Real-time electrical impedimetric monitoring of blood coagulation process under temperature and hematocrit variations conducted in a microfluidic chip

Role of Electrode Configuration and Morphology in Printed Prothrombin Time Sensors

Patients on long-term anticoagulation therapy require frequent testing of prothrombin time/international normalized ratio (PT/INR) to ensure therapeutic efficacy. Point-of-care (POC) PT tests for at-home monitoring eliminate the burden of visiting the clinic, but realizing a cost-effective and robust at-home POC test for PT has remained elusive. Recent demonstrations of printed PT sensors show promise for addressing the cost concerns; however, the printed sensors have lacked quality control to ensure reliability between tests. In this work, on-chip redundancy is introduced with fully printed impedimetric PT sensors by incorporating simultaneous testing with a single fingerstick volume of blood (8 μL). The influence of electrode dimensions and composition were studied, revealing an optimal electrode spacing of 200 μm and an unexpected dependence on the morphology of the electrodes. Three distinct silver morphologies were studied: aerosol jet printed silver nanoparticles (AgNPs), aerosol jet printed silver nanowires (AgNWs), and evaporated silver (Ag). In general, AgNPs exhibited the best PT sensor performance, due to relatively low conductance and high porosity. Overall, the printed impedimetric PT sensor functionalization was improved by incorporating simultaneous testing and, when combined with a handheld control device, shows promise for leading to a system that overcomes the challenges of commercial PT/INR coagulometers.

Effects of a second iron-dextran injection administered to piglets during lactation on differential gene expression in liver and duodenum at weaning

Six female littermate piglets were used in an experiment to evaluate the mRNA expression in tissues from piglets given one or two 1 mL injections of iron dextran (200 mg Fe/mL). All piglets in the litter were administered the first 1 mL injection < 24 h after birth. On day 7, piglets were paired by weight (mean body weight = 1.72 ± 0.13 kg) and one piglet from each pair was randomly selected as control (CON) and the other received a second injection (+Fe). At weaning on day 22, each piglet was anesthetized, and samples of liver and duodenum were taken from the anesthetized piglets and preserved until mRNA extraction. differential gene expression data were analyzed with a fold change cutoff (FC) of |1.2| P < 0.05. Pathway analysis was conducted with Z-score cutoff of P < 0.05. In the duodenum 435 genes were significantly changed with a FC ≥ |1.2| P < 0.05. In the duodenum, Claudin 1 and Claudin 2 were inversely affected by + Fe. Claudin 1 (CLDN1) plays a key role in cell-to-cell adhesion in the epithelial cell sheets and was upregulated (FC = 4.48, P = 0.0423). Claudin 2 (CLDN2) is expressed in cation leaky epithelia, especially during disease or inflammation and was downregulated (FC = -1.41, P = 0.0097). In the liver, 362 genes were expressed with a FC ≥ |1.2| P < 0.05. The gene most affected by a second dose of 200 mg Fe was hepcidin antimicrobial peptide (HAMP) with a FC of 40.8. HAMP is a liver-produced hormone that is the main circulating regulator of Fe absorption and distribution across tissues. It also controls the major flows of Fe into plasma by promoting endocytosis and degradation of ferroportin (SLC4A1). This leads to the retention of Fe in Fe-exporting cells and decreased flow of Fe into plasma. Gene expression related to metabolic pathway changes in the duodenum and liver provides evidence for the improved feed conversion and growth rates in piglets given two iron injections preweaning with contemporary pigs in a companion study. In the duodenum, there is a downregulation of gene clusters associated with gluconeogenesis (P < 0.05). Concurrently, there was a decrease in the mRNA expression of genes for enzymes required for urea production in the liver (P < 0.05). These observations suggest that there may be less need for gluconeogenesis, and possibly less urea production from deaminated amino acids. The genomic and pathway analyses provided empirical evidence linking gene expression with phenotypic observations of piglet health and growth improvements.

Tracking the dynamics of thrombus formation in a blood vessel-on-chip with visible-light optical coherence tomography

Thrombus formation is a physiological response to damage in a blood vessel that relies on a complex interplay of platelets, coagulation factors, immune cells, and the vessel wall. The dynamics of thrombus formation are essential for a deeper understanding of many disease processes, like bleeding, wound healing, and thrombosis. However, monitoring thrombus formation is challenging due to the limited imaging options available to analyze flowing blood. In this work, we use a visible-light optical coherence tomography (vis-OCT) system to monitor the dynamic process of the formation of thrombi in a microfluidic blood vessel-on-chip (VoC) device. Inside the VoC, thrombi form in a channel lined with a monolayer of endothelial cells and perfused by human whole blood. We show that the correlation of the vis-OCT signal can be utilized as a marker for thrombus formation. By thresholding the correlation during thrombus formation, we track and quantify the growth of the thrombi over time. We validate our results with fluorescence microscopic imaging of fibrin and platelet markers at the end of the blood perfusion assay. In conclusion, we demonstrate that the correlation of the vis-OCT signal can be used to visualize both the spatial and temporal behavior of the thrombus formation in flowing human whole blood.

A Multichannel Portable Platform With Embedded Thermal Management for Miniaturized Dielectric Blood Coagulometry

This article presents a standalone, multichannel, miniaturized impedance analyzer (MIA) system for dielectric blood coagulometry measurements with a microfluidic sensor termed ClotChip. The system incorporates a front-end interface board for 4-channel impedance measurements at an excitation frequency of 1 MHz, an integrated resistive heater formed by a pair of printed-circuit board (PCB) traces to keep the blood sample near a physiologic temperature of 37 °C, a software-defined instrument module for signal generation and data acquisition, and a Raspberry Pi-based embedded computer with 7-inch touchscreen display for signal processing and user interface. When measuring fixed test impedances across all four channels, the MIA system exhibits an excellent agreement with a benchtop impedance analyzer, with rms errors of ≤0.30% over a capacitance range of 47-330 pF and ≤0.35% over a conductance range of 2.13-10 mS. Using in vitro-modified human whole blood samples, the two ClotChip output parameters, namely, the time to reach a permittivity peak (Tpeak) and maximum change in permittivity after the peak (Δϵr,max) are assessed by the MIA system and benchmarked against the corresponding parameters of a rotational thromboelastometry (ROTEM) assay. Tpeak exhibits a very strong positive correlation (r = 0.98, p < 10-6, n = 20) with the ROTEM clotting time (CT) parameter, while Δϵr,max exhibits a very strong positive correlation (r = 0.92, p < 10-6, n = 20) with the ROTEM maximum clot firmness (MCF) parameter. This work shows the potential of the MIA system as a standalone, multichannel, portable platform for comprehensive assessment of hemostasis at the point-of-care/point-of-injury (POC/POI).

Janus Self-Propelled Chitosan-Based Hydrogel Spheres for Rapid Bleeding Control

Uncontrolled hemorrhage is a major cause of potentially preventable death in civilian trauma nowadays. Considerable concern has been given to the development of efficient hemostats with high blood absorption, self-propelled property, and Ca²⁺ release ability, for irregularly shaped and noncompressible hemorrhage. Herein, Janus self-propelled chitosan-based hydrogel with CaCO₃ (J-CMH@CaCO₃ ) is developed by partial ionic crosslinking of carboxylated chitosan (CCS) and Ca²⁺ , gravity settlement, and photopolymerization, followed by removing the shell of CCS. The obtained J-CMH@CaCO₃ is further used as a hemostat powered by the internal CaCO₃ and coordinated protonated tranexamic acid (J-CMH@CaCO₃ /T). Bubbles are generated and detached to provide the driving force, accompanied by the release of Ca²⁺ . The two aspects work in synergy to accelerate clot formation, endowing the J-CMH@CaCO₃ /T with excellent hemostatic efficiency. The J-CMH@CaCO₃ /T presents high blood absorption, favorable blood-clotting ability, desired erythrocyte and platelet aggregation, and acceptable hemocompatibility and cytocompatibility. In rodent and rabbit bleeding models, the J-CMH@CaCO₃ /T exhibits the most effective hemostasis to the best knowledge of the authors, wherein the hemorrhage is rapidly halted within 39 s. It is believed that the J-CMH@CaCO₃ /T with self-propelled property opens up a new avenue to design high-performance hemostats for clinical application.

A Review on Microfluidics-Based Impedance Biosensors

Electrical impedance biosensors are powerful and continuously being developed for various biological sensing applications. In this line, the sensitivity of impedance biosensors embedded with microfluidic technologies, such as sheath flow focusing, dielectrophoretic focusing, and interdigitated electrode arrays, can still be greatly improved. In particular, reagent consumption reduction and analysis time-shortening features can highly increase the analytical capabilities of such biosensors. Moreover, the reliability and efficiency of analyses are benefited by microfluidics-enabled automation. Through the use of mature microfluidic technology, complicated biological processes can be shrunk and integrated into a single microfluidic system (e.g., lab-on-a-chip or micro-total analysis systems). By incorporating electrical impedance biosensors, hand-held and bench-top microfluidic systems can be easily developed and operated by personnel without professional training. Furthermore, the impedance spectrum provides broad information regarding cell size, membrane capacitance, cytoplasmic conductivity, and cytoplasmic permittivity without the need for fluorescent labeling, magnetic modifications, or other cellular treatments. In this review article, a comprehensive summary of microfluidics-based impedance biosensors is presented. The structure of this article is based on the different substrate material categorizations. Moreover, the development trend of microfluidics-based impedance biosensors is discussed, along with difficulties and challenges that may be encountered in the future.

Assessment of fibrinolytic status in whole blood using a dielectric coagulometry microsensor

Rapid assessment of the fibrinolytic status in whole blood at the point-of-care/point-of-injury (POC/POI) is clinically important to guide timely management of uncontrolled bleeding in patients suffering from hyperfibrinolysis after a traumatic injury. In this work, we present a three-dimensional, parallel-plate, capacitive sensor - termed ClotChip - that measures the temporal variation in the real part of blood dielectric permittivity at 1 MHz as the sample undergoes coagulation within a microfluidic channel with <10 μL of total volume. The ClotChip sensor features two distinct readout parameters, namely, lysis time (LT) and maximum lysis rate (MLR) that are shown to be sensitive to the fibrinolytic status in whole blood. Specifically, LT identifies the time that it takes from the onset of coagulation for the fibrin clot to mostly dissolve in the blood sample during fibrinolysis, whereas MLR captures the rate of fibrin clot lysis. Our findings are validated through correlative measurements with a rotational thromboelastometry (ROTEM) assay of clot viscoelasticity, qualitative/quantitative assessments of clot stability, and scanning electron microscope imaging of clot ultrastructural changes, all in a tissue plasminogen activator (tPA)-induced fibrinolytic environment. Moreover, we demonstrate the ClotChip sensor ability to detect the hemostatic rescue that occurs when the tPA-induced upregulated fibrinolysis is inhibited by addition of tranexamic acid (TXA) - a potent antifibrinolytic drug. This work demonstrates the potential of ClotChip as a diagnostic platform for rapid POC/POI assessment of fibrinolysis-related hemostatic abnormalities in whole blood to guide therapy.

Engineered Hemostatic Biomaterials for Sealing Wounds

Hemostatic biomaterials show great promise in wound control for the treatment of uncontrolled bleeding associated with damaged tissues, traumatic wounds, and surgical incisions. A surge of interest has been directed at boosting hemostatic properties of bioactive materials via mechanisms triggering the coagulation cascade. A wide variety of biocompatible and biodegradable materials has been applied to the design of hemostatic platforms for rapid blood coagulation. Recent trends in the design of hemostatic agents emphasize chemical conjugation of charged moieties to biomacromolecules, physical incorporation of blood-coagulating agents in biomaterials systems, and superabsorbing materials in either dry (foams) or wet (hydrogel) states. In addition, tough bioadhesives are emerging for efficient and physical sealing of incisions. In this Review, we highlight the biomacromolecular design approaches adopted to develop hemostatic bioactive materials. We discuss the mechanistic pathways of hemostasis along with the current standard experimental procedures for characterization of the hemostasis efficacy. Finally, we discuss the potential for clinical translation of hemostatic technologies, future trends, and research opportunities for the development of next-generation surgical materials with hemostatic properties for wound management.

Predicting Cardiovascular Stent Complications Using Self-Reporting Biosensors for Noninvasive Detection of Disease

Self-reporting implantable medical devices are the future of cardiovascular healthcare. Cardiovascular complications such as blocked arteries that lead to the majority of heart attacks and strokes are frequently treated with inert metal stents that reopen affected vessels. Stents frequently re-block after deployment due to a wound response called in-stent restenosis (ISR). Herein, an implantable miniaturized sensor and telemetry system are developed that can detect this process, discern the different cell types associated with ISR, distinguish sub plaque components as demonstrated with ex vivo samples, and differentiate blood from blood clot, all on a silicon substrate making it suitable for integration onto a vascular stent. This work shows that microfabricated sensors can provide clinically relevant information in settings closer to physiological conditions than previous work with cultured cells.

Polymethyl Methacrylate-Based Smart Microfluidic Point-of-Care Testing of Prothrombin Time and International Normalized Ratio through Optical Detection

The mechanical heart valve is a crucial solution for many patients. However, it cannot function on the state of blood as human tissue valves. Thus, people with mechanical valves are put under anticoagulant therapy. A good measurement of the state of blood and how long it takes blood to form clots is the prothrombin time (PT); moreover, it is an indicator of how well the anticoagulant therapy is, and of whether the response of the patient to the drug is as needed. For a more specific standardized measurement of coagulation time, an international normalized ratio (INR) is established. Clinical testing of INR and PT is relatively easy. However, it requires the patient to visit the clinic for evaluation purposes. Many techniques are therefore being developed to provide PT and INR self-testing devices. Unfortunately, those solutions are either inaccurate, complex, or expensive. The present work approaches the design of an anticoagulation self-monitoring device that is easy to use, accurate, and relatively inexpensive. Hence, a two-channel polymethyl methacrylate-based microfluidic point-of-care (POC) smart device has been developed. The Arduino based lab-on-a-chip device applies optical properties to a small amount of blood. The achieved accuracy is 96.7%.

Blood Flow Velocimetry in a Microchannel During Coagulation Using Particle Image Velocimetry and Wavelet-Based Optical Flow Velocimetry

This article describes novel measurements of the velocity of whole blood flow in a microchannel during coagulation. The blood is imaged volumetrically using a simple optical setup involving a white light source and a microscope camera. The images are processed using particle image velocimetry (PIV) and wavelet-based optical flow velocimetry (wOFV), both of which use images of individual blood cells as flow tracers. Measurements of several clinically relevant parameters such as the clotting time, decay rate, and blockage ratio are computed. The high-resolution wOFV results yield highly detailed information regarding thrombus formation and corresponding flow evolution that is the first of its kind.

Facile and green approach towards biomass-derived hydrogel powders with hierarchical micro-nanostructures for ultrafast hemostasis

Although a series of biomass-derived hemostats has been developed, the desire for green-prepared hemostatic materials with biosafety has not decreased. Herein, we constructed porous carboxymethyl chitosan/sodium alginate/Ca(OH)₂ powders (PCSCPs) with suitable adaptability for instant control of irregular hemorrhage via a facile and green approach. By one-pot chemical crosslinking of carboxymethyl chitosan and sodium alginate, hydrogels were formed and immediately ionically cross-linked along with the generation of Ca(OH)₂ to prepare PCSCPs. As hydrogel powders, PCSCPs with abundant hydrophilic carboxymethyl groups and porous hierarchically micro-nanostructures displayed a high water absorption ratio of over 1600%. The PCSCPs were confirmed with favorable hemocompatibility, non-cytotoxic effects and excellent degradability. Hemostasis assays in vitro showed that PCSCPs possessed an outstanding property of platelet activation and red blood cell aggregation. The PCSCPs effectively shortened the hemostatic time and blood loss to ca. 50% in rodent bleeding models compared with medical gauze and commercial chitosan-based hemostats. Furthermore, a mouse subcutaneous implantation model demonstrated an ignorable inflammation response and potential tissue repair capability of PCSCPs. It's believed that green-prepared and biomass-derived PCSCPs are feasible biomedical hemostatic materials in view of engineering and provide a promising platform to design hemostats in prehospital management and clinical settings.

Kinetics of platelet adhesion to a fibrinogen-coated surface in whole blood under flow conditions

Aim

To test a novel method of assessment of platelet adhesion to a fibrinogen‐coated surface in whole blood under flow conditions.

Methods

We developed a fluidic device that mimics blood flow in vessels. The method of detection of platelet adhesion is based on recording of a scattered laser light signal from a fibrinogen‐covered surface. Testing was performed in platelet‐rich plasma (PRP) and whole blood of healthy volunteers. Control measurements were performed, followed by tests with inhibition of platelet GPIIa/IIIb and GPIb receptors. Then, the same testing sequence was performed in whole blood of persons with autoimmune thrombocytopenia and type 3 von Willebrand disease.

Results

The change in intensity of scattered light was 2.7 (2.4; 4.1) times higher in whole blood (0.2 ± 0.08V, n = 7) than in PRP (0.05 ± 0.02 V, n = 7), p < 0.01. The blocking of GP IIb/IIIa receptors decreased the intensity of scattered light to 8.5 (6.5;12)%; the blocking of GPIb receptors decreased it to 34 (23;58)%, p < 0.01. In the whole blood of a person with autoimmune thrombocytopenia, the inhibition of GPIb receptors decreased platelet adhesion, but no effect was observed in type 3 von Willebrand disease. Inhibition of platelet GPIIb/IIIa receptors alone or combined inhibition of GPIb and GPIIb/IIIa receptors resulted in almost total suppression of adhesion in both cases.

Conclusion

Our system effectively registers platelet adhesion to a fibrinogen‐coated surface under controlled‐flow conditions and may successfully be applied to the investigation of platelet adhesion kinetics.

Evolving Paradigm of Prothrombin Time Diagnostics with Its Growing Clinical Relevance towards Cardio-Compromised and COVID-19 Affected Population

Prothrombin time (PT) is a significant coagulation (hemostasis) biomarker used to diagnose several thromboembolic and hemorrhagic complications based on its direct correlation with the physiological blood clotting time. Among the entire set of PT dependents, candidates with cardiovascular ailments are the major set of the population requiring lifelong anticoagulation therapy and supervised PT administration. Additionally, the increasing incidence of COVID affected by complications in coagulation dynamics has been strikingly evident. Prolonged PT along with sepsis-induced coagulopathy (SIC score > 3) has been found to be very common in critical COVID or CAC-affected cases. Considering the growing significance of an efficient point-of-care PT assaying platform to counter the increasing fatalities associated with cardio-compromised and coagulation aberrations propping up from CAC cases, the following review discusses the evolution of lab-based PT to point of care (PoC) PT assays. Recent advances in the field of PoC PT devices utilizing optics, acoustics, and mechanical and electrochemical methods in microsensors to detect blood coagulation are further elaborated. Thus, the following review holistically aims to motivate the future PT assay designers/researchers by detailing the relevance of PT and associated protocols for cardio compromised and COVID affected along with the intricacies of previously engineered PoC PT diagnostics.

Development of an Optical Method for the Evaluation of Whole Blood Coagulation

Blood coagulation is a defense mechanism, which is activated in case of blood loss, due to vessel damage, or other injury. Pathological cases arise from malfunctions of the blood coagulation mechanism, and rapid growth of clots results in partially or even fully blocked blood vessel. The aim of this work is to characterize blood coagulation, by analyzing the time-dependent structural properties of whole blood, using an inexpensive design and robust processing approaches. The methods used in this work include brightfield microscopy and image processing techniques, applied on finger-prick blood samples. The blood samples were produced and directly utilized in custom-made glass microchannels. Color images were captured via a microscopy-camera setup for a period of 35 min, utilizing three different magnifications. Statistical information was extracted directly from the color components and the binary conversions of the images. The main advantage in the current work lies on a Boolean classification approach utilized on the binary data, which enabled to identify the interchange between specific structural elements of blood, namely the red blood cells, the plasma and the clotted regions, as a result of the clotting process. Coagulation indices produced included a bulk coagulation index, a plasma-reduction based index and a clot formation index. The results produced with the inexpensive design and the low computational complexity in the current approach, show good agreement with the literature, and a great potential for a robust characterization of blood coagulation.

Fully printed prothrombin time sensor for point-of-care testing

With an increasing number of patients relying on blood thinners to treat medical conditions, there is a rising need for rapid, low-cost, portable testing of blood coagulation time or prothrombin time (PT). Current methods for measuring PT require regular visits to outpatient clinics, which is cumbersome and time-consuming, decreasing patient quality of life. In this work, we developed a handheld point-of-care test (POCT) to measure PT using electrical transduction. Low-cost PT sensors were fully printed using an aerosol jet printer and conductive inks of Ag nanoparticles, Ag nanowires, and carbon nanotubes. Using benchtop control electronics to test this impedance-based biosensor, it was found that the capacitive nature of blood obscures the clotting response at frequencies below 10 kHz, leading to an optimized operating frequency of 15 kHz. When printed on polyimide, the PT sensor exhibited no variation in the measured clotting time, even when flexed to a 35 mm bend radius. In addition, consistent PT measurements for both chicken and human blood illustrate the versatility of these printed biosensors under disparate operating conditions, where chicken blood clots within 30 min and anticoagulated human blood clots within 20-100 s. Finally, a low-cost, handheld POCT was developed to measure PT for human blood, yielding 70% lower noise compared to measurement with a commercial potentiostat. This POCT with printed PT sensors has the potential to dramatically improve the quality of life for patients on blood thinners and, in the long term, could be incorporated into a fully flexible and wearable sensing platform.

Characterization of blood coagulation dynamics and oxygenation in ex-vivo retinal vessels by fluorescence hyperspectral imaging

Blood coagulation mechanisms forming a blood clot and preventing hemorrhage have been extensively studied in the last decades. Knowing the mechanisms behind becomes very important particularly in the case of blood vessel diseases. Real-time and accurate diagnostics accompanied by the therapy are particularly needed, for example, in diseases related to retinal vasculature. In our study, we employ for the first time fluorescence hyperspectral imaging (fHSI) combined with the spectral analysis algorithm concept to assess physical as well as functional information of blood coagulation in real-time. By laser-induced local disruption of retinal vessels to mimic blood leaking and subsequent coagulation and a proper fitting algorithm, we were able to reveal and quantify the extent of local blood coagulation through direct identification of the change of oxyhemoglobin concentration within few minutes. We confirmed and illuminated the spatio-temporal evolution of the essential role of erythrocytes in the coagulation cascade as the suppliers of oxygenated hemoglobin. By additional optical tweezers force manipulation, we showed immediate aggregation of erythrocytes at the coagulation site. The presented fluorescence-based imaging concept could become a valuable tool in various blood coagulation diagnostics as well as theranostic systems if coupled with the laser therapy.

Kinetics of Platelet Adhesion to Protein-Coated Surface in Whole Blood Samples at High Flow Rates

We studied platelet adhesion to fibrinogen-coated surface in whole blood samples under conditions of high flow rates. The degree of platelet adhesion was evaluated by the intensity of laser light scattered from protein-coated optical surface with adhered platelets. The intensity of adhesion in whole blood samples at high flow rates was by 2.7 (2.4; 4.1) times higher than in platelet-rich plasma samples. Among the factors intensifying platelet adhesion in the whole blood at high flow rates, von Willebrand factor is of utmost importance. At low flow rates, platelet adhesion almost totally depends on platelet-fibrinogen interaction. At high flow rates, the interactions of platelets with both fibrinogen and von Willebrand factor become equally important.

Recent advancements in microfluidics that integrate electrical sensors for whole blood analysis

Whole blood analysis reveals crucial information about various physiological and pathological conditions, including cancer metastasis, infection, and immune status, among others. Despite this rich information, the complex composition of whole blood usually required multiple sample preparation steps to purify targeted analytes. Traditionally, whole blood preparation processes, including centrifugation, lysis, dilution, or staining, are usually manually operated by well-trained technicians using bench-top instruments. This preparation can require a large blood volume and cannot be directly integrated with detection systems. Recently, various studies have integrated microfluidics with electrical sensors for whole blood analysis, with a focus on cell-based analysis, such as cell type, number, morphology, phenotype, and secreted molecules. These miniaturized systems require less sample and shorter reaction times. Besides, the sample processing and analysis can be fully integrated and automated with minimal operations. We believe these systems can transfer the current whole blood analysis from hospitals or laboratories into clinics or home settings to enable real-time and continuous health condition monitoring in point-of-care settings.

Electrochemical Impedance Characterization of Blood Cell Suspensions-Part 2: Three-Phase Systems With Single-Shelled Particles

The analyses presented in Part 1 are expanded to three-phase composite materials. The theory developed in Part 1 is used for analytical and numerical calculations of dielectric spectra. In this study, three-phase systems with single-shelled particles were considered. The disordered particle distribution, aligned orientation of particles, and particles placed in different lattice structures are studied. It is shown that both two-phase and three-phase composites exhibit β-dispersion, while three-phase composites additionally exhibit δ-dispersion. This is the fundamental difference in the spectra for two- and three-phase materials. In the case of aligned orientation, the effective permittivity in the direction perpendicular to the spheroid plane exhibits a maximum at a volume fraction of approximately 0.5. Both two- and three-phase materials display this behavior. This may be of interest for the development of new metamaterials. The dielectric properties of composite materials with random distribution and periodic arrangement of particles differ significantly. The dielectric spectrum of erythrocyte suspension in plasma was measured by means of electrochemical impedance spectroscopy. The measurement system consisted of a small chamber with two planar electrodes placed at the bottom and an impedance analyzer. The dielectric properties of erythrocyte cytoplasm and membrane were numerically determined based on experimental data. The measurement of the dielectric properties of whole blood and blood components is very promising for various medical applications.

Microfluidics in Haemostasis: A Review

Haemostatic disorders are both complex and costly in relation to both their treatment and subsequent management. As leading causes of mortality worldwide, there is an ever-increasing drive to improve the diagnosis and prevention of haemostatic disorders. The field of microfluidic and Lab on a Chip (LOC) technologies is rapidly advancing and the important role of miniaturised diagnostics is becoming more evident in the healthcare system, with particular importance in near patient testing (NPT) and point of care (POC) settings. Microfluidic technologies present innovative solutions to diagnostic and clinical challenges which have the knock-on effect of improving health care and quality of life. In this review, both advanced microfluidic devices (R&D) and commercially available devices for the diagnosis and monitoring of haemostasis-related disorders and antithrombotic therapies, respectively, are discussed. Innovative design specifications, fabrication techniques, and modes of detection in addition to the materials used in developing micro-channels are reviewed in the context of application to the field of haemostasis.

Point-of-Care Assessment of Hemostasis with a Love-Mode Surface Acoustic Wave Sensor

Monitoring of the hemostasis status is essential for therapeutic anticoagulants, undergoing surgery, cardiovascular diseases, etc. Although the clinical values of conventional blood coagulation tests have been well demonstrated, these devices have limitations such as large and expensive equipment, excessive sample volumes, long turnaround times, and difficulty in miniaturization for point-of-care use. Here, we present a novel strategy to evaluate blood hemostasis using the single-port Love-mode surface acoustic wave (SLSAW) sensor. The SLSAW sensor was designed as a plug-and-play-type unit for disposable use and operated under the harmonic resonant mode to produce frequency response to the blood coagulation cascade. Compared with a quartz crystal microbalance, Lamb wave, and film bulk acoustic resonator, the frequency shift of SLSAW was significantly increased, ranging from approximately 8960 to 10 368 kHz, which indicated enhancement of the signal-to-noise ratio. To demonstrate the feasibility of the SLSAW, studies were carried out to examine the effects of temperature and clotting reagents on coagulation times and kinetics. Activated partial thromboplastin times of plasma were validated by comparing with SYSMEX CA-7000 with the correlation (R²) as 0.996. In terms of coagulation kinetics, reaction time, clot formation time, maximum frequency shift, and clot formation rate of whole blood correlated well with corresponding parameters of the standard thromboelastography (TEG) analyzer (R² = 0.9942, 0.9868, 0.9712, and 0.9939, respectively). The SLSAW sensor, with the advantages of low cost, small size, little sample consumption (1 μL), disposable use, and simple operation, is a promising tool for point-of-care diagnosis of hemostasis.

Technology Advancements in Blood Coagulation Measurements for Point-of-Care Diagnostic Testing

In recent years, blood coagulation monitoring has become crucial to diagnosing causes of hemorrhages, developing anticoagulant drugs, assessing bleeding risk in extensive surgery procedures and dialysis, and investigating the efficacy of hemostatic therapies. In this regard, advanced technologies such as microfluidics, fluorescent microscopy, electrochemical sensing, photoacoustic detection, and micro/nano electromechanical systems (MEMS/NEMS) have been employed to develop highly accurate, robust, and cost-effective point of care (POC) devices. These devices measure electrochemical, optical, and mechanical parameters of clotting blood. Which can be correlated to light transmission/scattering, electrical impedance, and viscoelastic properties. In this regard, this paper discusses the working principles of blood coagulation monitoring, physical and sensing parameters in different technologies. In addition, we discussed the recent progress in developing nanomaterials for blood coagulation detection and treatments which opens up new area of controlling and monitoring of coagulation at the same time in the future. Moreover, commercial products, future trends/challenges in blood coagulation monitoring including novel anticoagulant therapies, multiplexed sensing platforms, and the application of artificial intelligence in diagnosis and monitoring have been included.

Electrical Analysis Of Normal And Diabetic Blood For Evaluation Of Aggregation And Coagulation Under Different Rheological Conditions

Introduction

Erythrocyte aggregation and blood coagulation are of great interest and are still under investigation by many researchers. Erythrocytes have a direct effect on hemorheological properties. Real-time in vitro studies on blood coagulation and aggregation provide a chance to understand their mechanisms in normal and pathological conditions. Additionally, this method offers control over the physical and chemical conditions during the study.

Objective

The present study introduced a simple in vitro technique to study blood aggregation and coagulation under controlled conditions.

Methods

The technique used in this study is based on the measurement of the electrical properties of blood. A simple flow chamber was made from two cylinders with a gap between them. The outer cylinder remains stationary, and the inner cylinder rotates about its axis. The inner cylinder velocity is controlled by a stepper motor. Blood samples are introduced in the gap between the two cylinders. Capacitance and impedance of blood samples were recorded by two electrodes attached to the outer cylinders and in direct contact with blood.

Results

Quantitative parameters were extracted from the capacitance and impedance time courses. These parameters were used to describe the aggregation and coagulation processes under different shear rates. Strong correlations between the aggregation index and shear rate were found for normal and diabetic blood samples. Additionally, strong negative correlations of coagulation time were found for normal and diabetic blood samples. In conclusion, the electrical analysis of blood reflects well the interactions between internal blood contents.

Conclusion

The parameters extracted from this technique can be used in the quantitative description of hemorheological processes under different physical conditions.

EIT Imaging of Intracranial Hemorrhage in Rabbit Models Is Influenced by the Intactness of Cranium

Electrical impedance tomography (EIT) has been shown to be a promising, bedside imaging method to monitor the progression of intracranial hemorrhage (ICH). However, the observed impedance changes within brain related to ICH differed among groups, and we hypothesized that the cranium intactness (open or closed) may be the one of potential reasons leading to the difference. Therefore, the aim of this study was to investigate this effect of open or closed cranium on impedance changes within brain in the rabbit ICH model. In this study, we first established the ICH model in 12 rabbits with the open cranium and in 12 rabbits with the closed cranium. Simultaneously, EIT measurements on the rabbits' heads were performed to record the impedance changes caused by injecting the autologous nonheparinized blood into cerebral parenchyma. Finally, the regional impedance changes on EIT images and the whole impedance changes were analyzed. It was surprisingly found that when the cranium was open, the impedance of the area where the blood was injected, as well as the whole brain impedance, decreased with the amount of blood being injected; when the cranium was closed, while the impedance of the area where blood was not injected continued to increase, the impedance of the area where blood was injected decreased within 20s of the blood being injected and then remained almost unchanged, and the whole brain impedance had a small fall and then notably increased. The results have validated that the cranium completeness (open or closed) has influences on impedance changes within brain when using EIT to monitor ICH. In future study on application of EIT to monitor ICH, the cranium completeness should be taken into account for establishing an ICH model and analyzing the corresponding EIT results.

Tannic Acid Cross-linked Polysaccharide-Based Multifunctional Hemostatic Microparticles for the Regulation of Rapid Wound Healing

Hemostatic microparticles (HMs) have been widely used in surgery. To improve the comprehensive performance of HMs, multifunctional HMs named HM₁₅ and HM₁₅ ' are prepared from starch, carboxymethyl chitosan, hyaluronic acid, and tannic acid. Herein, tannic acid is used as an effective cross-linker. A 3D network structure for cell growth and wound repair can be formed by secondary cross-linking. Through synergistic effect of these natural materials, the process of wound healing can be regulated controllably. HM₁₅ and HM₁₅ ' have the ability of rapid hemostasis. Moreover, HM₁₅ ' shows excellent properties in antibacteria and wound healing acceleration. Blood clotting time treated with different HMs is shortened obviously from 436.8 s to 126 s. Compared with Celox, HM₁₅ and HM₁₅ ' exhibited better broad spectrum antibacterial activity against both Escherichia coli and Staphylococcus aureus. Notably, the wound can be repaired rapidly by HM₁₅ ' in 14 days. These multifunctional HMs might have an important prospect in clinical application.

Design and Utility of a Point-of-Care Microfluidic Platform to Assess Hematocrit and Blood Coagulation

Purpose—

To develop a small volume whole blood analyzer capable of measuring the hematocrit and coagulation kinetics of whole blood.

Methods and Results—

A co-planar microfluidic chamber designed to facilitate self-driven capillary action across an internal electrical chip was developed and used to measure the electric parameters of whole human blood that had been anticoagulated or allowed to clot. To promote blood clotting, select chip surfaces were coated with a prothrombin time (PT) reagent containing lipidated tissue factor (TF), which activates the extrinsic pathway of coagulation to promote thrombin generation and fibrin formation. Whole human blood was added to the microfluidic device, and voltage changes within the platform were measured and interpreted using basic resistor-capacitor (RC) circuit and fluid dynamics theory. Upon wetting of the sensing zone, a circuit between two co-planar electrodes within the sensing zone was closed to generate a rapid voltage drop from baseline. The voltage then rose due to sedimentation of red blood cells (RBC) in the sensing zone. For anticoagulated blood samples, the time for the voltage to return to baseline was dependent on hematocrit. In the presence of coagulation, the initiation of fibrin formation in the presence of the PT reagent prevented the return of voltage to baseline due to the reduced packing of RBCs in the sensing zone.

Conclusions—

The technology presented in this study has potential for monitoring the hematocrit and coagulation parameters of patient samples using a small volume of whole blood, suggesting it may hold clinical utility as a point-of-care test.

Single Drop Whole Blood Diagnostics: Portable Biomedical Sensor for Cardiac Troponin I Detection

Detection of disease biomarkers from whole blood is very important in disease prevention and management. However, new generation assays like point-of-care or mobile diagnostics face a myriad of challenges in detecting proteins from whole blood. In this research, we have designed, fabricated, and characterized a portable biomedical sensor for the detection of cardiac troponin I (cTnI) directly from whole blood, without sample pretreatments. The sensing methodology is based on an extended gate electrical double layer (EDL) gated field effect transistor (FET) biosensor that can offer very high sensitivity, a wide dynamic range, and high selectivity to target analyte. The sensing methodology is not impeded by electrostatic screening and can be applied to all types of FET sensors. A portable biomedical system is designed to carry out the diagnostic assay in a very simple and rapid manner, that allows the user to screen for target protein from a single drop of blood, in 5 min. This biomedical sensor can be used in hospitals and homes alike, for early detection of cTnI which is a clinical marker for acute myocardial infarction. This sensing methodology could potentially revolutionize the modern health care industry.

Impedance biosensor for real-time monitoring and prediction of thrombotic individual profile in flowing blood

A new biosensor for the real-time analysis of thrombus formation is reported. The fast and accurate monitoring of the individual thrombotic risk represents a challenge in cardiovascular diagnostics and in treatment of hemostatic diseases. Thrombus volume, as representative index of the related thrombotic status, is usually estimated with confocal microscope at the end of each in vitro experiment, without providing a useful behavioral information of the biological sample such as platelets adhesion and aggregation in flowing blood. Our device has been developed to work either independently or integrated with the microscopy system; thus, images of the fluorescently labeled platelets are acquired in real-time during the whole blood perfusion, while the global electrical impedance of the blood sample is simultaneously monitored between a pair of specifically designed gold microelectrodes. Fusing optical and electrical data with a novel technique, the dynamic of thrombus formation events in flowing blood can be reconstructed in real-time, allowing an accurate extrapolation of the three-dimensional shape and the spatial distribution of platelet thrombi forming and growing within artificial capillaries. This biosensor is accurate and it has been used to discriminate different hemostatic conditions and to identify weakening and detaching platelet aggregates. The results obtained appear compatible with those quantified with the traditional optical method. With advantages in terms of small size, user-friendliness and promptness of response, it is a promising device for the fast and automatic individual health monitoring at the Point of Care (POC).

Ex-Vivo Characterization of Bioimpedance Spectroscopy of Normal, Ischemic and Hemorrhagic Rabbit Brain Tissue at Frequencies from 10 Hz to 1 MHz

Stroke is a severe cerebrovascular disease and is the second greatest cause of death worldwide. Because diagnostic tools (CT and MRI) to detect acute stroke cannot be used until the patient reaches the hospital setting, a portable diagnostic tool is urgently needed. Because biological tissues have different impedance spectra under normal physiological conditions and different pathological states, multi-frequency electrical impedance tomography (MFEIT) can potentially detect stroke. Accurate impedance spectra of normal brain tissue (gray and white matter) and stroke lesions (ischemic and hemorrhagic tissue) are important elements when studying stroke detection with MFEIT. To our knowledge, no study has comprehensively measured the impedance spectra of normal brain tissue and stroke lesions for the whole frequency range of 1 MHz within as short as possible an ex vivo time and using the same animal model. In this study, we established intracerebral hemorrhage and ischemic models in rabbits, then measured and analyzed the impedance spectra of normal brain tissue and stroke lesions ex vivo within 15 min after animal death at 10 Hz to 1 MHz. The results showed that the impedance spectra of stroke lesions significantly differed from those of normal brain tissue; the ratio of change in impedance of ischemic and hemorrhagic tissue with regard to frequency was distinct; and tissue type could be discriminated according to its impedance spectra. These findings further confirm the feasibility of detecting stroke with MFEIT and provide data supporting further study of MFEIT to detect stroke.

Hemostatic effect of topical hemocoagulase spray in digestive endoscopy

AIM: To evaluate the hemostatic effect of topical hemocoagulase spray in digestive endoscopy.

METHODS: Eighty-nine patients who developed oozing bleeding during endoscopic treatment from September 2014 to October 2014 at Center for Digestive Endoscopy, Tianjin Medical University General Hospital were randomly divided into either a study group (n = 39) or a control group (n = 50). The study group was given topical hemocoagulase spray intraoperatively, while the control group was given traditional 8% norepinephrine spray. Hemostatic efficacy was compared between the two groups. Bleeding site, wound cleanliness and perforation were recorded, and the rates of perforation and late bleeding were compared.

RESULTS: Successful hemostasis was achieved in 39 (100%) patients of the study group and in 47 (94.0%) patients of the control group, and there was no significant difference in the rate of successful hemostasis between the two groups. Compared with the control group, after topical hemocoagulase spray in the study group, the surgical field was clearer, the bleeding site was more easily identified, and the wound was cleaner. There was no significant difference in the rate of perforation between the study and control groups (16.7% vs 35.0%, P = 0.477), but the rates of late bleeding (0% vs 15.8%, P = 0.048) and overall complications (P = 0.032) were significantly lower in the study group.

CONCLUSION: Topical hemocoagulase spray has a definite hemostatic effect for oozing bleeding in digestive endoscopy, and this method is convenient, safe, and reliable. It is expected to become a new method for endoscopic hemostasis.