http://books.google.ro/books?

id=b1h_dPnYJ48C&pg=PA181&dq=plasma+viscosity&hl=ro&sa=X&ei=yLK
nT6KVLan24QST2IyXBw&ved=0CDYQ6AEwAA#v=onepage&q=plasma
%20viscosity&f=false
BLOOD HIGH VISCOSITY SYNDROMES AND HYPERVISCOSAEMIA

Plasma viscosity, proteins, and aggregation of red cells in diabetes. Genetic aspects
The degree of aggregation of red cells is elevated in many diabetics and will represent another
important abnormality along with elevation of plasma viscosity. Various viscosity factors can be
increased to different degree in different patients, and any individual patient might exhibit a
number of rheological abnormalities.
Although usually aggregation of red cells is linked with the level of fibrinogen, fibrinogen
itself is not as sensitive an indicator of anormality as the albumin/fibrinogen ratio, or
albumin/globulin ratio. The latter is a more sensitive indicator of pathorheology than albumin
and/or globulin concentrations in plasma.
Furthermore, it must be stated from the beginning of these discussions that viscosity factors
correlated with levels or ratios of proteins or lipids may not only differ in patients of different
ABO blood groups, or ethnic origin, or type of diabetes aetiology, but might differ at different
stages of severity of diabetes. In effect, even the slope and the sign of the slope of linear
regression can change with severity of disease or with the ABO blood group.
After this preamble we can consider specific information.
Nearly 30 years ago Ditzel (1955) reported his observations on aggregation of red cells in
diabetes. The increased degree of aggregation of red cells was considered by Ditzel (1967a,b) to
be one of the main factors in the diabetic microangiopathy. Davis and Landau (1970) stressed the
presence of sludging of red cells in the small blood vessels. Dintenfass (1974b) supplied
quantitative measure of aggregation of red cells in diabetes, by adjusting observed ESRs to
haematocrit of 30%, and correcting for plasma viscosity, taking plasma viscosity of lcP (ImPa-s)
as standard. Alternatively to ESRs (observed at 37 C in EDTA blood) he also used
sedimentation velocities as another measure of aggregation (Table 65).
Thus, adjusted ESRs showed values up to 260mm/h, while adjusted sedimentation velocities
showed values up to 340mm/h.
Not only is aggregation per se greater than in normals, but the actual morphology is different
also. Volger et al. (1975) stated that the mechanical integrity of red cell aggregates, as measured
by the shear stress necessary for their hydrodynamic disaggregation, is significantly higher in the
diabetics (2.80.65dyn/cm2) than in controls (2.1 0.65 dyn/cm2). Volger observed also
increased plasma viscosity in diabetics (1.490.17cP) vs. control (1.340.09cP),p being 0.05.
In their rheoscopic studies, Schmid-Schonbein and Volger (1976) recorded clumping of red
cells of diabetic patients greatly enhanced when compared with normal blood. In simultaneous
studies, deformability of red cells was measured by their ability to pass through 5-/*m pores.

Relative flow rate was greatly decreased in diabetics, thus indicating increased rigidity of red
cells (assuming that effects of platelets and white cells were eliminated).
Dintenfass and Davis's 1977a,b study showed that significant elevation of plasma viscosity
and of aggregation of red cells can be observed only in patients with blood sugar above 250
mg/100 ml or in clinically severely ill diabetics (presence of severe complications, including
retinopathy with haemorrhage, severe ischaemic heart disease, severe obliterative vascular
disease). Blood viscosity, for a group of 60 patients, was normal or lower and the corresponding
haematocrits lower than the normal values. Increased blood sugar level led to increased
aggregation of red cells.
In a study of 62 diabetics, Volger et al. (1976) found that elevation of plasma viscosity or
elevation of aggregation of red cells did not directly relate to the metabolic state.
Ozanne et al. (1983) observed that when compared with normal pregnancy,
late diabetic pregnancy was associated with an increased rate of RBC aggregation, and
predelivery diabetic pregnancy exhibited an increased rate and extent of erythrocyte aggregation.
Pre-eclamptic pregnancy differed from normal pregnancy only by having a lower plasma
viscosity.
Dintenfass (1974a) found a significant difference (p< 0.005) between the group with severe
complications and the group with complications either mild or absent, in the following
parameters: haematocrit, fibrinogen level, albumin/fibrinogen ratio, erythrocyte sedimentation
rates, and ESR5t.pi.. There was, however, no significant difference in the aggregation of red cells
between patients with severe complications and patients without complications or moderate
complications. There was no significant difference in the aggregation of red cells between males
and females suffering from diabetes mellitus.
Assays of fibrinogen level were carried out with results as follows.
(1) The means for the patients with severe complications and patients without complications
or with moderate complications were 658 and 444 mg%, respectively, if both males and females
were grouped together. There was very little difference between patients with or without
complications if males only were considered in this study.
(2) Patients without severe complications showed a significant correlation between
aggregation of red cells and the level of fibrinogen. That was not the case for patients with severe
complications, nor was it the case for patients grouped according to their blood group.
Furthermore, in the same study, the aggregation of red cells, estimated from the sedimentation
velocity, did not show any correlation with the albumin/ fibrinogen ratios when patients were
divided according to their sex or severity of complications.