By Author
  By Title
  By Keywords

July 1992, Volume 42, Issue 7

Original Article

HAEMOGLOBIN, HAEMATOCRIT AND PLASMA FIBRINOGEN IN CIGARETTE SMOKERS

Shoaib Tauheed  ( Physiology Department, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. )
Shaheen Shoaib  ( Physiology Department, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. )
Ahmad Kamal  ( Physiology Department, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. )

Acute change in smoking habits results in fluctua­tions in haemoglobin levels1. This study was therefore undertaken to see the effect of smoking on various haematological parameters.

SUBJECTS, METHODS AND RESULTS

Seventy males (40 smokers and 30 non-smokers) between the ages of 35 to 70 years were selected for this study. A detailed medical and smoking history was taken and a thorough medical examination was done. Smokers included had history of smoking 10 or more cigarettes per day for at least 5 years. None of the subjects were found to have diabetes, liver or respiratory disease, congestive cardiac failure, bleeding disorders or any active illness known to effect the haematological parameters. Venous samples were taken from resting subjects in the morning and anticoagulated with E1)TA (1.5 mg/ml) for haemoglobin and haematocrit determinations. Haemoglobin was done by Cyan methaemoglobin method and haematocrit by microhaematocrit method on microhaematocrit machine (Hamule W. Germany). Samples were centrifuged in duplicate for 10 minutes and then averaged. Fibrinogen levels were determined in citrated plasma by quantitative clotting technique using Sigma diagnostic kits. Haemoglobin, haematocrit and fibrinogen levels were significantly higher in smokers than non-smoker (Table I).

The percentage rise was 9.3, 10.3 and 47.4 respectively.


Table II and Figure show that flbrinogen concentra­tion increased significantly with the number of cigarettes smoked per day. Smokers with 11-20 dgarettes per day showed 9.7% and smokers with more than 20 cigarettes per day showed 14.5% rise offibrinogen when compared to the smokers of 10 cigarettes per day.

COMMENTS

The venous blood haemoglobin and haematocrit are the simplest and most frequently measured laboratory parameters. There is increasing debate as to their normal reference ranges in a healthy population and also their levels in various physiological adaptations, e.g., high altitude, pregnancy, exercise and disease states respiratory, cardiac and vascular diseases. The definition of normal population is difficult with smoking, stress, temperature and physical fitness. It is generally felt that the currently accepted upper limits for Hb levels of 180 gms/l in males and 165 gms/l in females are probably inappropriately high2. Levels of venous haematocrit that is generally accepted as normal may not necessarily be optimum3. The results of haemoglobin, haematocrit and raised llbrinogen levels reported here are in agreement with previous workers4-10. Fibrinogen also showed a dose dependent relationship with smoking5,10,11. Smoking increases fibrinogen levels and raised fibrinogen levels are associated with ischaemic heart disease9,12,13. A substantial part of the relationship be­tween smoking and ischaeinic heart disease appears to be mediated through fibrinogen concentration. It is concluded that reference values for healthy normal persons need reassessment specially with the exclusion of healthy smokers, the effect of smoking on various haematological parameters.

REFERENCES

1. Markman, M. Falling haematocrit value on cessation of smoking (letter),  JAMA., 1981;245:1314.
2. Lowe, G.D.O., Caen,J., Hershko, C., Lozzatto, L., Melacalf, D. et al. Blood rheology and hyperviscosity syndromes, in Bailliere\\\'s clinical haematology. London, Bailliere Tindal 1987;p.669.
3. Willison, JR. DuBoulay, G.H., Pal, BA., Russel, R.W., Thomas, D.J., Marshall, 3., Pearson, T.C. and Symon, L Effect of high haematocrit on alertness. Lancet, 1980;1:846-48
4. Stewart, R.D., Barelta, E.D., Platta, L.R. et al. Carboxyhaemoglobin levels in American blood donors. JAMA., 1974;228:1187-95.
5. Ernst, B., Matrai, A., Schomolzl, C.H. and Magyarosy, I. Dose- effect relationship between smoking and blood rheology. Br.J. Haematol., 1987;65:485-87.
6. Galea, 0. and Davidson, R.J.L Haematological and haemaorheological changes associated with cigarette smoking. J. Clin. Pathol., 1985;38:978-81.
7. Eisen, M.E. and Hammard, E.C.Theeffectofsmokingon packed cells volumee, red blood cell count, haemoglobin and platelet count Can.Med.Assoc.J., 1956:75:520-23.
8, Dintenfass, L Elevation of red cells, haematocntvaluesand fibrinogen levels in cigarette smokers. Med.J.Aust., 1975;1:671- 20.
9. Meade, T.W., Chakrabarty. R., Haines, A.P., North, W.R., Stirling Y.S. and Thompson, SO. Haemostatic function and cardiovascular death; early results of prospective study. Lancet, 1980:1:11150-53.
10. Wilkes, H.C., Kelleher, C. and Meade, T.W. Smoking and plasma fibrinogen. Lancet, 1988:1:307-8.
11. Kannel, W.B., DAgostino, RB. and Betanger, A.J. FIbrinogen, cigarette smoking and risk of cardiovascular disease; insights from the Framingham study. Am.Heart J., 1987;113:1006-10.
12. Meade, T.W., Mellowsm S., Brozovick, M., Miller, G.J., Chakarabarty, R.R., North, W.R., Haines, A.P. Sterling Y., Imeson, J.D. and Thompson, S.G. Haemostaticfunctionand ischaemic heart disease: Principle results of Northwick Part heart study. Lancet, 1986:2:533-37.
13. Stone, MC. and Thorp, 3M. Plasma fibrinogen - a major coronary risk factor. J.R.Coll.Gen. Pract., 1985;35:656-69.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: