

From the Medical Research Laboratories, Beth Israel Hospital, and the Department of Medicine, Harvard Medical School.

Arch Intern Med (Chic). 1940;66(6):1230-1245. doi:10.1001/archinte.1940.00190180042004
Abstract

That the total circulating blood volume is increased during congestive heart failure1 and is decreased after recovery1b,c has been convincingly demonstrated. Knowledge is incomplete, however, in regard to the mechanisms involved in creating and in disposing of the increased circulating volume of erythrocytes and plasma during the different stages of congestive failure. In the present investigation the reticulocyte percentage, red cell fragility, serum bilirubin and urinary and fecal excretion of pigment were studied in a series of patients at intervals during the height of, and recovery from, congestive heart failure; these findings were related to the observed changes in blood volume and clinical status.

METHODS  The total blood volume, plasma and circulating red blood cell mass were ascertained by means of Evans blue dye and the photoelectric colorimeter, as described by Gibson and Evans2 and Gibson and Evelyn.3 Measurements were made soon after the patient's admission to the hospital and

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