DAXOR Corporation - The BVA-100

© 2013 DAXOR Corporation

DAXOR CorporationThe BVA-100Utilization of Blood Volume Measurement in Medical and Surgical Conditions

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BVA-100• The first instrument of its kind to receive FDA

clearance• A revolutionary advance in blood volume

measurement• Providing blood volume measurement which is most:– Accurate– Rapid– Easy to perform– Highly repeatable– Clinically powerful

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History of Blood Volume Analysis• The procedure is over 80 years old.• Until recently, it was time consuming and difficult to

perform.• It was prone to inaccuracies.• Repeatability of the test was questionable.• It was primarily used as a research tool only.

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Principles of Blood Volume Analysis

Blood volume analysis is based on the fundamental concept of the indicator (tracer) dilution principle. An exact amount of tracer is injected into a known volume and an identical quantity is injected into an unknown volume. A comparison of the concentration of the tracer is calculated. The concentration of the tracer of the known volume is inversely proportional to that of the unknown volume.

Known Volume Unknown Volume

Tracer (I131 HSA)

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Measuring Deviation from Ideal Blood Volume

The BVA-100 determines the normal blood volume with “the ideal height and weight method.”* This method was found to be more accurate than methods involving height, weight, or body surface area.

* Feldschuh, J. and Enson, Y. Prediction of Normal Blood Volume: Relation of blood volume to body habitus. Circulation. 1977;56:605-612

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Blood Volume to Body Weight

Ratio(mL/kg)

Deviation from Desirable

Weight (+/-%)


Ratio(mL/kg)


Weight(+/-%)


Ratio(mL/kg)


Weight(+/-%)

99.7 -40 69.9 0 50.1 +76

97.1 -37 66.6 +6 48.7 +89

94.4 -34 63.9 +12 47.4 +103

91.2 -30 61.2 +19 46.1 +118

87.9 -26 58.9 +26 45 +134

84.7 -22 56.9 +34 44.1 +151

80.6 -17 55.0 +43 43.3 +168

77.0 -12 53.4 +53 42.6 +186

73.2 -6 51.7 +64 42.1 +205

41.4 +225

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© 2013 DAXOR Corporation 7



The Blood Volume Analyzer

The BVA-100 is the first semi-automated instrument of its type to receive clearance from the FDA to perform blood volume measurement.

It is intended to provide quantitative diagnostic information for use in a variety of medical situations where accurate knowledge of blood volume is essential.

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• The hematocrit is often used as a surrogate test to estimate blood volume.

• Within a single hematocrit point, blood volumes have been found to vary by as much as 50%. It is of limited use in estimating blood volume.

• The BVA-100 takes approximately 45 minutes to complete. It measures total blood volume, plasma volume, and red blood cell volume with an accuracy of ±2.5%.

BVA-100 and Hematocrit

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• The BVA-100 automatically– Uses a pre-measured amount of isotope.– Works with five data points.– Performs statistical analysis of results and, if necessary, discards an

outlier.– Converts large vessel hematocrit to whole body hematocrit and

corrects for plasma packing.

• Technicians should– Take five samples.– Make sure the standard and injectate are properly matched.– Avoid contamination of samples with injectate, saline, or anticoagulant.

Accurate Measurement with the BVA-100

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Clinical Conditions in Which Blood Volume is Important

Normal Blood VolumeTotal Blood Volume Plasma Volume Red Cell Volume Example of

ConditionNormal Normal Normal Normovolemic

Normal Decreased Increased Polycythemia vera

Normal Increased Increased Anemia with homeostatic plasma expansion. This form of anemia is the assumption that underlies using the hematocrit to indicate the severity of anemia.

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Increased Total Blood VolumeTotal Blood Volume Plasma Volume Red Cell Volume Example of Condition

Increased Increased Increased Congestive heart failure, emphysema, exercise

Increased Increased Normal Congestive heart failure

Increased Normal Increased Polycythemia vera, chronic obstructive pulmonary disease treated with diuretics

Increased Extremely Increased Decreased Congestive heart failure, especially with bleeding, therapeutic hemodilution prior to surgery

Increased Decreased Extremely Increased Chronic obstructive pulmonary disease with extreme overdiuresis

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Decreased Total Blood VolumeTotal Blood Volume Plasma Volume Red Cell Volume Example of Condition

Decreased Decreased Decreased Early hemorrhage, post-op “hidden anemia” – patient has red blood cell depletion and incomplete plasma expansion

Decreased Decreased Normal Dehydration, vasoconstrictive hypertension

Decreased Normal Decreased Anemia with incomplete compensatory plasma expansion, hypoalbuminemia

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Decreased Total Blood Volume (continued)

Total Blood Volume Plasma Volume Red Cell Volume Example of ConditionDecreased Extremely

DecreasedIncreased Extreme vasoconstriction, transfusion with

red cells without plasma; any condition causing hypoalbuminemia, latrogenic excessive treatment with diuretics in a CHF or pulmonary patient with expanded red cell volume

Decreased Increased ExtremelyDecreased

Chronic red blood cell depletion with incomplete plasma expansion; this is a common condition in chronically ill patients; Seen in people with HIV, cancer patients undergoing chemotherapy, conditions that cause bone marrow suppression

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Examples in Detail

• Increased plasma volume; red cell volume may be normal, increased, or reduced

• Total blood volume generally increases• Hematocrit underestimates red cell volume• Long-term diuretic treatment may lead to reduced total

blood volume and reduced tissue perfusion.• Blood volume measurement can measure the extent of

plasma expansion and determine the need for and track the effectiveness of diuretic treatment.

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Congestive Heart Failure


Examples in Detail

• Can have many causes; Particularly common among patients with HIV and cancer patients undergoing chemotherapy

• It is generally assumed that plasma volume will expand to maintain a normal blood volume.

• Many clinical blood volume measurements have found significant overall volume depletion.

• If plasma expansion is incomplete, the hematocrit overestimates the red cell volume, masking the true extent of anemia.

• Blood volume measurement can reveal the full extent of anemia so that appropriate treatment can be prescribed.

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Chronic Red Cell Depletion with Incomplete Plasma Expansion


Examples in DetailNormovolemic Anemia versus Hypovolemic Anemia

Patients with Identical Hematocrits

Greater blood loss in the hypovolemic case is masked by incomplete volume replacement. The result is that the hematocrit (30%) is identical, but the hypovolemic patient (25% volume loss) has greater blood loss and is significantly more vulnerable.

Normal Loss of 1/3 Original RBCs Loss of 1/2 Original RBCs

45%

30% 30%

55% 55%

30%

15% 5%

NormovolemicAnemia5000 cc

HypovolemicAnemia3750 cc

Normovolemicnormal red cellvolume 5000 cc

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Plasma

Red Cells

Fluid Replacement

Additional red blood cell loss undetected by blood volume analysis


Examples in Detail

• Two main mechanisms underlie hypertension: expanded blood volume and vasoconstriction.

• Diuretics are effective in treating hypertension caused by expanded blood volume.

• Vasodilators are effective in treating hypertension caused by vasoconstriction.

• Blood volume measurement can determine if hypertension is associated with an expanded blood volume and can help physicians determine appropriate treatment.

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Hypertension


Examples in Detail

Overdiuresis• Many conditions, including CHF and hypertension, are

treated with diuretic drugs.• If a patient is overdiuresed, the plasma volume drops

below normal, and tissue perfusion can be reduced.• Blood volume measurement can monitor the extent and

effectiveness of diuretic use and prevent overdiuresis.

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Examples in Detail

Septic Shock• In septic shock, a precipitous drop in blood pressure

must be reversed to prevent fatality.• Blood volume measurement can help detect loss of

blood volume and guide treatment decisions.• The Lutheran Medical Center reported a 20% lower

death rate in patients for whom the BVA–100 was used to detect a low blood volume.

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Examples in Detail

Surgical Blood Loss• Some patients enter surgery in a blood-depleted

state.• The hematocrit may not accurately reflect blood

volume status.• Blood volume measurement before surgery can help

physicians accurately assess how safe it is for a patient to enter surgery and how much blood they can safely lose.

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Advantages of Automated Blood Volume Analysis

• Directly measures blood volume, rather than relying on possibly inaccurate surrogate tests

• Provides key information for diagnosing and effectively treating a number of common conditions

• Accurate to within ±2.5%• Can be completed in 45 minutes; preliminary results

available in under 20 minutes• Accepted by the Food and Drug Administration

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© 2013 DAXOR Corporation 23

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DAXOR Corporation - The BVA-100