People with ME/CFS can have hypervolemia and not low blood volume

[MeSci]

I am fairly sure Daxor are wrong. Haematocrit is defined as red cell volume over total blood volume as measurable in a blood sample. Daxor seem to be trying to redefine the term so that they can sell their test. As far as I am aware the only significance of having more red cells to health is if the haematocrit (as originally defined) is high - which may precipitate thrombosis or embolism. The healthy feedback mechanism for red blood cell production will have to work on the basis of the true haematocrit - the bone marrow would not have receptors for total red cell mass. So a raised red cell mass that gave a normal haematocrit because of a raised plasma volume would be an indicator of a healthy bone marrow, not of polycythaemia.

Judging by the brochure this company is in to a hard sell - I would be sceptical.

I wondered this, so did a quick literature search, and found several papers reporting studies that used the Daxor, or reviewed the evidence on it, produced by researchers who did not reveal any conflicting interests - plus a few by people who clearly stated that they were involved with Daxor. Of course, they may have had undeclared interests, I suppose. Or the researchers may have been absolute shits (poetic licence )

BTW I laughed so much at that typo that I almost became asthmatic and was having trouble using the keyboard.

 

[Scarecrow]

BTW I laughed so much at that typo that I almost became asthmatic and was having trouble using the keyboard.

I was on the bus. People were staring at me.

 

[Gingergrrl]

BTW I laughed so much at that typo that I almost became asthmatic and was having trouble using the keyboard.

I was on the bus. People were staring at me.

Luckily I was at home when I read that typo but am still laughing about it now! I related to it b/c back when I was typing posts about methyl b-12 shots, about 90% of the time I would accidentally type "methyl b-12 shits" and only notice it when I re-read through my post before hitting reply.

 

[xchocoholic]

Hi @leokitten

I hope I didn't come across as being insensitive to your hypervolemia by posting about snl bloodletting. I'd just seen that skit recently and it cracked me up. SNL / Steve Martin was just so funny back then.

I'm happy to hear you have some answers. And you shared this. Hopefully you'll find a proper solution.

Sincerely .. x

 

[Jonathan Edwards]

Luckily I was at home when I read that typo but am still laughing about it now! I related to it b/c back when I was typing posts about methyl b-12 shots, about 90% of the time I would accidentally type "methyl b-12 shits" and only notice it when I re-read through my post before hitting reply.

As long as nobody wet themselves, I am pleased to have brightened up your days!!

 

[MeSci]

As long as nobody wet themselves

which could have caused hypovolaemia...or not!

 

[halcyon]

I am fairly sure that high protein levels do not increase blood volume in fact. This is an old theoretical idea based on a misconception about Starling's Law that may be best forgotten.

Why are colloids such as albumin given to produce volume expansion then?

 

[Gingergrrl]

Why are colloids such as albumin given to produce volume expansion then?

@halcyon Ironically my cardio mentioned "IV albumin" as a possible treatment for low blood volume for me in the future (but hoped I would improve from other things and not need it.) I have not googled it yet and was wondering what it means or why is was recommended especially since Dr. Edwards said it is an old idea that is not used anymore.

 

[MeSci]

@halcyon Ironically my cardio mentioned "IV albumin" as a possible treatment for low blood volume for me in the future (but hoped I would improve from other things and not need it.) I have not googled it yet and was wondering what it means or why is was recommended especially since Dr. Edwards said it is an old idea that is not used anymore.

I have come across a number of authoritative-seeming sites that say that serum albumin can be an indication of hydration status, with high levels suggesting dehydration. Here is one. Here is another.

I'd be interested in hearing @Jonathan Edwards's views on this.

 

[halcyon]

That's what I've been told by numerous doctors when my albumin has been high @MeSci.

 

[MeSci]

That's what I've been told by numerous doctors when my albumin has been high @MeSci.

Are you in the USA?

When I have repeatedly pointed out my high albumin levels to doctors as evidence for dehydration, they have said that that's not why they test albumin (I KNOW - but it can be used as evidence for this!), and that they use other measures for hydration status.

When I have asked what measures they use, they have come up with stupid responses, such as levels of other things that need to be interpreted IN LIGHT of hydration status.

But my explanations have fallen on deaf ears, and I have been the one to suffer misdiagnosis and related problems.

I have recently discovered the probable cause of my hyponatraemia that I have suffered on and off for 7 years - my ACE inhibitor, which can cause hyponatraemia through natriuresis - sodium loss in urine, typically occurring in a hypovolaemic context. But all this time the doctors insisted that the cause was overhydration/hypervolaemia due to excessive fluid intake and overuse of desmopressin. I knew that they were wrong, but they wouldn't listen. But I didn't know it was the ACE inhibitor.

I have suffered a hell of a lot over those 7 years as a result. Severe and frightening illness, loss of income, abuse from doctors and more.

Yesterday a doctor agreed with my self-diagnosis.

 

[halcyon]

Yes, I am in the US. I'm really happy that you figured out what was going on, that sounds really scary and I still can't believe they tried to withhold fluids from you when you desperately needed the opposite.

 

[Gingergrrl]

I am not sure if I have ever been tested for albumin? Is this a rare or special test or part of a normal blood panel?

If my albumin is low, does that confirm low blood volume?

Also, if someone gets IV albumin, is that made from human blood products or something synthetic?

 

[halcyon]

It's tested for on complete metabolic panels usually it seems. I doubt low albumin alone would be enough to suspect low volume.

I believe IV albumin is always a human blood product. There are other synthetic colloids that can be used instead, such as gelatins or dextrans.

 

[CFS_for_19_years]

When I have asked what measures they use, they have come up with stupid responses, such as levels of other things that need to be interpreted IN LIGHT of hydration status.

I don't know if it's THE best measure, or just one measure, but the BUN/creatinine ratio is one measure of dehydration, as long as your kidneys are functioning. An Internet search might bring up other options.

 

[Gingergrrl]

It's tested for on complete metabolic panels usually it seems. I doubt low albumin alone would be enough to suspect low volume.

I believe IV albumin is always a human blood product. There are other synthetic colloids that can be used instead, such as gelatins or dextrans.

@halcyon If it is part of the complete metabolic panel then I have definitely had it done and now wondering if it was normal b/c I don't remember it ever being flagged as low.

 

[MeSci]

I am not sure if I have ever been tested for albumin? Is this a rare or special test or part of a normal blood panel?

If my albumin is low, does that confirm low blood volume?

It's part of the bone health panel in the UK. The general rule is high albumin = low blood volume, low albumin = high blood volume (because it's more diluted).

 

[MeSci]

Yes, I am in the US. I'm really happy that you figured out what was going on, that sounds really scary and I still can't believe they tried to withhold fluids from you when you desperately needed the opposite.

They didn't just try - in hospital with severe hyponatraemia they put me on fluid restriction, consequently sending me home with constipation so severe that I had hallucinations. They wouldn't give me a laxative because I had had slight diarrhoea earlier - but I don't think I'd passed anything for 2 days in the end.

The weekend senior doctor had observed that I was dehydrated, going by skin turgour. I don't know if anyone used the simple manual CVP assessment method mentioned by @Jonathan Edwards.

But the weekend doctor was overruled by the consultant who took over. I was left with an unused cannula in my hand for 3 days, which the weekend doctor had put in in preparation for IV saline, which I never got. No one noticed it, until I pointed it out to a doctor, by which time it was itching, and rather a mess going by the expressions on the faces of staff when it was removed.

On getting home I had to do some hasty research for natural laxatives and made some tea with feverfew picked from my garden. Mercifully it worked!

 

[MeSci]

I don't know if it's THE best measure, or just one measure, but the BUN/creatinine ratio is one measure of dehydration, as long as your kidneys are functioning. An Internet search might bring up other options.

I have come across a number of papers which posit various methods for assessing hydration status, and I was surprised how difficult it is deemed to be by the authors. Some say that central venous pressure (CVP) is the most reliable method, but are talking about an invasive and risky procedure involving insertion of a catheter rather than @Jonathan Edwards's manual method.

 

[Leopardtail]

Interesting. Doctors tend to get very muddled about this sort of physiology. I am fairly sure that high protein levels do not increase blood volume in fact. This is an old theoretical idea based on a misconception about Starling's Law that may be best forgotten. As zzz points out, an autonomic dysfunction with venodilatation - as occurs with some peripheral neuropathies for instance will tend to lead to an increased blood volume but, crucially, this volume will seem to be too low, especially if you stand up. This is because the capacity of the 'bag' of the circulation has increased, maybe even more than the blood volume has increased. What people call hypovolaemia often means relative hypovolaemia, which could easily be absolute hypervolaemia, I think.

So what actually matters for symptoms is whether or not the blood volume fits the size of the circulation bag. In heart failure there is too much blood for the bag. If you sit up some of the plasma leaks into the feet and you feel better but when you go to bed that all drains back to the circulation bag and you wake up short of breath again.

So I am not actually sure that measuring blood volume itself is necessarily much help - at least not on its own. What you want to know is if the volume is enough for your circulation. That you can tell quite easily in a physical examination by looking at the central venous pressure - CVP. A precise measure of CVP requires equipment but a simple and pretty reliable way is to lie the person down and look at the neck veins when you press on the abdomen to squeeze blood out of the venous pool there. If blood volume is higher than ideal the neck veins are full to start with. If it is low they do not even fill when you press on the abdomen. There is a strange exception to the rule in constrictive pericarditis where you want the volume to be relatively high to ensure enough blood gets into the tight pericardium.

My suspicion is that this is all the same thing in ME - autonomic dysfunction with both relative and absolute shits in volume.

I have normal serum sodium, but brain function and muscle function improve massively with saline exceeding 1ltr, it also does not cause urination of high rapidity or volume. Would this indicate low blood volume?