Published, Version of Record (VoR) Open Access Discount via Drexel Libraries Read and Publish Program 2026 Open CC BY V4.0
Abstract
Whole blood viscosity (WBV) is a key hemorheological property influenced by cellular and biochemical factors and is associated with cardiovascular, cerebrovascular, and microcirculatory disorders. Despite its clinical relevance, comprehensive reference intervals for WBV and oxygen delivery indices—the ODI (oxygen delivery index) and TODI (tissue oxygen delivery index)—in healthy male and female adults have not been established. The objectives of this study were to (1) determine sex-specific reference intervals of WBV in healthy adults, (2) establish reference intervals for the ODI and TODI, and (3) evaluate the influence of hematologic, biochemical, lipid, and non-lipid determinants—as well as the effects of age—on systolic and diastolic blood viscosity (SBV and DBV). WBV was measured across nine shear rates (1–1000 s−1) in 150 healthy men and 150 healthy women using an automated scanning capillary tube viscometer (SCTV). Hematologic and biochemical profiles were obtained, and correlations with DBV and SBV were assessed. Reference intervals were calculated using CLSI-recommended nonparametric methods. WBV was consistently higher in men than women across all shear rates, with sex-based differences accentuated at low shear. Hemoglobin and hematocrit showed the strongest positive correlations with WBV (r ≈ 0.77–0.80), while RDW and HDL cholesterol showed negative associations. Triglycerides exhibited strong viscosity-enhancing effects in men, whereas total cholesterol, LDL, and triglycerides were all significantly increased viscosity in women. Protein-related determinants (total protein, albumin, and γ-gap) displayed striking sex divergence, with strong positive associations in men but attenuated or negative associations in women. Age showed no meaningful relationship with WBV in either sex. Reference intervals for the ODI and TODI revealed modest sex differences with tighter distributions in women. WBV, ODI, and TODI demonstrate clear sex-specific physiological patterns in healthy adults. Hematocrit remains the dominant determinant of blood viscosity, while lipid and protein-related factors contribute differently in men and women. These newly established reference intervals provide essential benchmarks for clinical interpretation and for understanding viscosity-related risk in cardiovascular and microcirculatory disease.