Browsing by Author "Reinhart, Walter H."
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Item Effect of osmolality on erythrocyte rheology and perfusion of an artificial microvascular network(Microvascular Research, 3/1/2016) Reinhart, Walter H.; Piety, Nathaniel Z.; Goede, Jeroen S.; Shevkoplyas, Sergey S.Plasma sodium concentration is normally held within a narrow range. It may, however, vary greatly under pathophysiological conditions. Changes in osmolality lead to either swelling or shrinkage of red blood cells (RBCs). Here we investigated the influence of suspension osmolality on biophysical properties of RBCs and their ability to perfuse an artificial microvascular network (AMVN). Blood was drawn from healthy volunteers. RBC deformability was measured by osmotic gradient ektacytometry over a continuous range of osmolalities. Packed RBCs were suspended in NaCl solutions (0.45, 0.6, 0.9, 1.2, and 1.5 g/dL), resulting in supernatant osmolalities of 179±4, 213±1, 283±2, 354±3, and 423±5 mOsm/kg H2O. MCV (mean corpuscular volume) and MCHC (mean corpuscular hemoglobin concentration), were determined using centrifuged microhematocrit. RBC suspensions at constant cell numbers were used to measure viscosity at shear rates ranging from 0.11 to 69.5 s?1 and the perfusion rate of the AMVN. MCV was inversely and MCHC directly proportional to osmolality. RBC deformability was maximized at isosmotic conditions (290 mOsm/kg H2O) and markedly decreased by either hypo- or hyperosmolality. The optimum osmolality for RBC suspension viscosity was shifted towards hyperosmolality, while lower osmolalities increased suspension viscosity exponentially. However, the AMVN perfusion rate was maximized at 290 mOsm/kg H2O, and changed by less than 10% over a wide range of osmolalities. These findings contribute to the basic understanding of blood flow in health and disease, and may have significant implications for the management of osmotic homeostasis in clinical practice.Item Influence of feeding hematocrit and perfusion pressure on hematocrit reduction (Fåhræus effect) in an artificial microvascular network(Microcirculation, 11/1/2018) Reinhart, Walter H.; Piety, Nathaniel Z.; Shevkoplyas, Sergey S.Objective Hct in narrow vessels is reduced due to concentration of fast?flowing RBCs in the center, and of slower flowing plasma along the wall of the vessel, which in combination with plasma skimming at bifurcations leads to the striking heterogeneity of local Hct in branching capillary networks known as the network Fåhræus effect. We analyzed the influence of feeding Hct and perfusion pressure on the Fåhræus effect in an AMVN. Methods RBC suspensions in plasma with Hcts between 20% and 70% were perfused at pressures of 5?60 cm H2O through the AMVN. A microscope and high?speed camera were used to measure RBC velocity and Hct in microchannels of height of 5 ?m and widths of 5?19 ?m. Results Channel Hcts were reduced compared with Hctfeeding in 5 and 7 ?m microchannels, but not in larger microchannels. The magnitude of Hct reduction increased with decreasing Hctfeeding and decreasing ?P (flow velocity), showing an about sevenfold higher effect for 40% Hctfeeding and low pressure/flow velocity than for 60% Hctfeeding and high pressure/flow velocity. Conclusions The magnitude of the network Fåhræus effect in an AMVN is inversely related to Hctfeeding and ?P.Item Influence of red blood cell aggregation on perfusion of an artificial microvascular network(Microcirculation, 7/1/2018) Reinhart, Walter H.; Piety, Nathaniel Z.; Shevkoplyas, Sergey S.Red blood cells (RBCs) suspended in plasma form multicellular aggregates under low flow conditions, increasing apparent blood viscosity at low shear rates. It has previously been unclear, however, if RBC aggregation affects microvascular perfusion. Here we analyzed the impact of RBC aggregation on perfusion and ‘capillary’ hematocrit in an artificial microvascular network (AMVN) at driving pressures ranging from 5 to 60 cmH2O to determine if aggregation could improve tissue oxygenation. RBCs were suspended at 30% hematocrit in either 46.5 g/L dextran 40 (D40, non-aggregating medium) or 35 g/L dextran 70 (D70, aggregating medium) solutions with equal viscosity. Aggregation was readily observed in the AMVN for RBCs suspended in D70 at driving pressures ? 40 cmH2O. The AMVN perfusion rate was the same for RBCs suspended in aggregating and non-aggregating medium, at both ‘venular’ and ‘capillary’ level. Estimated ‘capillary’ hematocrit was higher for D70 suspensions than for D40 suspensions at intermediate driving pressures (5 – 40 cm H2O). We conclude that although RBC aggregation did not affect the AMVN perfusion rate independently of the driving pressure, a higher hematocrit in the ‘capillaries’ of the network for D70 suspensions suggested a better oxygen transport capacity in the presence of RBC aggregation.Item Optimal hematocrit in an artificial microvascular network(Transfusion, 9/1/2018) Piety, Nathaniel Z.; Reinhart, Walter H.; Stutz, Julianne; Shevkoplyas, Sergey S.BACKGROUND Higher hematocrit increases the oxygen?carrying capacity of blood but also increases blood viscosity, thus decreasing blood flow through the microvasculature and reducing the oxygen delivery to tissues. Therefore, an optimal value of hematocrit that maximizes tissue oxygenation must exist. STUDY DESIGN AND METHODS We used viscometry and an artificial microvascular network device to determine the optimal hematocrit in vitro. Suspensions of fresh red blood cells (RBCs) in plasma, normal saline, or a protein?containing buffer and suspensions of stored red blood cells (at Week 6 of standard hypothermic storage) in plasma with hematocrits ranging from 10 to 80% were evaluated. RESULTS For viscometry, optimal hematocrits were 10, 25.2, 31.9, 37.1, and 37.5% for fresh RBCs in plasma at shear rates of 3.2 or less, 11.0, 27.7, 69.5, and 128.5 inverse seconds. For the artificial microvascular network, optimal hematocrits were 51.1, 55.6, 59.2, 60.9, 62.3, and 64.6% for fresh RBCs in plasma and 46.4, 48.1, 54.8, 61.4, 65.7, and 66.5% for stored RBCs in plasma at pressures of 2.5, 5, 10, 20, 40, and 60 cm H2O. CONCLUSION Although exact optimal hematocrit values may depend on specific microvascular architecture, our results suggest that the optimal hematocrit for oxygen delivery in the microvasculature depends on perfusion pressure. Therefore, anemia in chronic disorders may represent a beneficial physiological response to reduced perfusion pressure resulting from decreased heart function and/or vascular stenosis. Our results may help explain why a therapeutically increasing hematocrit in such conditions with RBC transfusion frequently leads to worse clinical outcomes.Item Shape matters: the effect of red blood cell shape on perfusion of an artificial microvascular network(Transfusion, 4/1/2017) Piety, Nathaniel Z.; Reinhart, Walter H.; Pourreau, Patrick H.; Abidi, Rajaa; Shevkoplyas, Sergey S.BACKGROUND The shape of human red blood cells (RBCs) deteriorates progressively throughout hypothermic storage, with echinocytosis being the most prevalent pathway of this morphological lesion. As a result, each unit of stored blood contains a heterogeneous mixture of cells in various stages of echinocytosis and normal discocytes. Here we studied how the change in shape of RBCs following along the path of the echinocytic transformation affects perfusion of an artificial microvascular network (AMVN). STUDY DESIGN AND METHODS Blood samples were obtained from healthy consenting volunteers. RBCs were leukocyte-reduced, re-suspended in saline, and treated with various concentrations of sodium salicylate to induce shape changes approximating the stages of echinocytosis experienced by RBCs during hypothermic storage (e.g. discocyte, echinocyte I, echinocyte II, echinocyte III, sphero-echinocyte and spherocyte). The AMVN perfusion rate was measured for 40% hematocrit suspensions of RBCs with different shapes. RESULTS The AMVN perfusion rates for RBCs with discocyte and echinocyte I shapes were similar, but there was a statistically significant decline in the AMVN perfusion rate between RBCs with shapes approximating each subsequent stage of echinocytosis. The difference in AMVN perfusion between discocytes and spherocytes (the last stage of the echinocytic transformation) was 34%. CONCLUSION The change in shape of RBCs from normal discocytes progressively through various stages of echinocytosis to spherocytes produced a substantial decline in the ability of these cells to perfuse an artificial microvascular network. Echinocytosis induced by hypothermic storage could therefore be responsible for a similarly substantial impairment of deformability previously observed for stored RBCs.Item Washing stored red blood cells in an albumin solution improves their morphological and hemorheological properties(Transfusion, 8/1/2016) Reinhart, Walter H.; Piety, Nathaniel Z.; Deuel, JeremyW.; Makhro, Asya; Schulzki, Thomas; Bogdanov, Nikolay; Goede, Jeroen S.; Bogdanova, Anna; Abidi, Rajaa; Shevkoplyas, Sergey S.BACKGROUND Prolonged storage of red blood cells leads to storage lesions, which may impair clinical outcomes after transfusion. A hallmark of storage lesions is progressive echinocytic shape transformation, which can be partially reversed by washing in albumin solutions. Here we have investigated the impact of this shape recovery on biorheological parameters. METHODS Red blood cells stored hypothermically for 6–7 weeks were washed in a 1% human serum albumin solution. Red cell deformability was measured with osmotic gradient ektacytometry. The viscosity of red cell suspensions were measured with a Couette-type viscometer. The flow behaviour of red cells suspended at 40% hematocrit was tested with an artificial microvascular network. RESULTS Washing in 1% albumin reduced higher degrees of echinocytes and increased the frequency of discocytes, thereby shifting the morphological index towards discocytosis. Washing also reduced red cell swelling. This shape recovery was not seen after washing in saline, buffer or plasma. Red cell shape normalisation did not improve cell deformability measured by ektacytometry, but it tended to decrease suspension viscosities at low shear rates and improved the perfusion of an artificial microvascular network. CONCLUSIONS Washing of stored red blood cells in a 1% human serum albumin solution specifically reduces echinocytosis, and this shape recovery has a beneficial effect on microvascular perfusion in vitro. Washing in 1% albumin may represent a new approach to improving the quality of stored red cells, and thus potentially reducing the likelihood of adverse clinical outcomes associated with transfusion of blood stored for longer periods of time.