Enhanced biliary bilirubin excretion after heparin-induced erythrocyte mass depletion.

The effect of large-dose heparin therapy on erythrocyte mass depletion in ponies was investigated to determine whether stimulation of reticuloendothelial cell activity and catabolic function would be evidenced by enhanced catabolism of heme to bilirubin. Ponies with chronic external biliary fistula were used to examine biliary excretion of bilirubin both before and after heparin loading (107 U/kg, IV, plus 320 U/kg, subcutaneously) and at maintenance dosages of 320 U/kg given (subcutaneously) at 12 and 24 hours after initial loading with heparin. Results indicated that by 48 hours after ponies were first treated with heparin, catabolism of heme increased, resulting in a 35% increase in plasma bilirubin concentration and a 65% enhancement in biliary bilirubin excretion. During this period, both hematocrit and blood hemoglobin concentrations decreased by 35%. After the last heparin treatment at 24 hours after initial heparin loading, all measured variables returned toward base line within 48 hours. These studies indicated that heparin augments phagocytosis of erythrocytes, resulting in enhanced plasma bilirubin concentration and biliary bilirubin excretion.