Effect of erythrocyte aggregation at pathological levels on NO/O2 transport in small arterioles

Influence of red blood cell aggregation on perfusion of an artificial microvascular network

OBJECTIVE

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 AMVN at driving pressures ranging from 5 to 60 cm H₂ O to determine if aggregation could improve tissue oxygenation.

METHODS

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.

RESULTS

Aggregation was readily observed in the AMVN for RBCs suspended in D70 at driving pressures ≤40 cm H₂ O. 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 H₂ O).

CONCLUSIONS

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.

Hemodynamic Functionality of Transfused Red Blood Cells in the Microcirculation of Blood Recipients

The primary goal of red blood cell (RBC) transfusion is to supply oxygen to tissues and organs. However, due to a growing number of studies that have reported negative transfusion outcomes, including reduced blood perfusion, there is rising concern about the risks in blood transfusion. RBC are characterized by unique flow-affecting properties, specifically adherence to blood vessel wall endothelium, cell deformability, and self-aggregability, which define their hemodynamic functionality (HF), namely their potential to affect blood circulation. The role of the HF of RBC in blood circulation, particularly the microcirculation, has been documented in numerous studies with animal models. These studies indicate that the HF of transfused RBC (TRBC) plays an important role in the transfusion outcome. However, studies with animal models must be interpreted with reservations, as animal physiology may not reflect human physiology. To test this concept in humans, we have directly examined the effect of the HF of TRBC, as expressed by their deformability and adherence to vascular endothelium, on the transfusion-induced effect on the skin blood flow and hemoglobin increment in β-thalassemia major patients. The results demonstrated, for the first time in humans, that the TRBC HF is a potent effector of the transfusion outcome, expressed by the transfusion-induced increase in the recipients' hemoglobin level, and the change in the skin blood flow, indicating a link between the microcirculation and the survival of TRBC in the recipients' vascular system. The implication of these findings for blood transfusion practice and to vascular function in blood recipients is discussed.

Influence of erythrocyte aggregation at pathological levels on cell-free marginal layer in a narrow circular tube

Human red blood cells (RBCs) were perfused in a circular micro-tube (inner diameter of 25 μm) to examine the dynamic changes of cell-free marginal region at both physiological (normal) and pathophysiological (hyper) levels of RBC aggregation. The cell-free area (CFA) was measured to provide additional information on the cell-free layer (CFL) width changes in space and time domains. A prominent enhancement in the mean CFL width was found in hyper-aggregating conditions as compared to that in non-aggregating conditions (P <  0.001). The frequent contacts between RBC and the tube wall were observed and the contact frequency was greatly decreased when the aggregation level was increased from none to normal (P <  0.05) and to hyper (P <  0.001) levels. In addition, the enhanced aggregation from none to hyper levels significantly enlarged the CFA (P <  0.01). We concluded that the RBC aggregation at pathophysiological levels could promote not only the CFL width (one-dimensional parameter) but also the spatiotemporal variation of CFA (two-dimensional parameter).

Erythrocyte aggregation may promote uneven spatial distribution of NO/O2 in the downstream vessel of arteriolar bifurcations

This study examined the effect of red blood cell (RBC) aggregation on nitric oxide (NO) and oxygen (O2) distributions in the downstream vessels of arteriolar bifurcations. Particular attention was paid to the inherent formation of asymmetric cell-free layer (CFL) widths in the downstream vessels and its consequential impact on the NO/O2 bioavailability after the bifurcations. A microscopic image-based two-dimensional transient model was used to predict the NO/O2 distribution by utilizing the in vivo CFL width data obtained under non-, normal- and hyper-aggregating conditions at the pseudoshear rate of 15.6±2.0s(-1). In vivo experimental result showed that the asymmetry of CFL widths was enhanced by the elevation in RBC aggregation level. The model demonstrated that NO bioavailability was regulated by the dynamic fluctuation of the local CFL widths, which is corollary to its modulation of wall shear stress. Accordingly, the uneven distribution of NO/O2 was prominent at opposite sides of the arterioles up to six vessel-diameter (6D) away from the bifurcating point, and this was further enhanced by increasing the levels of RBC aggregation. Our findings suggested that RBC aggregation potentially augments both the formation of asymmetric CFL widths and its influence on the uneven distribution of NO/O2 in the downstream flow of an arteriolar bifurcation. The extended heterogeneity of NO/O2 downstream (2D-6D) also implied its potential propagation throughout the entire arteriolar microvasculature.