Erythrocyte aggregation at non-steady flow conditions: a comparison of characteristics measured with electrorheology and image analysis

Imaging Erythrocyte Sedimentation in Whole Blood

The erythrocyte sedimentation rate (ESR) is one of the oldest medical diagnostic tools. However, currently there is some debate on the structure formed by the cells during the sedimentation process. While the conventional view is that erythrocytes sediment as separate aggregates, others have suggested that they form a percolating gel, similar to other colloidal suspensions. However, visualization of aggregated erythrocytes, which would settle the question, has always been challenging. Direct methods usually study erythrocytes in 2D situations or low hematocrit (∼1%). Indirect methods, such as scattering or electric measurements, provide insight on the suspension evolution, but cannot directly discriminate between open or percolating structures. Here, we achieved a direct probing of the structures formed by erythrocytes in blood at stasis. We focused on blood samples at rest with controlled hematocrit of 45%, from healthy donors, and report observations from three different optical imaging techniques: direct light transmission through thin samples, two-photon microscopy and light-sheet microscopy. The three techniques, used in geometries with thickness from 150 μm to 3 mm, highlight that erythrocytes form a continuous network with characteristic cracks, i.e., a colloidal gel. The characteristic distance between the main cracks is of the order of ∼100 μm. A complete description of the structure then requires a field of view of the order of ∼1 mm, in order to obtain a statistically relevant number of structural elements. A quantitative analysis of the erythrocyte related processes and interactions during the sedimentation need a further refinement of the experimental set-ups.

Simultaneous Determination of Human Erythrocyte Deformability and Adhesion Energy: A Novel Approach Using a Microfluidic Chamber and the "Glass Effect"

The simultaneous determination of adhesion and deformability parameters of erythrocytes was carried out through a microfluidic device, which uses an inverted optical microscope with new image acquisition and analysis technologies. Also, an update of the models describing erythrocyte adhesion and deformation was proposed. Measurements were carried out with red blood cells suspended in saline solution with human serum albumin at different concentrations. Erythrocytes adhered to a glass surface were subjected to different low shear stress (from 0.04 to 0.25 Pa), causing cellular deformation and dissociation. The maximum value obtained of the erythrocyte deformability index was 0.3, and that of the adhesion energy per unit area was 1.1 × 10^-6 Pa m, both according to previous works. The obtained images of RBCs adhered to glass reveal that the adhesion is stronger in a single point of the cell, suggesting a ligand migration that concentrates the adhesion in a "spike-like tip" in the cell. Moreover, adhesion energy results indicate that the energy required to separate erythrocytes in media with a lower albumin concentration is greater. Both results could be explained by the mobility of membrane receptors.

Advanced Constitutive Modeling of the Thixotropic Elasto-Visco-Plastic Behavior of Blood: Description of the Model and Rheological Predictions

This work focuses on the advanced modeling of the thixotropic nature of blood, coupled with an elasto-visco-plastic formulation by invoking a consistent and validated model for TEVP materials. The proposed model has been verified for the adequate description of the rheological behavior of suspensions, introducing a scalar variable that describes dynamically the level of internal microstructure of rouleaux at any instance, capturing accurately the aggregation and disaggregation mechanisms of the RBCs. Also, a non-linear fitting is adopted for the definition of the model's parameters on limited available experimental data of steady and transient rheometric flows of blood samples. We present the predictability of the new model in various steady and transient rheometric flows, including startup shear, rectangular shear steps, shear cessation, triangular shear steps and LAOS tests. Our model provides predictions for the elasto-thixotropic mechanism in startup shear flows, demonstrating a non-monotonic relationship of the thixotropic index on the shear-rate. The intermittent shear step test reveals the dynamics of the structural reconstruction, which in turn is associated with the aggregation process. Moreover, our model offers robust predictions for less examined tests such as uniaxial elongation, in which normal stress was found to have considerable contribution. Apart from the integrated modeling of blood rheological complexity, our implementation is adequate for multi-dimensional simulations due to its tensorial formalism accomplished with a single time scale for the thixotropic effects, resulting in a low computational cost compared to other TEVP models.

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

The aggregation of red blood cells (RBCs) in normal blood (non-coagulation) has been quantitatively measured by blood pulsatile flow based on multiple-frequency electrical impedance spectroscopy. The relaxation frequencies f_c under static and flowing conditions of blood pulsatile flow are utilized to evaluate the RBC aggregation quantitatively with the consideration of blood flow factors (RBC orientation, deformation, thickness of electrical double layer (EDL)). Both porcine blood and bovine blood are investigated in experiments, for the reason that porcine blood easily forms RBC aggregates, while bovine blood does not. The results show that the relaxation frequencies f_c of porcine blood and bovine blood present opposite performance, which indicates that the proposed relaxation frequency f_c is efficient to measure RBCs aggregation. Furthermore, the modified Hanai equation is proposed to quantitatively calculate the influence of RBCs aggregation on relaxation frequency f_c. The study confirms the feasibility of a high speed, on-line RBC aggregation sensing method in extracorporeal circulation systems.

Partitioning of red blood cell aggregates in bifurcating microscale flows

Microvascular flows are often considered to be free of red blood cell aggregates, however, recent studies have demonstrated that aggregates are present throughout the microvasculature, affecting cell distribution and blood perfusion. This work reports on the spatial distribution of red blood cell aggregates in a T-shaped bifurcation on the scale of a large microvessel. Non-aggregating and aggregating human red blood cell suspensions were studied for a range of flow splits in the daughter branches of the bifurcation. Aggregate sizes were determined using image processing. The mean aggregate size was marginally increased in the daughter branches for a range of flow rates, mainly due to the lower shear conditions and the close cell and aggregate proximity therein. A counterintuitive decrease in the mean aggregate size was apparent in the lower flow rate branches. This was attributed to the existence of regions depleted by aggregates of certain sizes in the parent branch, and to the change in the exact flow split location in the T-junction with flow ratio. The findings of the present investigation may have significant implications for microvascular flows and may help explain why the effects of physiological RBC aggregation are not deleterious in terms of in vivo vascular resistance.

Methods in hemorheology and their clinical applications1

The lecture was presented during the Fåhraeus award ceremony for 2016 at the University of Lisbon. It summarizes the main results and some of the more important hemorheological contributions achieved in the Laboratory of Biodynamics and Biorheology of the Institute of Mechanics to BAS and in collaboration with other laboratories of the research group, involved in many studies explaining hemorheological disturbances in various clinical conditions. An original method for the study of microstructural changes in the biological fluids by measuring the electrical conductivity simultaneously with the the rheological properties of red blood cells (RBC) in the whole blood and red blood cell suspensions in a viscometric flow was suggested. The influence of the disturbed hemorheological parameters on the common carotid artery and cerebral blood flow was studied. Analysis of blood flow in the common carotid artery bifurcation with stenosis was done. This lecture does not claim to be a comprehensive review, and many important studies were not cited. The author would like to acknowledge the valuable collaboration of all those cited in the reference list.

RBC aggregation in dextran solutions can be measured by flow cytometry

The impact of macromolecules on RBC aggregation continues to be of interest, nevertheless present measurements still have limitations and need improvement. We applied flow cytometry to measure RBC aggregation in dextran T500 (Dx500) solution. The samples were fixed in the aggregated state by glutaraldehyde. Fixed RBC exhibit auto fluorescence, which can be detected by flow cytometry. Single cells, doublets, triplets and larger aggregates can be distinguished quantitatively and quickly due to the correlation between auto fluorescence intensity and number of RBC per measured event. With the increase in concentration of Dx500, percentages of all aggregates and bigger aggregates increased significantly at concentration of 2%, 4% and 6%, while decreased when the concentration reached 8% and 10%. The percentage of bigger aggregates in concentration of 4% was higher than that in 2% and 6%. The data of flow cytometry was confirmed by microscopic observation and are in good agreement with the literature. The method provide additional advantages to the conventional measurement of RBC aggregation. It gets the distribution of single cells and aggregates as derived from the microscopic observation with hematocrit of physiological level. It uses sample volume as 1/5∼1/10 as needed in sendimentation and photometricmethods.

Hybrid System for Ex Vivo Hemorheological and Hemodynamic Analysis: A Feasibility Study

Precise measurement of biophysical properties is important to understand the relation between these properties and the outbreak of cardiovascular diseases (CVDs). However, a systematic measurement for these biophysical parameters under in vivo conditions is nearly impossible because of complex vessel shape and limited practicality. In vitro measurements can provide more biophysical information, but in vitro exposure changes hemorheological properties. In this study, a hybrid system composed of an ultrasound system and microfluidic device is proposed for monitoring hemorheological and hemodynamic properties under more reasonable experimental conditions. Biophysical properties including RBC aggregation, viscosity, velocity, and pressure of blood flows are simultaneously measured under various conditions to demonstrate the feasibility and performance of this measurement system. The proposed technique is applied to a rat extracorporeal loop which connects the aorta and jugular vein directly. As a result, the proposed system is found to measure biophysical parameters reasonably without blood collection from the rat and provided more detailed information. This hybrid system, combining ultrasound imaging and microfluidic techniques to ex vivo animal models, would be useful for monitoring the variations of biophysical properties induced by chemical agents. It can be used to understand the relation between biophysical parameters and CVDs.

Effects of Aggregation on Blood Sedimentation and Conductivity

The erythrocyte sedimentation rate (ESR) test has been used for over a century. The Westergren method is routinely used in a variety of clinics. However, the mechanism of erythrocyte sedimentation remains unclear, and the 60 min required for the test seems excessive. We investigated the effects of cell aggregation during blood sedimentation and electrical conductivity at different hematocrits. A sample of blood was drop cast into a small chamber with two planar electrodes placed on the bottom. The measured blood conductivity increased slightly during the first minute and decreased thereafter. We explored various methods of enhancing or retarding the erythrocyte aggregation. Using experimental measurements and theoretical calculations, we show that the initial increase in blood conductivity was indeed caused by aggregation, while the subsequent decrease in conductivity resulted from the deposition of erythrocytes. We present a method for calculating blood conductivity based on effective medium theory. Erythrocytes are modeled as conducting spheroids surrounded by a thin insulating membrane. A digital camera was used to investigate the erythrocyte sedimentation behavior and the distribution of the cell volume fraction in a capillary tube. Experimental observations and theoretical estimations of the settling velocity are provided. We experimentally demonstrate that the disaggregated cells settle much slower than the aggregated cells. We show that our method of measuring the electrical conductivity credibly reflected the ESR. The method was very sensitive to the initial stage of aggregation and sedimentation, while the sedimentation curve for the Westergren ESR test has a very mild slope in the initial time. We tested our method for rapid estimation of the Westergren ESR. We show a correlation between our method of measuring changes in blood conductivity and standard Westergren ESR method. In the future, our method could be examined as a potential means of accelerating ESR tests in clinical practice.

Microfluidic-based speckle analysis for sensitive measurement of erythrocyte aggregation: A comparison of four methods for detection of elevated erythrocyte aggregation in diabetic rat blood

Biochemical alterations in the plasma and red blood cell (RBC) membrane of diabetic blood lead to excessive erythrocyte aggregation (EA). EA would significantly impede the blood flow and increase the vascular flow resistance contributing to peripheral vascular diseases. In this study, a simple microfluidic-based method is proposed to achieve sensitive detection of hyperaggregation. When a blood sample is delivered into the device, images of blood flows are obtained with a short exposure time for a relatively long measuring time. A micro-particle image velocimetry technique was employed to monitor variation of the flow rate of blood as a function of time. Given that EA formation in the channel creates clear speckle patterns, the EA extent can be estimated by calculating a speckle area (ASpeckle) through a normalized autocovariance function. The hematocrit effect is assessed by comparing optical images transmitted through blood samples. EA variations caused by dextran treatment are quantitatively evaluated using characteristic time (λSpeckle) obtained by fitting the variations of ASpeckle. Other indices including number of RBCs in an aggregate (NRBC), characteristic time of erythrocyte sedimentation rate (λESR), and aggregation index estimated from ultrasound signals (AIEcho) are determined under different EA conditions using conventional techniques. The four different methods are applied to diabetic blood samples to compare their indices under hyperaggregation conditions. It is found that the proposed method can detect variation of EA reasonably, compared with conventional measurement techniques. These experimental demonstrations support the notion that the proposed method is capable of effectively monitoring the biophysical properties of diabetic blood.

Role Ca(2+) in mechanisms of the red blood cells microrheological changes

To assess the physiological role of intracellular Ca(2+) in the changes of microrheological red blood cell (RBC) properties (RBC deformability and aggregation), we employed several types of chemicals that can increase and decrease of the intracellular Ca(2+) concentration. The rise of Ca(2+) influx, stimulated by mechanical loading, A23187, thrombin, prostaglandin F(2α) was accompanied by a moderate red cell deformability lowering and an increase of their aggregation. In contrast, Ca(2+) entry blocking into the red cells by verapamil led to a significant RBC aggregation decrease and deformability rise. Similar microrheological changes were observed in the red blood cells treated with phosphodiesterase inhibitors IBMX, vinpocetine, rolipram, pentoxifylline. When forskolin (10 μM), an AC stimulator was added to RBC suspension, the RBC deformability was increased (p <0.05). Somewhat more significant deformability rise appeared after RBC incubation with dB-AMP. Red cell aggregation was significantly decreased under these conditions (p<0.01). On the whole the total data clearly show that the red cell aggregation and deformation changes were connected with an activation of both intracellular signaling pathways: Ca(2+) regulatory mechanism and Gs-protein/adenylyl-cyclase-cAMP system. And the final red cell microrheological regulatory effect is connected with the crosstalk between these systems.