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Prepublished online as a Blood First Edition Paper on February 6, 2003; DOI 10.1182/blood-2002-09-2814.
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Blood, 1 June 2003, Vol. 101, No. 11, pp. 4416-4422
HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY
Hemostasis and coagulation at a hematocrit level of 0.85: functional consequences of erythrocytosis
Junpei Shibata,
Jo Hasegawa,
Hans-Joachim Siemens,
Eva Wolber,
Leif Dibbelt,
Dechun Li,
Dörthe M. Katschinski,
Joachim Fandrey,
Wolfgang Jelkmann,
Max Gassmann,
Roland H. Wenger, and
Klaus F. Wagner
From the Department of Anesthesiology, Clinic of Internal Medicine II, Institute for Clinical Chemistry, and Institute of Physiology, University Lübeck, Lübeck, Germany; Department of Anesthesiology, Johns Hopkins University, Baltimore, MD; Institute of Veterinary Physiology, University Zürich, Zürich, Switzerland; Institute of Physiology, University Essen, Essen, Germany; and Carl-Ludwig-Institute of Physiology, University of Leipzig, Leipzig, Germany.
We have generated a transgenic mouse line that reaches a hematocrit concentration of 0.85 due to constitutive overexpression of human erythropoietin in an oxygen-independent manner. Unexpectedly, this excessive erythrocytosis did not lead to thrombembolic complications in all investigated organs at any age. Thus, we investigated the mechanisms preventing thrombembolism in this mouse model. Blood analysis revealed an age-dependent elevation of reticulocyte numbers and a marked thrombocytopenia that matched the reduced megakaryocyte numbers in the bone marrow. However, platelet counts were not different from wild-type controls, when calculations were based on the distribution (eg, plasma) volume, thereby explaining why thrombopoietin levels did not increase in transgenic mice. Nevertheless, bleeding time was significantly increased in transgenic animals. A longitudinal investigation using computerized thromboelastography revealed that thrombus formation was reduced with increasing age from 1 to 8 months in transgenic animals. We observed that increasing erythrocyte concentrations inhibited profoundly and reversibly thrombus formation and prolonged the time of clot development, most likely due to mechanical interference of red blood cells with clot-forming platelets. Transgenic animals showed increased nitric oxide levels in the blood that could inhibit vasoconstriction and platelet activation. Finally, we observed that plasmatic coagulation activity in transgenic animals was significantly decreased. Taken together, our findings suggest that prevention of thrombembolic disease in these erythrocytotic transgenic mice was due to functional consequences inherent to increased erythrocyte concentrations and a reduction of plasmatic coagulation activity, the cause of which remains to be elucidated.

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