Hemorheology, also spelled haemorheology (haemo from Greek 'αἷμα, haima 'blood'; and rheology, from Greek ῥέω rhéō, 'flow' and -λoγία, -logia 'study of'), or blood rheology, is the study of flow properties of blood and its elements of plasma and cells. Proper tissue perfusion can occur only when blood's rheological properties are within certain levels. Alterations of these properties play significant roles in disease processes. Blood viscosity is determined by plasma viscosity, hematocrit (volume fraction of red blood cell, which constitute 99.9% of the cellular elements) and mechanical properties of red blood cells. Red blood cells have unique mechanical behavior, which can be discussed under the terms erythrocyte deformability and erythrocyte aggregation. Because of that, blood behaves as a non-Newtonian fluid. As such, the viscosity of blood varies with shear rate. Blood becomes less viscous at high shear rates like those experienced with increased flow such as during exercise or in peak-systole. Therefore, blood is a shear-thinning fluid. Contrarily, blood viscosity increases when shear rate goes down with increased vessel diameters or with low flow, such as downstream from an obstruction or in diastole. Blood viscosity also increases with increases in red cell aggregability.
Blood viscosity Blood viscosity is a measure of the resistance of blood to flow. It can also be described as the thickness and stickiness of blood. This biophysical property makes it a critical determinant of friction against the vessel walls, the rate of venous return, the work required for the heart to pump blood, and how much oxygen is transported to tissues and organs. These functions of the cardiovascular system are directly related to vascular resistance, preload, afterload, and perfusion, respectively. The primary determinants of blood viscosity are hematocrit, red blood cell deformability, red blood cell aggregation, and plasma viscosity. Plasma's viscosity is determined by water-content and macromolecular components, so these factors that affect blood viscosity are the plasma protein concentration and types of proteins in the plasma. Nevertheless, hematocrit has the strongest impact on whole blood viscosity. One unit increase in hematocrit can cause up to a 4% increase in blood viscosity. This relationship becomes increasingly sensitive as hematocrit increases. When the hematocrit rises to 60 or 70%, which it often does in polycythemia, the blood viscosity can become as great as 10 times that of water, and its flow through blood vessels is greatly retarded because of increased resistance to flow. This will lead to decreased oxygen delivery. Other factors influencing blood viscosity include temperature, where an increase in temperature results in a decrease in viscosity. This is particularly important in hypothermia, where an increase in blood viscosity will cause problems with blood circulation.
Clinical significance Many conventional cardiovascular risk factors have been independently linked to whole blood viscosity.
Anemia can reduce blood viscosity, which may lead to heart failure. Furthermore, elevation of plasma viscosity correlates to the progression of coronary and peripheral artery diseases.
Normal level In pascal-seconds (Pa·s), the viscosity μ {\displaystyle \mu } of blood at 37 °C is normally 3 × 10−3 to 4 × 10−3, respectively 3 - 4 centipoise (cP) in the centimetre gram second system of units.
μ = ( 3 ∼ 4 ) ⋅ 10 − 3 P a ⋅ s {\displaystyle \mu =(3\sim 4)\cdot 10^{-3}\,Pa\cdot s}
ν = μ ρ = ( 3 ∼ 4 ) ⋅ 10 − 3 P a ⋅ s 1.06 ⋅ 10 3 k g m 3 = ( 2.8 ∼ 3.8 ) ⋅ 10 − 6 m 2 s {\displaystyle \nu ={\frac {\mu }{\rho }}={\frac {(3\sim 4)\cdot 10^{-3}Pa\cdot s}{1.06\cdot 10^{3}{\frac {kg}{m^{3}}}}}=(2.8\sim 3.8)\cdot 10^{-6}\,{\frac {m^{2}}{s}}} , where ρ {\displaystyle \rho } is the density. Blood viscosity can be measured by viscometers capable of measurements at various shear rates, such as a rotational viscometer.
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