Effect of perfluorochemical emulsion on hemorheology and shear induced blood trauma. Possible mechanisms and future applications

Mechanical blood trauma in assisted circulation: sublethal RBC damage preceding hemolysis

After many decades of improvements in mechanical circulatory assist devices (CADs), blood damage remains a serious problem during support contributing to variety of adverse events, and consequently affecting patient survival and quality of life. The mechanisms of cumulative cell damage in continuous-flow blood pumps are still not fully understood despite numerous in vitro, in vivo, and in silico studies of blood trauma. Previous investigations have almost exclusively focused on lethal blood damage, namely hemolysis, which is typically negligible during normal operation of current generation CADs. The measurement of plasma free hemoglobin (plfHb) concentration to characterize hemolysis is straightforward, however sublethal trauma is more difficult to detect and quantify since no simple direct test exists. Similarly, while multiple studies have focused on thrombosis within blood pumps and accessories, sublethal blood trauma and its sequelae have yet to be adequately documented or characterized. This review summarizes the current understanding of sublethal trauma to red blood cells (RBCs) produced by exposure of blood to flow parameters and conditions similar to those within CADs. It also suggests potential strategies to reduce and/or prevent RBC sublethal damage in a clinically-relevant context, and encourages new research into this relatively uncharted territory.

Viscosity of Animal Erythrocyte Suspensions mixed with a Perflurocarbon Emulsion

Artificial blood substitutes (ABS) offer an alternative to donated blood. Increasing the oxygen carrying capacity of blood plasma through the addition of a Perfluorocarbon emulsion (PFE) is one approach in creating a blood substitute. The peripheral resistance of the circulatory system may be altered depending on the rheological properties of the ABS. Measurements of the rheological behavior of mixtures of a PFE, Oxygent, and erythrocyte suspensions were conducted at room temperature at different hematocrits using sheep (nonaggregating) and swine (aggregating) erythrocytes. The pure PFE was found to be shear thinning. Adding 6 and 12 g per 100 mL of sheep blood at the various hematocrits increased the viscosity of the suspension from as low as 4% (6 g PFE/40% Hct) to as high as 26.5% (12 g PFE/plasma). The nonaggregating sheep erythrocyte and PFE mixtures exhibited Newtonian behavior. Shear thinning behavior continued upon addition of 6 and 12 g per 100 mL of swine blood at the various hematocrits, with a slight increase in viscosity in most cases. It was observed that adding 12 g of PFE (approximately 3 x intended clinical dose) to 40% Hct swine blood at room temperature led to a significant decrease in viscosity.

Predictions of capillary oxygen transport in the presence of fluorocarbon additives

A mathematical model of capillary oxygen transport was formulated to determine the effect of increasing plasma solubility, e.g., by the addition of an intravascular fluorocarbon emulsion. The effect of increased plasma solubility is studied for two distributions of fluorocarbon, when the fluorocarbon droplets are uniformly distributed throughout the plasma and when the fluorocarbon droplets are concentrated in a layer adjacent to the endothelium. The model was applied to working hamster retractor muscle at normal and lowered hematocrit. The intracapillary mass transfer coefficient was found to increase by 18% as the solubility was increased by a factor of 1.7 at a hematocrit of 43%. An additional increase of 6% was predicted when the solubility increase was concentrated in the layer adjacent to the endothelium. At a hematocrit of 25%, the intracapillary mass transfer coefficient increased 14% when the solubility was increased by a factor of 1.7.