The effect of hematocrit, fibrinogen concentration and temperature on the kinetics of clot formation of whole blood

BACKGROUND

Dynamic mechanical analysis of blood clots can be used to detect the coagulability of blood.

OBJECTIVE

We investigated the kinetics of clot formation by changing several blood components, and we looked into the clot "signature" at its equilibrium state by using viscoelastic and dielectric protocols.

METHODS

Oscillating shear rheometry, ROTEM, and a dielectro-rheological device was used.

RESULTS

In fibrinogen- spiked samples we found the classical high clotting ability: shortened onset, faster rate of clotting, and higher plateau stiffness. Electron microscopy explained the gain of stiffness. Incorporated RBCs weakened the clots. Reduction of temperature during the clotting process supported the development of high moduli by providing more time for fiber assembly. But at low HCT, clot firmness could be increased by elevating the temperature from 32 to 37°C. In contrast, when the fibrinogen concentration was modified, acceleration of clotting via temperature always reduced clot stiffness, whatever the initial fibrinogen concentration. Electrical resistance increased continuously during clotting; loss tangent (D) (relaxation frequency 249 kHz) decreased when clots became denser: fewer dipoles contributed to the relaxation process. The relaxation peak (Dmax) shifted to lower frequencies at higher platelet count.

CONCLUSION

Increasing temperature accelerates clot formation but weakens clots. Rheometry and ROTEM correlate well.

Venoarteriolar reflex responses in diabetic patients

The aim of this study was to investigate the venoarteriolar reflex (VAR) responses in type 1 (T1DM) and type 2 (T2DM) diabetes mellitus (DM) with polyneuropathy and to estimate their relationship with age, DM duration, initial cutaneous temperature and body mass index. Four groups of subjects were investigated: 1st group -20 patients with T1DM; 2nd group -50 patients with T2DM; 3rd group of 20 healthy subjects with similar age and body mass index (BMI) to the T1DM group; 4th group (Control2) of 24 healthy subjects adjusted by age and BMI to the T2DM group. The cutaneous perfusions of the big toe pulp were monitored as baseline perfusions at a temperature of 32°C in supine and sitting position with hanging legs and back in supine position. Loss of venoarteriolar reflex responses was established in 75% of T1DM patients, 78% of T2DM patients and in none of the investigated healthy controls. Reduced venoarteriolar perfusion responses were established in both T1DM and T2DM patients with polyneuropathy compared with healthy subjects. Reliable positive associations between VAR responses and the age, DM duration and initial cutaneous temperature were found.

Numerical analysis of 3D blood flow and common carotid artery hemodynamics in the carotid artery bifurcation with stenosis

The results for blood flow in the carotid artery bifurcation on the basis of numerical simulation of Navier-Stokes equations are presented in this study. Four cases of carotid bifurcation are considered: common carotid artery (CCA) bifurcation without stenoses and cases with one, two and three stenoses are also presented. The results are obtained by performing numerical simulations considering one pulse wave period based on the finite volume discretization of Navier-Stokes equations. The structures of the flow around the bifurcation are obtained and the deformation of the pulse wave from common carotid artery (CCA) to the internal carotid artery (ICA) and external carotid artery (ECA) is traced. The axial velocity and wall shear stress (WSS) distribution and contours are presented considering the characteristic time points. The results of the WSS distribution around the bifurcation allow a prediction of the probable sites of stenosis growth.

Experimental evaluation of mechanical and electrical properties of RBC suspensions in Dextran and PEG under flow II. Role of RBC deformability and morphology

Mechanical and electrical properties of the normal RBCs suspensions and of hardened after treatment with glutaraldehyde (0.01-2.5%) RBCs in isotonic physiological solution and Dextran 70,000 (Dextran 70) and Polyethylene glycol 35,000 (PEG) and adjusted to hematocrit of 40%, were evaluated. Apparent viscosity and conductivity were measured under steady and transient flow regimes at low shear rates and at different local structure of the flow at 37 °C. A time course of conductivity was recorded in parallel with the rheological properties of the RBC suspensions and conductivity and apparent viscosity dependences on shear rates were studied and compared at different concentrations of Dextran 70, PEG and glutaraldehyde. Low shear viscosity decreased after RBCs treatment with glutaraldehyde and at 0.5-2.5% it is constant. Echinocytes are observed at low Dextran 70 and PEG concentrations while spherocytes are found mainly in smears treated with higher concentrations. The results show that the apparent viscosity and conductivity of RBCs suspensions in Dextran 70 and PEG are strongly influenced by flow, shear rates, concentration, cell deformability and morphology and the method is sensitive to study the mechanical and electrical properties of RBC suspension and to provide experimental description of RBCs and other cell-to-cell interactions.

Hemorheological changes and characteristic parameters derived from whole blood viscometry in chronic heroin addicts

A group of 15 chronic opioid addicts (DA) with mean age 26.5+/-7.3 years was studied by means of a rotational Contraves Low Shear 30 viscometer and the results have been compared with a control group of 19 healthy subjects. It was found that the mean whole blood viscosity values of the investigated group of heroin abusers (n=15) were elevated compared to that of healthy persons (n=19) over the whole shear rate range and fell by more than ten orders of magnitude (Savov et al., 2006). The present investigation uses the coefficients of the models of Ostwald-de-Walle (power law) and Herschel-Bulkley law, which describe whole blood flow curves (tau-gamma) within the shear rates range from 10(-2) to 10(2) s(-1) and itself incorporate whole blood viscosity data in the entire shear rate range. A significant difference in the mean yield shear stress tau(0) values of the drug abusers' group compared to the controls was found. A strong positive linear correlation was determined between the parameters of RBC aggregation in the group of heroin addicts confirming our previous results (Ivanov and Antonova, 2005; Savov, Zvetkova et al., 2007; Savov, Antonova et al., 2007) for intensive RBC and platelet aggregation and morphological changes in DA group.

Hemorheological disturbances in cerebrovascular diseases

The aim of the study was to evaluate the possible relationship of the hemorheological disturbances with the clinical symptoms and some risk factors (RF) for cerebrovascular diseases (CVD). The study included 68 patients with CVD, 29 with transient ischemic attacks (TIA) and 39 with chronic unilateral cerebral infarctions (UCI) and 47 healthy control subjects. A questionnaire for RF for CVD was filled. Hemorheological variables: leucocytes, hemoglobin, hematocrit, fibrinogen (Fib), plasma (PV) and whole blood viscosity (WBV) at different shear rates by Couette rotational viscometer Contraves Low Shear 30 were investigated and the hemorheological indices of erythrocyte aggregation (IEA), erythrocyte deformability (IED) and of oxygen transport to tissues (TO(2)) were calculated. The arterial hypertension was the most frequent RF in the examined patients'. The hemorheological investigation showed significant increase of Fib in the patients with TIA and of PV and WBV in both patients' groups. The comparative study of the hemorheological variables with the RF for CVD showed predominating significant correlations with blood pressure (systolic, diastolic and mean) values, with age, cholesterol, physical activity and the body mass index. Our study confirms the possibility the hemorheological variables to be accepted as RF for development of stroke and for its recurrences.

Age dependent changes of arterial wall viscoelasticity

Viscoelastic characteristics (VEC) of old rat aorta (Wistar, 10 months) were obtained by sinusoidal excitation of intraluminal pressure (p) in cylindrical arterial preparations. The pressure excitation frequency (f(exc)) was swept in the range 3-30 Hz up and down at several mean-pressure levels while response volume oscillations were recorded and resonance curves were plotted. Natural frequency (f(0)), dynamic modulus of elasticity (E') and coefficient of viscosity (beta) were estimated from resonance curves and the dependences of VEC on p were drawn. The results showed that f(0) decreased linearly with p whereas our previous data for young rat aorta (Wistar, 4 months) showed independence of f(0) on p. E' increased nonlinearly with p with the values being higher in comparison to young rat aorta. This means stiffening of rat aorta with age in accordance with the known literature data. beta-values increased linearly with p being higher in comparison to young rat aorta, demonstrative of raised intrinsic friction in the wall. VEC values were higher at decreasing f(exc) suggesting that the direction of excitation sweeping also determines the arterial wall biomechanical behaviour. It could be concluded that blood vessels VEC worsen with age, which endangers the arterial wall integrity, especially at higher intraluminal pressure.

Studies of electrorheological properties of blood

The electrorheological (ER) properties of blood indicate changes in the blood rheological behaviour due to imposition of electric field. The present work identifies and quantifies ER properties of blood at different shear rates and at different local structure of the flow field. A concurrent measurement system, based on a Contraves Low Shear 30 rotational rheometer was used in this study. It includes a pair of cylindrically shaped platinum electrodes, embedded into the wall of a resin replica of the Couette type flow chamber of the rheometer, constructed for conductivity measurement, and associated software (Data acquisition system). The relationship between the whole blood and plasma conductivity (the main active component of blood impedance) was studied in parallel with the changes in the rheological behaviour under steady and transient flow conditions. The time variation of blood conductivity at different flow regimes and the dependences of the apparent whole blood and plasma viscosity were investigated in the presence and absence of an electric field of 2 kHz. The results show that blood conductivity is strongly dependent on the blood factors considered and that any application using blood conductivity measurement should take into account the effect of flow, shear rates and hematocrit. The results also show that valuable information on the mechanical properties of blood can be obtained, in particular concerning the structuring and kinetics of "rouleaux formation".

Whole blood viscosity and erythrocyte hematometric indices in chronic heroin addicts

Whole blood viscosity (WBV) and hematometric indices of erythrocytes as red blood cell count (RBC), mean erythrocyte volume (MCV), hemoglobin (HGB), hematocrit (HCT), mean hemoglobin content of erythrocytes (MCH), HGB/HCT values (MCHC) and red blood cell distribution width (RDW) have been studied in a group of 15 chronic opioid addicts under methadone maintenance therapy with mean age 26.53 +/- 7.34 years. WBV elevation and changes in MCV, HGB, HCT, RDW were found in intravenous drug users compared to healthy individuals. As well, RBC was decreased leading to an increase in MCH and MCHC values. Correlation analysis suggested that the correlation among the RBC, HGB, HCT and WBV was the closest. Heroin macrocytosis (heroin macrocytic anemia) was established, related with the increased RDW in chronic heroin abusers. The results are in accordance with data revealing abnormal effects of alcohol and other drugs on whole blood rheology and hematometric/morphometric characteristics of erythrocytes.

Hemorheological disturbances and characteristic parameters in patients with cerebrovascular disease

Whole blood and plasma viscosity were measured of 90 patients with chronic cerebrovascular disease (CVD) and 56 healthy individuals by Couette rotational viscometer Contraves Low Shear 30 at a steady flow. Plasma viscosity was measured with capillary viscometer of Ubbelohde type. Two subgroups of patients were investigated: 23 patients with transient ischemic attacks (TIAs) and 67 patients with chronic cerebral infarctions (CCI). They were compared with two control groups: 56 healthy individuals without risk factors for stroke and 37 randomly selected subjects with risk factors for stroke. It is established significant elevation of plasma viscosity in the patients with cerebral ischemia. The elevation of blood viscosity was most pronounced at shear rate of 94.5 s(-1). This comparison is confirmed by the criterion, using blood rigidity number h defined by the formula of Whittington and Harkness. Conclusion is drawn from our study that chronic ischemic cerebrovascular disorders are characterized with chronic hyperviscosity.