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DAXOR Corporation
The BVA-100
Utilization of Blood Volume Measurement
in Medical and Surgical Conditions
1© 2013 DAXOR Corporation
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
2© 2013 DAXOR Corporation
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.
3© 2013 DAXOR Corporation
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)
4© 2013 DAXOR Corporation
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
5© 2013 DAXOR Corporation
Measuring Deviation from
Ideal Blood Volume
Blood Volume
to Body Weight
Ratio
(mL/kg)
Deviation from
Desirable
Weight (+/-%)
Blood Volume
to Body Weight
Ratio
(mL/kg)
Deviation from
Desirable
Weight
(+/-%)
Blood Volume
to Body Weight
Ratio
(mL/kg)
Deviation from
Desirable
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
6© 2013 DAXOR Corporation
7© 2013 DAXOR Corporation
Measuring Deviation from
Ideal Blood Volume
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.
8© 2013 DAXOR Corporation
The Blood Volume Analyzer
• 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
9© 2013 DAXOR Corporation
The Blood Volume Analyzer
• 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
10© 2013 DAXOR Corporation
Clinical Conditions in Which
Blood Volume is Important
Normal Blood Volume
Total Blood Volume Plasma Volume Red Cell Volume Example of Condition
Normal 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.
11© 2013 DAXOR Corporation
Clinical Conditions in Which
Blood Volume is Important
Increased Total Blood Volume
Total 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
12© 2013 DAXOR Corporation
Clinical Conditions in Which
Blood Volume is Important
Decreased Total Blood Volume
Total 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
13© 2013 DAXOR Corporation
Clinical Conditions in Which
Blood Volume is Important
Decreased Total Blood Volume (continued)
Total Blood Volume Plasma Volume Red Cell Volume Example of Condition
Decreased Extremely
Decreased
Increased 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 Extremely
Decreased
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
14© 2013 DAXOR Corporation
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.
15© 2013 DAXOR Corporation
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.
16© 2013 DAXOR Corporation
Chronic Red Cell Depletion with
Incomplete Plasma Expansion
Examples in Detail
Normovolemic 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.
45%
30% 30%
15% 5%
55% 55%
30%
Normal Loss of 1/3 Original RBCs Loss of 1/2 Original RBCs
Normovolemic
Anemia
5000 cc
Hypovolemic
Anemia
3750 cc
Normovolemic
normal red cell
volume 5000 cc
17© 2013 DAXOR Corporation
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.
18© 2013 DAXOR Corporation
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.
19© 2013 DAXOR Corporation
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.
20© 2013 DAXOR Corporation
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.
21© 2013 DAXOR Corporation
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
22© 2013 DAXOR Corporation
Empire State Building
350 Fifth Ave., Suite 7120
New York, NY 10118
Phone: 1-888-774-3268
E-mail: info@daxor.com
© 2013 DAXOR Corporation 23

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DAXOR Corporation - The BVA-100

  • 1. DAXOR Corporation The BVA-100 Utilization of Blood Volume Measurement in Medical and Surgical Conditions 1© 2013 DAXOR Corporation
  • 2. 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 2© 2013 DAXOR Corporation
  • 3. 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. 3© 2013 DAXOR Corporation
  • 4. 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) 4© 2013 DAXOR Corporation
  • 5. 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 5© 2013 DAXOR Corporation
  • 6. Measuring Deviation from Ideal Blood Volume Blood Volume to Body Weight Ratio (mL/kg) Deviation from Desirable Weight (+/-%) Blood Volume to Body Weight Ratio (mL/kg) Deviation from Desirable Weight (+/-%) Blood Volume to Body Weight Ratio (mL/kg) Deviation from Desirable 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 6© 2013 DAXOR Corporation
  • 7. 7© 2013 DAXOR Corporation Measuring Deviation from Ideal Blood Volume
  • 8. 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. 8© 2013 DAXOR Corporation
  • 9. The Blood Volume Analyzer • 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 9© 2013 DAXOR Corporation
  • 10. The Blood Volume Analyzer • 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 10© 2013 DAXOR Corporation
  • 11. Clinical Conditions in Which Blood Volume is Important Normal Blood Volume Total Blood Volume Plasma Volume Red Cell Volume Example of Condition Normal 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. 11© 2013 DAXOR Corporation
  • 12. Clinical Conditions in Which Blood Volume is Important Increased Total Blood Volume Total 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 12© 2013 DAXOR Corporation
  • 13. Clinical Conditions in Which Blood Volume is Important Decreased Total Blood Volume Total 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 13© 2013 DAXOR Corporation
  • 14. Clinical Conditions in Which Blood Volume is Important Decreased Total Blood Volume (continued) Total Blood Volume Plasma Volume Red Cell Volume Example of Condition Decreased Extremely Decreased Increased 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 Extremely Decreased 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 14© 2013 DAXOR Corporation
  • 15. 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. 15© 2013 DAXOR Corporation Congestive Heart Failure
  • 16. 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. 16© 2013 DAXOR Corporation Chronic Red Cell Depletion with Incomplete Plasma Expansion
  • 17. Examples in Detail Normovolemic 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. 45% 30% 30% 15% 5% 55% 55% 30% Normal Loss of 1/3 Original RBCs Loss of 1/2 Original RBCs Normovolemic Anemia 5000 cc Hypovolemic Anemia 3750 cc Normovolemic normal red cell volume 5000 cc 17© 2013 DAXOR Corporation Plasma Red Cells Fluid Replacement Additional red blood cell loss undetected by blood volume analysis
  • 18. 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. 18© 2013 DAXOR Corporation Hypertension
  • 19. 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. 19© 2013 DAXOR Corporation
  • 20. 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. 20© 2013 DAXOR Corporation
  • 21. 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. 21© 2013 DAXOR Corporation
  • 22. 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 22© 2013 DAXOR Corporation
  • 23. Empire State Building 350 Fifth Ave., Suite 7120 New York, NY 10118 Phone: 1-888-774-3268 E-mail: info@daxor.com © 2013 DAXOR Corporation 23