Quantitative Measurement and Evaluation of Red Blood Cell Aggregation in Normal Blood Based on a Modified Hanai Equation

Quantification of the Phenomena Affecting Reflective Arterial Photoplethysmography

Photoplethysmography (PPG) is a widely emerging method to assess vascular health in humans. The origins of the signal of reflective PPG on peripheral arteries have not been thoroughly investigated. We aimed to identify and quantify the optical and biomechanical processes that influence the reflective PPG signal. We developed a theoretical model to describe the dependence of reflected light on the pressure, flow rate, and the hemorheological properties of erythrocytes. To verify the theory, we designed a silicone model of a human radial artery, inserted it in a mock circulatory circuit filled with porcine blood, and imposed static and pulsatile flow conditions. We found a positive, linear relationship between the pressure and the PPG and a negative, non-linear relationship, of comparable magnitude, between the flow and the PPG. Additionally, we quantified the effects of the erythrocyte disorientation and aggregation. The theoretical model based on pressure and flow rate yielded more accurate predictions, compared to the model using pressure alone. Our results indicate that the PPG waveform is not a suitable surrogate for intraluminal pressure and that flow rate significantly affects PPG. Further validation of the proposed methodology in vivo could enable the non-invasive estimation of arterial pressure from PPG and increase the accuracy of health-monitoring devices.

Red Blood Cell Sedimentation Index Using Shear Stress of Blood Flow in Microfluidic Channel

Red blood cell sedimentation has been used as a promising indicator of hematological diseases and disorders. However, to address several issues (i.e., syringe installation direction, blood on-off flow control, image-based quantification, and hemodilution) raised by the previous methods, it is necessary to devise a new method for the effective quantification of red blood cell sedimentation under a constant blood flow. In this study, the shear stress of a blood flow is estimated by analyzing an interface in a co-flowing channel to quantify the red blood cell sedimentation in blood syringes filled with blood (hematocrit = 50%). A red blood cell sedimentation index is newly suggested by analyzing the temporal variations in the shear stress. According to the experimental investigation, the sedimentation index tends to decrease at a higher flow rate. A higher level of hematocrit has a negative influence on the sedimentation index. As a performance demonstration of the present method, the red blood cell sedimentation processes of various test bloods were quantitatively compared in terms of the shear stress, image intensity, and sedimentation velocity. It was found that the proposed index provided a more than 10-fold increase in sensitivity over the previous method (i.e., image intensity). Additionally, it provided more consistent results than another conventional sedimentation method (sedimentation velocity). In conclusion, the present index can be effectively adopted to monitor the red blood cell sedimentation in a 10-min blood delivery.

Assessment of Blood Biophysical Properties Using Pressure Sensing with Micropump and Microfluidic Comparator

To identify the biophysical properties of blood samples consistently, macroscopic pumps have been used to maintain constant flow rates in a microfluidic comparator. In this study, the bulk-sized and expensive pump is replaced with a cheap and portable micropump. A specific reference fluid (i.e., glycerin solution [40%]) with a small volume of red blood cell (RBC) (i.e., 1% volume fraction) as fluid tracers is supplied into the microfluidic comparator. An averaged velocity (<Ur>) obtained with micro-particle image velocimetry is converted into the flow rate of reference fluid (Qr) (i.e., Qr = CQ × Ac × <Ur>, Ac: cross-sectional area, CQ = 1.156). Two control variables of the micropump (i.e., frequency: 400 Hz and volt: 150 au) are selected to guarantee a consistent flow rate (i.e., COV < 1%). Simultaneously, the blood sample is supplied into the microfluidic channel under specific flow patterns (i.e., constant, sinusoidal, and periodic on-off fashion). By monitoring the interface in the comparator as well as Qr, three biophysical properties (i.e., viscosity, junction pressure, and pressure-induced work) are obtained using analytical expressions derived with a discrete fluidic circuit model. According to the quantitative comparison results between the present method (i.e., micropump) and the previous method (i.e., syringe pump), the micropump provides consistent results when compared with the syringe pump. Thereafter, representative biophysical properties, including the RBC aggregation, are consistently obtained for specific blood samples prepared with dextran solutions ranging from 0 to 40 mg/mL. In conclusion, the present method could be considered as an effective method for quantifying the physical properties of blood samples, where the reference fluid is supplied with a cheap and portable micropump.

Quantitative Monitoring of Dynamic Blood Flows Using Coflowing Laminar Streams in a Sensorless Approach

Determination of blood viscosity requires consistent measurement of blood flow rates, which leads to measurement errors and presents several issues when there are continuous changes in hematocrit changes. Instead of blood viscosity, a coflowing channel as a pressure sensor is adopted to quantify the dynamic flow of blood. Information on blood (i.e., hematocrit, flow rate, and viscosity) is not provided in advance. Using a discrete circuit model for the coflowing streams, the analytical expressions for four properties (i.e., pressure, shear stress, and two types of work) are then derived to quantify the flow of the test fluid. The analytical expressions are validated through numerical simulations. To demonstrate the method, the four properties are obtained using the present method by varying the flow patterns (i.e., constant flow rate or sinusoidal flow rate) as well as test fluids (i.e., glycerin solutions and blood). Thereafter, the present method is applied to quantify the dynamic flows of RBC aggregation-enhanced blood with a peristaltic pump, where any information regarding the blood is not specific. The experimental results indicate that the present method can quantify dynamic blood flow consistently, where hematocrit changes continuously over time.

β-Dispersion of blood during sedimentation

Aggregation of human red blood cells (RBC) is central to various pathological conditions from bacterial infections to cancer. When left at low shear conditions or at hemostasis, RBCs form aggregates, which resemble stacks of coins, known as 'rouleaux'. We experimentally examined the interfacial dielectric dispersion of aggregating RBCs. Hetastarch, an RBC aggregation agent, is used to mimic conditions leading to aggregation. Hetastrach concentration is incrementally increased in blood from healthy donors to measure the sensitivity of the technique. Time lapse electrical impedance measurements were conducted as red blood cells form rouleaux and sediment in a PDMS chamber. Theoretical modeling was used for obtaining complex permittivity of an effective single red blood cell aggregate at various concentrations of hetastarch. Time response of red blood cells' impedance was also studied to parametrize the time evolution of impedance data. Single aggregate permittivity at the onset of aggregation, evolution of interfacial dispersion parameters, and sedimentation kinetics allowed us to distinguish differential aggregation in blood.

Experimental Investigation of Air Compliance Effect on Measurement of Mechanical Properties of Blood Sample Flowing in Microfluidic Channels

Air compliance has been used effectively to stabilize fluidic instability resulting from a syringe pump. It has also been employed to measure blood viscosity under constant shearing flows. However, due to a longer time delay, it is difficult to quantify the aggregation of red blood cells (RBCs) or blood viscoelasticity. To quantify the mechanical properties of blood samples (blood viscosity, RBC aggregation, and viscoelasticity) effectively, it is necessary to quantify contributions of air compliance to dynamic blood flows in microfluidic channels. In this study, the effect of air compliance on measurement of blood mechanical properties was experimentally quantified with respect to the air cavity in two driving syringes. Under periodic on–off blood flows, three mechanical properties of blood samples were sequentially obtained by quantifying microscopic image intensity (<I>) and interface (α) in a co-flowing channel. Based on a differential equation derived with a fluid circuit model, the time constant was obtained by analyzing the temporal variations of β = 1/(1–α). According to experimental results, the time constant significantly decreased by securing the air cavity in a reference fluid syringe (~0.1 mL). However, the time constant increased substantially by securing the air cavity in a blood sample syringe (~0.1 mL). Given that the air cavity in the blood sample syringe significantly contributed to delaying transient behaviors of blood flows, it hindered the quantification of RBC aggregation and blood viscoelasticity. In addition, it was impossible to obtain the viscosity and time constant when the blood flow rate was not available. Thus, to measure the three aforementioned mechanical properties of blood samples effectively, the air cavity in the blood sample syringe must be minimized (V_{air, R} = 0). Concerning the air cavity in the reference fluid syringe, it must be sufficiently secured about V_{air, R} = 0.1 mL for regulating fluidic instability because it does not affect dynamic blood flows.