Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/02—Detecting, measuring or recording for evaluating the cardiovascular system, e.g. pulse, heart rate, blood pressure or blood flow
  • A61B5/02028—Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
  • A61B5/02035—Determining blood viscosity
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N11/00—Investigating flow properties of materials, e.g. viscosity, plasticity; Analysing materials by determining flow properties
  • G01N11/02—Investigating flow properties of materials, e.g. viscosity, plasticity; Analysing materials by determining flow properties by measuring flow of the material
  • G01N11/04—Investigating flow properties of materials, e.g. viscosity, plasticity; Analysing materials by determining flow properties by measuring flow of the material through a restricted passage, e.g. tube, aperture
  • G01N11/06—Investigating flow properties of materials, e.g. viscosity, plasticity; Analysing materials by determining flow properties by measuring flow of the material through a restricted passage, e.g. tube, aperture by timing the outflow of a known quantity
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
  • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
  • G01N33/483—Physical analysis of biological material
  • G01N33/487—Physical analysis of biological material of liquid biological material
  • G01N33/49—Blood

Definitions

• This invention relates to the process and apparatus for measuring the resistance to flow of a patient's blood under conditions approximating the microcirculatory vessels. Resistance to flow of blood is measured as an apparent vis ⁇ cosity, the flow taking place through a porous bed.
• the apparent viscosity of blood decreases from indefinitely large values near zero flow rates to an asymptotic value of the order of 3 to 5 centipoise above wall shear stresses of
• Aggregating phenomena also can occur due to stasis in a blood vessel brought about by surgical proce ⁇ dures.
• the aggregating tendency of red cells is a manifes- tation of attraction between their surfaces which can also be detected as an increase in sliding friction, if the cells are forced to move past each other slowly.
• U.S. Patent 3,911,728 discloses a process for measuring blood viscosity by placing a blood sample and a confined gas in a tube having a narrow cross-section and reciprocally moving the blood through the narrow cross-section. The gas pressure variations due to compression of the gas are measured and then correlated with viscosity.
• Other indirect means for measuring physical characteristics of blood are shown in U.S. Patents 3,918,908, 3,967,934, 4,187,462 and 4,202,204. Since the means for measuring blood viscosity as disclosed in the • cited patents are indirect, errors are introduced which ren ⁇ der the results far less reliable than could be obtained with a direct blood viscosity measurement.
• the apparent vis- cosity of blood is measured under conditions analogous to slow flow in the microcirculatory vessels by means of a por ⁇ ous bed, having pore dimensions comparable to the inner diam ⁇ eters of the microcirculatory vessels, whereby the sliding frictional effects, divisions of the flow and recombination of flow found in the living microcitculatory vessels can be approximated, and at the same time the flow through the bed is limited to a rate such that, in combination with the small
• the porosity can be created in a variety of ways, for example, by packing fine spherical beads into a column, by synthesis of macroreticular networks from reagents like divinyl benzene or by phase separation of polyolefins. All that is required is that the porosity be reasonably uniform throughout the bed, to minimize channeling, and that the pore diameters fall in the range of approximately 100 ym to 200 ym, preferably from 10 ym to 50 ym. Furthermore, reproducibility from bed to bed is obviously desirable.
• A total area of bed normal to flow, cm 2 (so that Q/A is the approach velocity to the bed, cm/sec)
• ⁇ P pressure difference across bed, dyn/cm
• volumetric flow rate Q As practiced, it is convenient to measure volumetric flow rate Q by timing the fall of the upper meniscus of blood from a height h to a final height h...
• the meniscus moves downward in a capillary tube of about 1 mm inside diameter, thus of cross-sectional areas
• the equivalent shear stress ⁇ in the equivalent cap ⁇ illary is defined as:
• the hollow column diameter 1/lOth or less the diameter of the porous bed for example, 1 mm column diameter with a 1 cm bed diameter.
• the approach velocity to the porous bed which is inconveniently low in value, is reflected in a flow velocity through the hollow column 100- fold greater, leading to meniscus movements measureable in the range of centimeters per minute.
• Blood can be drawn into anticoagulant sample tubes and tested subsequently in the device of this invention. However, it is believed that greatest accuracy is achieved when blood is drawn directly from the patient's vein and im ⁇ mediately introduced into this device.
• the device is pre ⁇ ferably pre-warmed into this device.
• the device is prefer- ably pre-warmed to body temperature, 37°C.
• One of the out ⁇ standing advantages is the speed with which a determination can be made. The end-point reading can easily be obtained within 180 seconds from venopuncture, before coagulation begins. The ability to carry out the test so rapidly means
• the temperature of the blood will necessarily be close to that of the body, 37°C, and thus, the viscosity measured will correspond to usual physiological temperatures in the icro- vasculature.
• FIG. 1 is a side view of the apparatus of this inven ⁇ tion including a vent cap.
• Fig. 2 is a side view of an embodiment of this inven ⁇ tion including a vacuum tube.
• Fig. 3 is a partial cross-sectional view showing measurement of blood flow in accordance with this invention.
• the apparatus of this invention 10 includes a hollow column 12, and a chamber 14 which chamber contains a porous bed 16.
• a blood sample inlet 18 is provided at the top of the column 12 and a hydrophobic vent cap 20 is fitted over a blood outlet 22 at the lower end of chamber 14.
• a blood sample preferably, but not necessarily taken immed ⁇ iately beforehand from the patient into a syringe by veni- puncture, is introduced through inlet 18 and is allowed to flow through column 12 progressively filling chamber 14 while air is expelled through hydrophobic vent cap 20.
• the hydro ⁇ phobic vent cap 20 prevents passage of blood therethrough so that, after the chamber 14 and column 12 are filled with blood, the vent cap 20 can be removed in order to initiate blood flow through the chamber 16 and the column 12.
• FIG. 2 an alternative embodiment is shown which includes means for taking a blood sample directly from the patient and introducing it into the apparatus, of
• the apparatus includes a column 12, a cham ⁇ ber 14, and a porous bed 16.
• the top surface 24 of the porous bed 16 be spaced apart from the column outlet 26 in order to pro- mote even flow across the horizontal cross-sectional areas of the packed bed 16.
• the packed bed 16 be spaced apart from the chamber outlet 22 such as by means of a screen 28 in order to promote even flow a- cross the horizontal cross-section of the packed bed 16.
• a venipuncture device 30 which includes a holder 32 and a needle 34.
• Venipuncture is accomplished in the usual way by grasping piece 32 so as to introduce needle 34 into the vein of a patient. Blood is introduced rapidly into the column 12 and the chamber 16 when needle 36 is inserted through seal 38 into tube 40 which is maintained under vacuum. The vacuum in tube 40 will cause blood eventually to flow through column 12, chamber 16 and into vacuum tube 40, unless hydrophobic vent cap 20 is interposed. In that case, the blood is stopped at that place.
• the blood viscometer 10 is placed within fixture 48 by means of clamps 50 and 52 after chamber 16 and column 12 have been filled with a patient's blood.
• fixture 48 is thermostatically controlled at a constant temperature, preferably 37°C, in order to maintain the viscometer and blood contained therein at constant temper ⁇ ature.
• the hydrophobic vent cap (not shown) is removed from chamber outlet 22 so that blood flows by gravity down column 12, down chamber 16 so that the air-blood interfaces pass first between light emitting diode 54 and photodiode 56 which starts a conventional clock mechanism (not shown) having an associated time readout 58.
• the air-blood interface passes downwardly through column 12, it passes a second set compris ⁇ ing a light emitting diode 60 and a photodiode 62 which causes
• the clock mechanism to stop.
• the operator then can easily read the elapsed time between the top set of diodes 54 and 56 and the bottom set of diodes 60 and 62 from the time readout 58.
• the blood passing through column 12 and chamber 16 flows into container 64. Since the blood flow rate through the column 12 depends upon its viscosity, the operator can easily determine the tendency of a particular patient to have abnor ⁇ mal icrocirculation by comparing the time readout with a previously established standard.
• the material utilized in the porous bed should not promote blood hemolysis and should allow blood permeation such that the average wall shear stress with blood is about
• Suitable average pore sizes are be ⁇ tween about 10 ym and about 200 ym, preferably between about 10 ym and about 50 ym.
• the bed should have a specific Darcy permeability of not more than 50 Darcy units (50 x 10 —8 cm2) , preferably less than 10 Darcy units.
• Representative suitable particles include glass beads, preferably silane treated; polystyrene beads; polyethylene particles, and beds formed by sintering or related processes, for example, rods of sintered porous glass and analogous products produced by sintering granular plastic such as polyethylene, polypropylene, poly- vinyl chloride, etc.
• suitable bed thicknesses are between about 1 cm and about 10 cm, preferably between about 2 cm and about 4 cm and bed diameters are 0.4 to 2 cm, preferably 0.75 to 1.5 cm.
• the apparatus of this invention does not require excessively large blood samples to be taken from the patient for testing. Therefore, the preferred bed sizes are set forth above while preferred column dimensions are of a height between about 1 cm and about 5, cm, preferably between about 2 cm and about 3 cm and an inside diameter be ⁇ tween about 0.5 mm and about 2 mm, preferably around 1- mm and preferably not more than 1/10 the diameter of the porous bead.
• OMPI It is obvious that the apparatus of Fig. 1 or of Fig. 2 could be initially filled with blood in the reverse direc ⁇ tion to that shown, by placing hydrophobic vent cap 20 on opening 18 and introducing blood through opening 22. In this case, readout apparatus of Fig. 3 would be modified by fixing clamps 50 and 52 on a frame having an axis of rotation slightly below the diode pair 60-62.
• the apparatus after filling in the reverse direction is loaded into the clamps when they are in the loading posi- tion as described, thus with the chamber 14 above column 12, with hydrophobic vent 20 underneath.
• a sample of blood is found to take 30 seconds, its viscosity is then 30/6 or 5 times the viscosity of saline.
• the standard fluid will be run in the device at the same temperature as the blood sample, preferably at or near 37°C, as explained above, for most patients.
• the device can also be run at lower temperatures, for example 20°C, especially when cryoglobulinemia is suspected in the patient. If cryoglobulinemia is present, apparent blood viscosity will be drastically increased when measured at 20°C as compared to 37°C. In such a case, it would be desirable to take sufficient blood from the patient to fill two devices, and run one at 37°C and the other at 20°C.

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• Health & Medical Sciences (AREA)
• Life Sciences & Earth Sciences (AREA)
• Engineering & Computer Science (AREA)
• Biomedical Technology (AREA)
• Physics & Mathematics (AREA)
• Pathology (AREA)
• Chemical & Material Sciences (AREA)
• General Health & Medical Sciences (AREA)
• General Physics & Mathematics (AREA)
• Molecular Biology (AREA)
• Cardiology (AREA)
• Hematology (AREA)
• Biophysics (AREA)
• Biochemistry (AREA)
• Analytical Chemistry (AREA)
• Immunology (AREA)
• Animal Behavior & Ethology (AREA)
• Medical Informatics (AREA)
• Surgery (AREA)
• Heart & Thoracic Surgery (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Ecology (AREA)
• Physiology (AREA)
• Urology & Nephrology (AREA)
• Food Science & Technology (AREA)
• Medicinal Chemistry (AREA)
• Investigating Or Analysing Biological Materials (AREA)
• Measuring Pulse, Heart Rate, Blood Pressure Or Blood Flow (AREA)

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Citations (4)

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• 1983
  • 1983-06-08 WO PCT/US1983/000914 patent/WO1984000003A1/en not_active Ceased
  • 1983-06-08 DE DE8383902218T patent/DE3371278D1/de not_active Expired
  • 1983-06-08 JP JP58502331A patent/JPS59501378A/ja active Granted
  • 1983-06-08 EP EP83902218A patent/EP0111551B1/en not_active Expired
  • 1983-06-13 CA CA000430277A patent/CA1195142A/en not_active Expired

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Non-Patent Citations (5)

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