PEQULIARITIES OF ENDOBRONCHIAL MICROHEMOCIRCULATION IN PATIENTS WITH POLYCYTHEMIA VERA

Abstract

The study of endobronchial microhemocirculation in 30 patients with polycythemia vera without concomitant bronchopulmonary diseases was done. At the moment of examination IIA stage of polycythemia vera (without spleen myeloid metaplasia) was diagnosed in 18 patients, IIB stage of the disease (with spleen myeloid metaplasia) was diagnosed in 12 patients. All the patients had the bronchoscopy with endobronchial laser Doppler flowmetry; the biopsy of the right proximal bronchus mucous tunic was done to 12 patients. As a result of histological study of biopsy material, the overflow of vessels with blood and their widening, dystrophic changes of vessels walls, perivascular sclerosis, erythrocytic stases in the vessels of a small size, thrombocytes aggregates inside the vessels, agglomerates from erythrocytes and thrombocytes in arteriols and capillaries without a fibrin clot were diagnosed in all the patients. Sludge-syndrome (small vessels occlusion) was significantly more typical for the patients with IIB stage of the disease. All the rest 30 patients were found to have low parameters of endobronchial microhemocirculation at laser Doppler flowmetry. Thus, in the patients with polycythemia vera at the stage of intensive clinical and hematologic manifestations there was a disturbance of endobronchial microhemocirculation, and the most significant changes of microciculatory blood flow were diagnosed in the patients in IIB stage. Sludge-syndrome plays the most important role in the disturbance of microhemocirculation at polycythemia vera. It develops as a result of intensive polycythemia and thrombocytosis which contribute to the formation of erythrocyte and thrombocyte stases. After treatment and normalization of erythrocytes parameters, hemoglobin, hematocrit in the peripheral blood, the parameters of endobronchial microhemocirculation improve but do not normalize fully as a result of polyetiology of the disturbances of microcirculatory channel functioning. Revealed changes lead to the development of tissue hypoxia, exchange acidosis, atrophic changes of bronchi mucous tunic and respiratory tract intercurrent infections.