1. The transfer factor for carbon monoxide and its subdivisions, the membrane diffusing capacity (Dm) and the pulmonary capillary blood volume (Vc), were measured in 16 patients with polycythaemia secondary to chronic hypoxic lung disease and in ten hypoxic non-polycythaemic control subjects.

2. The mean pulmonary capillary blood volume was significantly lower in the polycythaemic patients (31.6 ml, sd 11.2) compared with the control group (65.2 ml, sd 22.5) (P<0.001).

3. Erythrapheresis, as a method of isovolaemic haemodilution, was performed in 15 of the polycythaemic patients. The mean packed cell volume fell from 58 (sd 5)% to 47 (sd 5)% after treatment, with significant reductions in blood viscosity at both high and lower shear rates (P<0.001).

4. The mean pulmonary capillary blood volume increased from 32.3 ml (sd 11.3) before treatment to 48.7 ml (sd 18.7) after erythrapheresis (P<0.01), with no significant change in membrane diffusing capacity.

5. The rise in pulmonary capillary blood volume is another potential physiological advantage of the reduction of packed cell volume in patients with polycythaemia secondary to hypoxic lung disease.

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