Application of drag-reducing polymer solutions as test fluids for in vitro evaluation of potential blood damage in blood pumps

Biomechanical properties of erythrocytes circulating in artificial hearts measured by dielectrophoretic method

Blood damage is recognized as one of the major problems caused by non-physiological shear force induced by artificial hearts. At present, the generally accepted manifestation of mechanical blood damage is the amount of free hemoglobin released into the blood. However, there is little research on the changes of blood cell state after circulating in artificial hearts at the single-cell level. It is well known that the mechanical properties of cells are of enormous relevance in the regulation of cellular physiological and pathological processes. In this regard, it is highly needed to study the mechanical properties of blood cells affected by non-physiological shear force. In this paper, a dielectrophoresis-based method of measuring the mechanical properties of erythrocytes circulating in artificial hearts was proposed, which was quantified with some crucial parameters such as strain, elongation index (EI), and Young's modulus. Experimental results indicated that with the increase of the working time of artificial hearts, the deformability of erythrocytes decreased, the stiffness substantially increased, and the mechanical stability decreased, particularly at long exposure times. The proposed method provides a deep insight into the mechanism of subhemolytic damage at the single-cell level and has a great potential to serve as a new tool for in vitro evaluation of potential blood damage in artificial hearts.

In Vitro Comparative Assessment of Mechanical Blood Damage Induced by Different Hemodialysis Treatments

Gradual deterioration of red blood cells (RBCs) due to mechanical stress (chronic hemolysis) is unavoidable during treatments that involve extracorporeal blood circulation, such as hemodialysis (HD). This effect is generally undetectable and does not generate any acute symptoms, but it leads to an increase in plasma free hemoglobin (fHb). There are no absolute safety levels for fHb increase, indicating the need for an empirical evaluation using comparative testing. The increase in fHb levels was investigated in vitro by applying double‐needle double‐pump HD (HD‐DNDP), a new modality in which arterial and venous pumps both run continuously. fHb was measured during typical and worst‐case simulated dialysis treatments (double‐needle single‐pump HD [HD‐DNSP], hemodiafiltration [HDF‐DN], single‐needle double‐pump HD [HD‐SNDP], and HD‐DNDP) performed in vitro using bovine blood for 4 h. Hemolysis‐related indices (fHb%; index of hemolysis, IH; and normalized IH) were calculated and used for comparison. The increase in fHb during either HDF‐DN or HD‐SNDP with Artis and AK200 dialysis machines was similar, while the fHb at the maximum real blood flow rate (Qb_real) at the completion of the HD‐DNDP treatment on Artis was higher than that for HD‐DNSP using a Phoenix dialysis machine (fHb% = 1.24 ± 0.13 and 0.92 ± 0.12 for the Artis machine with HD‐DNDP at Qb_real = 450 mL/min and Phoenix with HD‐DNSP at Qb_real = 500 mL/min, respectively). However, the fHb levels increased linearly, and no steep changes were observed. The increases observed during HD‐DNDP were the same order of magnitude as those for widely used bloodlines and treatment modes for delivering dialysis treatments. The observed results matched literature findings, and thus the measured fHb trends are not predicted to have clinical side effects. HD‐DNDP treatment with Artis does not merit any additional concern regarding mechanical stress to RBCs compared with that observed for routinely used dialysis treatments, bloodlines and machines. Although the in vitro measurement of the fHb increase in bovine blood does not allow a prediction of the absolute level of blood mechanical damage or the possible effects in humans, such measurements are valuable for assessing hemolytic harm by performing tests comparing the proposed treatment with existing devices.