Variability in human plasma volume responses during high-altitude sojourn

Abstract

When sea-level (SL) residents rapidly ascend to high altitude (HA), plasma volume (PV) decreases. A quantitative model for predicting individual %∆PV over the first 7 days at HA has recently been developed from the measurements of %∆PV in 393 HA sojourners. We compared the measured %∆PV with the %∆PV predicted by the model in 17 SL natives living 21 days at HA (4300 m). Fasting hematocrit (Hct), hemoglobin (Hb) and total circulating protein (TCP) concentrations at SL and on days 2, 7, 13, and 19 at HA were used to calculate %∆TCP and %∆PV. Mean [95%CI] measured %∆PV on HA2, 7, 13 and 19 was −2.5 [−8.2, 3.1], −11.0 [−16.6, −5.5], −11.7 [−15.9, −7.4], and −16.8 [−22.2, −11.3], respectively. %∆PV and %∆TCP were positively correlated (P < 0.001) at HA2, 7, 13, and 19 (r 2  = 0.77, 0.88, 0.78, 0.89, respectively). The model overpredicted mean [95% CI] decrease in %∆PV on HA2 (−12.5 [−13.9, −11.1]) and HA7 (−21.5 [−23.9, −19.1]), accurately predicted the mean decrease on HA13 (−14.3, [−20.0, −8.7]), and predicted a mean increase in %∆PV on HA19 (12.4 [−5.0, 29.8]). On HA2, 7, 13, and 19 only 2, 2, 6, and 1, respectively, of 17 individual measures of %∆PV were within 95% CI for predicted %∆PV. These observations indicate that PV responses to HA are largely oncotically mediated, vary considerably among individuals, and available quantitative models require refinement to predict %∆PV exhibited by individual sojourners.