The diagnosis and management of hereditary spherocytosis

Elastic hysteresis loop acts as cell deformability in erythrocyte aging

The decrease in cellular deformability shows strong correlation with erythrocyte aging. Cell deformation can be divided into passive deformation and active deformation; however, the active deformation has been ignored in previous studies. In this work, Young's moduli of age-related erythrocytes were tested by atomic force microscopy. Furthermore, the deformation and passive and active deformation values were calculated by respective areas. Our results showed that erythrocytes in the densest fraction had the highest values of the Young's modulus, deformation, and active deformation, but the lowest values of passive deformation. Moreover, values of the deformation and active deformation both increased gradually with erythrocyte aging. The present data indicate that the elastic hysteresis loop between the approach and the retract curve could be regarded as erythrocyte deformability, and cellular deformability could be characterized by energy states. In addition, active deformation might be a crucial mechanical factor for clearing aged erythrocytes. This could provide an important information on erythrocyte biomechanics in the removal of aged cell.

Applications of imaging flow cytometry in the diagnostic assessment of red cell membrane disorders

BACKGROUND

Red cell membranopathies refers to phenotypically and morphologically heterogeneous disorders. High throughput imaging flow cytometry (IFC) combines the speed, sensitivity, and phenotyping abilities of flow cytometry with the detailed imagery and functional insights of microscopy to produce high content image analysis with quantitative analysis. We have evaluated the applications of IFC to examine both the morphology as well as fluorescence signal intensity in red cell membranopathies.

METHODS

Fluorescence intensity of eosin-5-maleimide (EMA) labeled red cells was measured for diagnosis of RBC membrane protein defect on Amnis ImageStreamX followed by Image analysis on IDEAS software to study features such as circularity and shape ratio.

RESULTS

The hereditary spherocytosis (HS) group showed significantly decreased MFI (52,800 ± 9,100) than normal controls (81,100 ± 4,700) (p < .05) whereas non-HS showed 78,300 ± 9,900. The shape ratio of hereditary elliptocytosis (HE) was significantly higher (43.8%) than normal controls (14.6%). The circularity score is higher in HS (64.15%) than the normal controls (44.3%) whereas the circularity score was very less in HE (10%) due to the presence of elliptocytes.

CONCLUSIONS

The advantages of the IFC over standard flow cytometry is its ability to provide high-content image analysis and measurement of parameters such as circularity and shape ratio allow discriminating red cell membranopathies (HS and HE) due to variations in shape and size. It could be a single, effective, and rapid IFC test for detection and differentiation of red cell membrane disorders in hematology laboratories where an IFC is available.

Delay in the measurement of eosin-5′-maleimide (EMA) binding does not affect the test result for the diagnosis of hereditary spherocytosis

BACKGROUND

The eosin-5′-maleimide (EMA) binding test is a flow cytometric test widely used to detect hereditary spherocytosis (HS). EMA binds to plasma membrane proteins of red blood cells (RBCs), mainly to band 3 protein. The mean fluorescence of EMA-stained RBCs in HS patients is lower when compared with control RBCs due to the decreased amount of target proteins. EMA dye in aqueous solution is sensitive to light and high temperature. Its fluorescence can decrease when exposed to light or ambient temperatures higher than 4°C. The aim of the study was to evaluate the stability of fluorescence readings of EMA-labeled RBCs over a period of 24 h.

METHODS

The EMA test was performed in peripheral blood from 35 patients with microcytic anemia (five with HS, and 30 without HS). Peripheral blood samples were stained immediately after blood collection and analyzed using a flow cytometer at three time points: 0, after 1 and 24 h of storage at 4°C in the darkness. The results are presented as the percentage of normal control RBCs fluorescence. Flow cytometric studies were performed with Cytomics FC500 (Beckman Coulter, USA).

RESULTS

In HS patients the mean result of the test reached 66.72%±9.26% of normal controls, and in non-HS patients the EMA result was 99.48%±5.03% of normal control cells. The results of patients with HS were 66.72%±9.26%, 66.90%±10.24% and 67.86%±11.31% at 0 h, and after 1 and 24 h of storage, respectively. The results obtained from non-HS patients at time 0, after 1 and 24 h of storage reached 99.48%±5.03%, 99.49%±5.34% and 99.78%±6.13%, respectively. There was no difference between the results from each time point in samples from patients with or without HS.

CONCLUSIONS

Results of the EMA binding test do not depend on storage time of stained samples when stored at 4°C up to 24 h after staining.

Theoretical model of reticulocyte to erythrocyte shape transformation

A theoretical model describing the kinetics of reticulocyte shape transformation was developed. The model considers the evolution of a simple cellular shape under transmembrane pressure difference, and proposes a four-parameter axisymmetric approximation of the cell surface. The mathematical analysis considers plasma membrane tension in the plane of bilayer leaflets, membrane spontaneous curvature and transmembrane transport of water. Cytoskeleton dilatational and shear rigidity, and the energetic barrier preventing the decrease of cell volume below a certain minimum are also incorporated. The set of adequate physical assumptions allowed for formulation of the equation for free energy of the investigated system. Computer simulations of cell shape changes, down to the state of free energy minimum, together with estimation of the time needed for the resulting transport of water, revealed a complex, three-phase picture of temporal alterations in cellular geometry with a wide spectrum of final results, and led to propose a standard model of reticulocyte-erythrocyte transformation. According to the model, both cell volume and surface undergo changes, and the work of the pressure, initially accumulated in the cytoskeleton, is consumed for local bending of the cell membrane. Further simulations with modified initial shape or parameters of the standard model show the trajectories of system evolution and help in better understanding the conditions for the erythro-, sphero-, ovalo-, stomato-, and leptoidal metamorphosis of maturing red blood cells. The stability of the final biconcave shape was also verified. Spherogenic modifications were discussed in the context of spherocytosis. Future development of the model was proposed.

Stiffness of normal and pathological erythrocytes studied by means of atomic force microscopy

During recent years, atomic force microscopy has become a powerful technique for studying the mechanical properties (such as stiffness, viscoelasticity, hardness and adhesion) of various biological materials. The unique combination of high-resolution imaging and operation in physiological environment made it useful in investigations of cell properties. In this work, the microscope was applied to measure the stiffness of human red blood cells (erythrocytes). Erythrocytes were attached to the poly-L-lysine-coated glass surface by fixation using 0.5% glutaraldehyde for 1 min. Different erythrocyte samples were studied: erythrocytes from patients with hemolytic anemias such as hereditary spherocytosis and glucose-6-phosphate-dehydrogenase deficiency patients with thalassemia, and patients with anisocytosis of various causes. The determined Young's modulus was compared with that obtained from measurements of erythrocytes from healthy subjects. The results showed that the Young's modulus of pathological erythrocytes was higher than in normal cells. Observed differences indicate possible changes in the organization of cell cytoskeleton associated with various diseases.

[Recombinant Human Erythropoietin (r-HuEPO) therapy in a newborn with hereditary spherocytosis]

The newborn with hereditary spherocytosis can develop severe anemia, requiring red blood cell transfusions. Therapy with r-HuEPO has been proposed to avoid transfusions.

CASE REPORT

Hereditary spherocytosis was diagnosed in a newborn who had severe and early jaundice. He was treated with r-HuEPO, and did not require red blood cells transfusion.

CONCLUSION

Recombinant erythropoïetin might be an interesting alternative to red blood cells transfusions during the neonatal period in newborns with hereditary spherocytosis.

[A patient with hereditary spherocystosis and sudden deafness after splenectomy]

We report the case of a 29 year-old male with of hereditary spherocytosis, who developed two episodes of sensorineural hearing loss in his right ear after splenectomy due to repetitive hemolytic crisis. We discuss the eventual altiopathogenic mechanism of this audiological disorder.