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Published on: June 4, 2015
The impact of suctioning RBCs from a simulated operative site on mechanical fragility and hemolysis
Jay S Raval1, Jonathan H Waters, Mark H Yazer
1Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Background:
Intraoperative cell salvage exerts shear stress upon RBCs, particularly as they are suctioned from the surgical field. Shear stress can result in overt hemolysis or it can cause sublethal injury to the suctioned RBCs. The mechanical fragility (MF) test uses shear stress to measure the extent of RBC sublethal injury. RBCs that have sustained sublethal injury are more susceptible to shear stress induced hemolysis. In this study we suctioned whole blood samples from an artificial surgical field to determine if pre-menopausal female RBCs would demonstrate greater resistance to hemolysis and less sublethal injury compared to that of males and post-menopausal females.
Methods:
Ten CPD-preserved whole blood units from these 3 donor groups were obtained and samples suctioned at -150 mmHg from a simulated surgical field. The MF test was then performed and the % hemolysis calculated. In addition the MF test was serially performed on these whole blood units during the 21 days of storage.
Results:
There were no differences in the extent of hemolysis or RBC shear stress resistance after suctioning between the 3 donor groups. During storage the pre-menopausal female RBCs demonstrated higher shear stress tolerance compared to the males or post-menopausal females at all of the time points.
Conclusion:
Although during static storage pre-menopausal female RBCs in CPD-preserved whole blood demonstrated higher shear stress tolerance, this enhanced resistance was not observed after suctioning from a simulated surgical field.
Insights
Pre-menopausal female red blood cells (RBCs) showed higher shear stress tolerance during storage but not after simulated surgical suctioning compared to males and post-menopausal females.
Area of Science:
- Biomedical Engineering
- Hematology
- Transfusion Medicine
Background:
- Intraoperative cell salvage involves suctioning red blood cells (RBCs), exposing them to shear stress.
- Shear stress can cause RBC hemolysis or sublethal injury, impacting mechanical fragility (MF).
- The MF test quantifies sublethal RBC injury by measuring susceptibility to shear-induced hemolysis.
Purpose of the Study:
- To investigate if pre-menopausal female RBCs exhibit greater resistance to hemolysis and sublethal injury compared to males and post-menopausal females when suctioned from a simulated surgical field.
- To assess RBC mechanical fragility during storage and after simulated intraoperative handling.
Main Methods:
- Whole blood samples from pre-menopausal females, males, and post-menopausal females were collected in CPD preservative.
- Samples were suctioned at -150 mmHg from a simulated surgical field.
- Mechanical fragility tests were conducted immediately after suctioning and serially throughout 21 days of storage to calculate % hemolysis and shear stress tolerance.
Main Results:
- No significant differences in hemolysis or RBC shear stress resistance were observed between the three donor groups immediately after suctioning.
- During 21 days of storage, pre-menopausal female RBCs demonstrated significantly higher shear stress tolerance compared to males and post-menopausal females at all time points.
- Sublethal RBC injury, as measured by MF, did not differ between groups post-suctioning.
Conclusions:
- Enhanced shear stress tolerance of pre-menopausal female RBCs during static storage was not evident after simulated intraoperative suctioning.
- RBCs from different donor groups exhibit similar mechanical fragility when subjected to the shear stress of simulated surgical suctioning.
- Further research is needed to understand the mechanisms behind RBC mechanical fragility and potential sex-based differences in response to intraoperative handling.
