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Quantitative model of hematologic and plasma volume responses after rapid ascent and acclimation to moderate through high altitudes

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AJP Regulatory Integrative and Comparative Physiology

Published online on

Abstract

Despite decades of research, the magnitude and time course of hematologic and plasma volume (PV) changes following rapid ascent and acclimation to various altitudes are not precisely described. To develop a quantitative model, we utilized a comprehensive database and general linear mixed models to analyze 1055 hemoglobin ([Hb]) and hematocrit (Hct) measurements collected at sea level and repeated time points at various altitudes in 393 unacclimatized men (n=270) and women (n=123) who spent between 2 hours and 7 days at 2500-4500 m under well-controlled experimental conditions. The PV change (PV) was calculated from Hb and Hct measurements. The results are: 1) PV decreases rapidly (~6%) after the 1st day at 2500 m and [Hb] and Hct are increased by 0.5 g/dl and 1.5 points, respectively, 2) PV decreases an additional 1% and [Hb] and Hct increase an additional 0.1 g/dl and 0.2 points for every 500 m increase in elevation above 2500 m after the 1st day, 3) PV continues to decrease over time at altitude but the magnitude of this decrease and subsequent increase in [Hb] and Hct levels is dependent on elevation and sex, 4) individuals with high initial levels of [Hb] and Hct and older individuals hemoconcentrate less at higher elevations. This study provides the first quantitative delineation of PV and hematological responses during the first week of exposure over a wide range of altitudes and demonstrates that absolute altitude and time at altitude, as well as initial hematologic status, sex, and age impact the response.