CENTRAL  SOUTH  DAKOTA  MEDICAL NEWS
THE CLINICAL VIEW
By: Phillip E. Hoffsten, M.D.
5  JULY  2001

The Problem of Too Much Blood

Perhaps one of the most pervasive problems in our society is not enough blood getting to vital areas. A stroke occurs when a part of the brain has its blood supply cut off. A heart attack happens when one of the major heart arteries gets stopped up and then that part of the heart with no blood supply dies. Amputations of the feet occur in diabetics when the blood supply to the feet will no longer keep the feet alive. Thus, "bad circulation" or not enough blood is a major problem.

What about the opposite problem? Is there such a thing as "too much blood"? The answer is yes, and the problem presents in many forms.

Perhaps the most common form of too much blood is called congestive heart failure. In this condition, the heart is not strong enough to pump all of the blood that the body needs for its normal function. With this, the body tends to retain fluid and the blood volume grows. When this volume reaches a critical level, the lungs become overloaded with blood and there is no room for air leading the person to become very short of breath and potentially have a fatal outcome.

Blood is made up of multiple components. There is the blood plasma which is a clear amber fluid with protein and salt in it. Then there are three cellular components in the blood called the red cells, the white cells and the platelets. The red blood cells carry oxygen and help dispose of carbon dioxide. The white blood cells fight infection and are involved in the immunity and allergy problems of the body. The platelets are involved in blood clotting so that acute leukemic crisis for which there was no predictably effective treatment. It appears now that the use of Glevac puts chronic myelogenous leukemia into remission for an indefinitely long period of time. Unfortunately, it does not reverse the basic genetic flaw that causes chronic myelogenous leukemia but Glevac does prevent the expression of this genetic flaw allowing the person to continue a normal life.

Because of research costs and the few people who have chronic myelogenous leukemia, the cost of this drug is estimated at $2400 per month. And you thought that your drug bills were high.

            The last component of blood to talk about is the platelets. There is a condition called essential thrombocythemia in which the person makes an excessive number of platelets. A normal platelet count is around 300,000 platelets per cubic millimeter of blood. People with essential thrombocythemia make more than 1,000,000 platelets per cubic millimeter of blood. As you might imagine, one of the problems with this condition is that the person's blood clots too easily causing strokes and heart attacks and other such problems.

So in answer to the question, can a person have too much blood? The answer is yes. A person can have blood volume overload called congestive heart failure or have too much of one of the cellular components in the blood. Treatment for congestive heart failure is one of the bread and butter aspects of medical care. Generally, control can be achieved with the use of diuretics and a change in personal habits. Treatment of polycythemia in which the person has too many red cells can be easily treated in your local clinics with removal of extra blood that the person does not need. Treatment of leukemia and treatment of the problem of too many platelets is a high-tech question that requires specialty care for which the person can be referred on to a hemorrhage is not a problem. Congestive heart failure as mentioned above occurs when the plasm component of the blood becomes overloaded.

Normally, blood is about 45% red blood cells. If a person lives at sea level where the oxygen content of air is somewhat higher, the body's need for red blood cells tends to be slightly less. When a person lives at 10,000 feet in the mountains, the air is much thinner. Somehow, the body is able to detect this and stimulate this person's blood to make more red cells to provide better oxygen-carrying capacity in the low-oxygen atmosphere. Rarely, a disease called polycythemia vera occurs in which the person spontaneously begins to make large amounts of red cells even though they do not need them. When the red blood cell content of blood reaches 60% or more, the blood becomes syrupy and rather more like motor oil than like gasoline. The result is that the heart has a harder time pumping "thick blood" and the person's circulation again fails because of not enough blood pumped. Polycythemia vera is best treated with repeated removal of blood until the person becomes slightly iron deficient and just cannot make blood too fast anymore.

The problem of too many white cells is called leukemia. There are at least eight different kinds of white blood cells. Any one of these eight different kinds can become cancerous and begin to grow uncontrollably. If the condition is called acute leukemia, the prognosis is not good. Successful treatment is very difficult. If the condition is called chronic leukemia, the treatment is much more successful.

Recently a new product was evaluated and released for commercial use. This product called Glevac effectively treats chronic myelogenous leukemia which is one of the forms of chronic leukemia. Prior to the development of Glevac, chronic myelogenous leukemia would smolder with a high white count but few symptoms for several years and then eventuate into an hematologist. Your local clinics are equipped to deal with the diagnosing of these problems and the appropriate treatment or referral as needed.