Blood

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
Image shows red blood cells, different types of white blood cells - monocytes, T-cell and B-cell lymphocytes, plus platelets.
Types of blood cells. Author: Blausen.com staff (2014). Medical gallery of Blausen Medical 2014. DOI:10.15347/wjm/2014.010. Copyright: CC-BY-3.0

Blood consists of red blood cells, different kinds of white blood cells, plasma and platelets (fragments of blood cells).

Abnormalities in red blood cell shape, red blood cells not being able to change shape properly, and altered blood flow have been detected in patients with ME/CFS. Treatments that address blood flow issues may lead to improvement in symptoms for some patients.

A number of studies have found differences in certain white blood cells. A potential biomarker has been identified by stressing a subset of white blood cells known as PMBCs.

Abnormalities[edit | edit source]

Low blood volume[edit | edit source]

A high proportion of ME/CFS patients have been shown via a Dual Tag Test to have significantly lower blood volume than healthy controls.[1][2] A 2018 study using a standard dual isotope erythrocyte labelling technique to determine blood volume, erythrocyte and plasma volume found significantly lower measured blood volume and red blood cell volume per body weight in female ME/CFS with clinical symptoms of orthostatic intolerance (OI) as compared to female ME/CFS patients without a clinical symptoms of orthostatic intolerance (OI).[3]

Less red blood cell deformability[edit | edit source]

Multiple studies have found unusual properties of red blood cells, including issues with deformability.[4][5][citation needed] Deformability is the ability of a red blood cell to change shape. This is necessary because some capillaries are narrower than the red blood cells themselves. If red blood cells are not deformable enough, blood flow slows down.

More misshapen red blood cells[edit | edit source]

The shape of red blood cells has been found to be unusual in ME/CFS patients in several studies.[citation needed] This can also slow blood flow, as well as change how molecules dock on the surface of a red blood cell. One study found significantly increased quantities of stomatocytes in the blood of CFS patients. Stomatocytes are red blood cells that have lost their concave shape, usually due to a membrane defect.[6]

Both changes in deformability and changes in shape can be related to the way nutrients are or are not being processed in the body. For example, excess cholesterol can change the shape of red blood cells in some conditions by adhering to the outside of the membrane.[7]

While deformability and unusual red blood cell shape can be indicative of ME/CFS, these abnormalities also occur in other conditions. For example, red blood cell deformability is affected in parasitic infections such as malaria, and metabolic disorders such as diabetes;[8] and unusual red blood cell shape is found in several nutritional deficiencies.[9] While unusual shape and decreased deformability may be said to be signs of illness, they are not characteristic of ME/CFS alone.

Plasma and impaired metabolic in ME/CFS[edit | edit source]

A biomarker being investigated for ME/CFS found that plasma together with several types of white blood cells, known as collectively as peripheral blood mononuclear cells (PBMCs), reacted differently to plasma and white blood cells from healthy controls when put under a salt stress test designed to mimic post-exertional malaise. The PBMCs from the blood of ME/CFS patients was then put in plasma from healthy controls, which significantly improved their response to the biological stress.[10]

The original hypothesis being tested was that "extensive consumption and potential depletion of ATP, a high-energy metabolite" would be found in the blood of ME/CFS patients, and this was confirmed, along with finding a unique metabolic signature that correctly identified all patients and no healthy controls.[10]

Symptoms Resulting from Abnormalities[edit | edit source]

Orthostatic intolerance (OI), or difficulty tolerating changes in position, has been estimated to occur in up to 97% of ME/CFS patients.[11] OI is linked to under-oxygenation of the brain[citation needed] due to a combination of red blood cell abnormalities and low blood volume. It has also been suggested that blood pressure and other circulatory system abnormalities contribute to this under-oxygenation.[citation needed]

Proposed Causes for Blood Abnormalities[edit | edit source]

Abnormality Treatments and Adjustments[edit | edit source]

Notable studies[edit | edit source]

Articles and blogs[edit | edit source]

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. ↑ Hurwitz, BE; Coryell, VT; Parker, M; Martin, P; LaPerriere ...., A; Bilsker, MS. "Chronic fatigue syndrome: illness severity, sedentary lifestyle, blood volume and evidence of diminished cardiac function". Clinical Science. 118 (2): 125–135.
  2. ↑ Streeten, DHP; Bell, D (1998). "Circulating Blood Volume in Chronic Fatigue Syndrome". Journal of Chronic Fatigue Syndrome. 4: 3–11.
  3. ↑ 3.0 3.1 Campen, C. (Linda) M. C. van; Visser, Frans C. (2018). "Blood Volume Status in Patients with Chronic Fatigue Syndrome: Relation to Complaints". International Journal of Clinical Medicine. 09 (11): 809–819. doi:10.4236/ijcm.2018.911067. ISSN 2158-284X.
  4. ↑ 4.0 4.1 Saha, Amit K; Schmidt, Brendan R; Wilhelmy, Julie; Nguyen, Vy; Do, Justin; Suja, Vineeth C; Nemat-Gorgani, Mohsen; Ramasubramanian, Anand K; Davis, Ronald W (November 2018). "Erythrocyte Deformability As a Potential Biomarker for Chronic Fatigue Syndrome". Blood (132): 4874. doi:10.1182/blood-2018-99-117260.
  5. ↑ Saha, Amit K.; Schmidt, Brendan R.; Wilhelmy, Julie; Nguyen, Vy; Abugherir, Abed; Do, Justin K.; Nemat-Gorgani, Mohsen; Davis, Ronald W.; Ramasubramanian, Anand K. "Red blood cell deformability is diminished in patients with Chronic Fatigue Syndrome". Clinical Hemorheology and Microcirculation. 71 (1): 113–116. doi:10.3233/CH-180469. ISSN 1386-0291. PMC 6398549. PMID 30594919.
  6. ↑ Richards, RS; Wang, L; Jelinek, H (January 2007). "Erythrocyte oxidative damage in chronic fatigue syndrome". Archives of Medical Research. 38 (1): 94–98.
  7. ↑ Owen, J.S.; Brown, D.J.; Harry, D.S.; Beaven, G.H.; McIntyre, N ....; Gratzer, W.B. (December 1985). "Erythrocyte echinocytosis in liver disease. Role of abnormal plasma high density lipoproteins". J Clin Invest. 76 (6): 2275–2285.
  8. ↑ Tomaiuolo, G. (2014). "Biomechanical properties of red blood cells in health and disease towards microfluidics". Biomicrofluidics. 8 (5).
  9. ↑ "Poikilocytosis -- Abnormal RBC shape". Laboratory Info. 2017.
  10. ↑ 10.0 10.1 10.2 Davis, R. W.; Wilhelmy, J.; Nemat-Gorgani, M.; Kashi, A.; Esfandyarpour, R. (April 25, 2019). "A nanoelectronics-blood-based diagnostic biomarker for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)". Proceedings of the National Academy of Sciences. 116 (21): 10250–10257. doi:10.1073/pnas.1901274116. ISSN 0027-8424. PMID 31036648.
  11. ↑ Miwa, K (July 2015). "Cardiac dysfunction and orthostatic intolerance in patients with myalgic encephalomyelitis and a small left ventricle". Heart and Vessels. 30 (4): 484–489.
  12. ↑ Fluge, Øystein; Mella, Olav; Bruland, Ove; Risa, Kristin; Dyrstad, Sissel E.; Alme, Kine; Rekeland, Ingrid G.; Sapkota, Dipak; Røsland, Gro V. (December 22, 2016). "Metabolic profiling indicates impaired pyruvate dehydrogenase function in myalgic encephalopathy/chronic fatigue syndrome". JCI insight. 1 (21): e89376. doi:10.1172/jci.insight.89376. ISSN 2379-3708. PMC 5161229. PMID 28018972.
  13. ↑ Xu, Jiabao; Potter, Michelle; Tomas, Cara; Elson, Jo; Morten, Karl; Poulton, Joanna; Wang, Ning; Jin, Hanqing; Hou, Zhaoxu (2018). "A new approach to find biomarkers in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) by single-cell Raman micro-spectroscopy". The Analyst. doi:10.1039/C8AN01437J. ISSN 0003-2654.
  14. ↑ van Campen, C. (Linda) M. C.; Rowe, Peter C.; Visser, Frans C. (November 15, 2018). "Blood Volume Status in ME/CFS Correlates With the Presence or Absence of Orthostatic Symptoms: Preliminary Results". Frontiers in Pediatrics. 6. doi:10.3389/fped.2018.00352. ISSN 2296-2360.

platelet (also known as a thrombocyte) A colorless disk-like blood cell that assists in blood clotting by adhering to other platelets and to damaged linings of blood vessels. Simply put, platelets clump together to form blood clots. (A blood clot is also called a thrombus.) People with low levels of platelets may have trouble with blood clotting, and may bleed easily from minor wounds.

platelet (also known as a thrombocyte) A colorless disk-like blood cell that assists in blood clotting by adhering to other platelets and to damaged linings of blood vessels. Simply put, platelets clump together to form blood clots. (A blood clot is also called a thrombus.) People with low levels of platelets may have trouble with blood clotting, and may bleed easily from minor wounds.

orthostatic intolerance (OI) - The development of symptoms when standing upright, where symptoms are relieved upon reclining. Patients with orthostatic intolerance have trouble remaining upright for more than a few seconds or a few minutes, depending upon severity. In severe orthostatic intolerance, patients may not be able to sit upright in bed. Orthostatic intolerance is often a sign of dysautonomia. There are different types of orthostatic intolerance, including postural orthostatic tachycardia syndrome (POTS).

The word "membrane" can have different meanings in different fields of biology. In cell biology, a membrane is a layer of molecules that surround its contents. Examples of cell-biology membranes include the "cell membrane" that surrounds a cell, the "mitochondrial membranes" that form the outer layers of mitochondria, and the "viral envelope" that surrounds enveloped viruses. In anatomy or tissue biology, a membrane is a barrier formed by a layer of cells. Examples of anatomical membranes include the pleural membranes that surrounds the lungs, the pericardium which surrounds the heart, and some of the layers within the blood-brain barrier.

membrane The word "membrane" can have different meanings in different fields of biology. In cell biology, a membrane is a layer of molecules that surround its contents. Examples of cell-biology membranes include the "cell membrane" that surrounds a cell, the "mitochondrial membranes" that form the outer layers of mitochondria, and the "viral envelope" that surrounds enveloped viruses. In anatomy or tissue biology, a membrane is a barrier formed by a layer of cells. Examples of anatomical membranes include the pleural membranes that surrounds the lungs, the pericardium which surrounds the heart, and some of the layers within the blood-brain barrier.

plasma The liquid part of blood, lymph, or milk after removing any suspended material. Most of the time, "plasma" simply refers to blood, after all the blood cells have been removed. If you also remove the clotting factors, then the plasma is referred to as "serum".

An alternate term that is sometimes used for myalgic encephalomyelitis, by people who believe the evidence for inflammation in ME is insufficient. This terminology reflects the belief that the "-itis" suffix implies inflammation.

myalgic encephalopathy An alternate term that is sometimes used for myalgic encephalomyelitis, by people who believe the evidence for inflammation in ME is insufficient. This terminology reflects the belief that the "-itis" suffix implies inflammation.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

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