The task the editors have set themselves is to survey the field of clinical hemorheology from basic principles to up-to-date research. It is only in a new science like this that it is possible to span the whole field in a book of this size. Hemorheology, as a new approach to the study and management of a wide range of circulatory diseases, is now beginning to appear with increasing frequency in general as well as specialized medical journals. Hemorheology is also just beginning to creep into the undergraduate medical curriculum. Therefore, the majority of graduate doctors are unequipped to assess the place of hemorheology in the overall framework of circulatory physiology and pathology or to assess its relevance to their everyday practice. It is hoped that this book will fill this gap. The approach of the book is interdisciplinary. The first part deals with basic principles of blood flow, circulation and hemorheology. It has been written with the general doctor in mind, who has no special knowledge of hemodynamics and rheological concepts, terminology or methodology. To maintain the emphasis on practical clinical applications, all the chapters in the second part of the book have been written by clinical specialists practicing in the individual areas of disease. The book is so designed that clinicians may be able to read the relevant chapters in the second part of the book in isolation, using the basic science aspects contained in the first part of the book as reference chapters.

Inhalt

1. Introduction: On the way to modern clinical hemorheology.- 2. Biophysics.- 2.1. Basic concepts.- 2.1.1. Rheology.- 2.1.2. Stress, strain and strain rate.- 2.1.3. Elastic solid and viscous fluid.- 2.1.4. Classification of viscous liquids.- 2.1.5. Viscoelasticity.- 2.1.6. Surface rheology.- 2.2. Viscometry.- 2.2.1. Laminar and turbulent flow.- 2.2.2. Temperature control.- 2.2.3. Steady-flow viscometers.- 2.2.4. Tube viscometers.- 2.2.5. Rotational viscometers.- 2.2.6. Oscillatory flow methods.- 2.3. Other techniques quantifying blood rheology.- 2.3.1. Optical aggregometry.- 2.3.2. Blood filtration.- 2.4. Rheology of normal blood.- 2.4.1. Shear dependence.- 2.4.2. Plasma viscosity.- 2.4.3. Effect of hematocrit.- 2.5. Blood sampling and handling in hemorheological tests.- 2.5.1. Postural changes.- 2.5.2. Venous occlusion.- 2.5.3. Diurnal, seasonal and climatic variations.- 2.5.4. Anticoagulation and storage.- 2.6. Clinical interpretation of hemorheological data.- 2.6.1. Plasma viscosity.- 2.6.2. Blood viscosity.- 2.6.3. Blood filtration.- 2.6.4. Optical aggregometry and erythrocyte sedimentation rate.- 2.7. References.- 3. Rheology of blood cells.- 3.1. Introduction.- 3.2. Dynamic deformability of blood cells.- 3.2.1. Blood cells deformability: "extrinsic factors".- 3.2.2. Red blood cell deformability: "intrinsic factors".- 3.2.3. White blood cell deformability: "intrinsic factors".- 3.3. Rheological implications of blood cell deformabilities.- 3.4. Blood cell aggregation - disaggregation and interaction with vascular endothelium.- 3.4.1. Red blood cell aggregation: mechanisms.- 3.4.2. Red blood cell aggregation: measurement.- 3.4.3. Adhesion of blood cells to vessel walls.- 3.5. Acknowledgements.- 3.6. References.- 4. Structural, hemodynamic and rheological characteristics of blood flow in the circulation.- 4.1. Introduction.- 4.2. Structural and hemodynamic characteristics of the vascular system.- 4.3. Functional compartments within the vascular system.- 4.3.1. The high pressure conduit vessels.- 4.3.2. The control compartment.- 4.3.3. The exchange compartment.- 4.3.4. The low pressure compartment.- 4.4. Blood cell rheology in the circulation.- 4.4.1. Bulk flow regime I.- 4.4.2. Transition zone IIa.- 4.4.2.1. Fahraeus effect.- 4.4.2.2. Fahraeus-Lindqvist effect.- 4.4.3. Transition zone IIb.- 4.4.4. Single file flow regime III.- 4.5. Summary and conclusions.- 4.6. References.- 5. Physiological and pathophysiological significance of hemorheology.- 5.1. The role of hemorheology in circulatory physiology.- 5.1.1. Vascular hindrance and blood viscosity as determinants of resistance.- 5.1.2. Fundamental determinants of blood viscosity.- 5.1.3. Blood rheology in relation to circulation in vivo.- 5.1.4. Influence of blood rheology on oxygen transport.- 5.1.5. Influence of leukocytes on blood flow in the microcirculation.- 5.1.6. Modeling of microcirculatory networks.- 5.2. Circulatory consequences of pathological alterations in blood rheology.- 5.2.1. Hemorheological abnormalities in hematological disorders.- 5.2.2. Hemorheological abnormalities in cardiovascular disease.- 5.2.3. Compensatory adjustments to pathological alteration in blood rheology.- 5.3. Summary and conclusions.- References.- 6. Cardiovascular diseases.- 6.1. Introduction.- 6.2. Myocardial ischemia.- 6.2.1. Epidemiological evidence.- 6.2.2. Established myocardial ischemia.- 6.2.3. Changes associated with acute myocardial ischemia.- 6.2.4. Therapeutic implications.- 6.3. Hypertension.- 6.4. Cerebral ischemia.- 6.4.1. Physiological and epidemiological evidence.- 6.4.2. Role in the evolution of cerebral infarction.- 6.4.3. Therapeutic implications.- 6.5. Ischemia of the leg.- 6.5.1. Pathological role.- 6.5.2. Clinical significance.- 6.5.3. Therapeutic implications.- 6.6. Raynaud's phenomenon.- 6.6.1. Pathological role.- 6.6.2. Therapeutic implications.- 6.7. Conclusions.- 6.8. References.- 7. Thrombosis and hemorheology.- 7.1. Introduction.- 7.1.1. Sites of thrombosis.- 7.1.2. Structure of thrombi.- 7.2. Rheology and platelets.- 7.2.1. Platelets and hemostasis.- 7.2.2. Effects of red cells on platelets in hemostasis.- 7.2.3. Platelet adhesion.- 7.2.4. Platelet aggregation and secretion.- 7.2.5. Effects of red cells on platelet aggregation.- 7.2.6. Effects of fibrinogen on platelet behavior.- 7.3. Rheology, coagulation and fibrinolysis.- 7.4. Venous thromboembolism.- 7.4.1. Flow conditions and leg vein thrombosis.- 7.4.2. Hematocrit and leg vein thrombosis.- 7.4.3. Fibrinogen and leg vein thrombosis.- 7.4.4. Retinal vein thrombosis.- 7.5. Arterial thromboembolism.- 7.5.1. Cardiac thromboembolism.- 7.5.2. Arterial thrombosis and atherogenesis.- 7.5.3. Occlusive arterial thrombi on atherosclerotic plaques.- 7.5.4. Outcome of occlusive arterial thrombosis.- 7.6. Thrombosis of arterial shunts and grafts.- 7.7. Microvascular thrombosis.- 7.7.1. Disseminated intravascular coagulation.- 7.7.2. Leukostatis.- 7.8. References.- 8. Hemorheology and blood diseases.- 8.1. Introduction.- 8.2. The pathophysiology of blood hyperviscosity.- 8.3. The syndrome of polycythemic hyperviscosity.- 8.3.1. Erythrocytosis.- 8.3.2. Hyperleukocytic leukemias.- 8.4. The syndrome of sclerocythemic hyperviscosity.- 8.4.1. Sickle cell disease.- 8.4.2. Hemolytic anemias.- 8.5. The syndrome of plasmatic hyperviscosity.- 8.5.1. Paraprotein diseases.- 8.5.2. Hematological stress syndrom.- 8.6. Summary and conclusions 249 References.- 9. Obstetrics, neonatology and gynaecology.- 9.1. Why rheology in obstetrics, gynaecology and neonatology?.- 9.2. Maternal rheology in normal pregnancy.- 9.3. Normal fetal hemorheology.- 9.4. Pathological pregnancy.- 9.4.1. Maternal smoking in pregnancy.- 9.4.2. Pre-eclampsia.- 9.4.3. Hemorheological therapy in pre-eclampsia.- 9.4.4. Diabetes mellitus in pregnancy.- 9.5. Rheology in the neonate.- 9.6. Treatment of neonatal hyperviscosity.- 9.7. Rheological sequelae of oral contraception.- 9.8. References.- 10. Diabetes.- 10.1. Introduction.- 10.2. Diabetes and its complications.- 10.3. Relevance of blood rheology in diabetes.- 10.4. Macrorheology of blood in diabetes.- 10.4.1. Whole blood viscosity.- 10.4.2. Plasma and serum viscosity.- 10.5. Microrheology of blood in diabetes.- 10.5.1. Red cell deformability.- 10.5.2. Red cell aggregation.- 10.5.3. Red cell adhesion.- 10.6. Implications.- 10.6.1. Whole blood viscosity and large vessel disease.- 10.6.2. Red cell deformability, plasma viscosity and mic…