Interaction of red blood cells adjacent to and within a thrombus in experimental cerebral ischaemia

Cerebral ischaemia is associated with altered platelet and fibrin network ultrastructure indicating increased coagulation activity and resistance to fibrinolysis; which may lead to the occlusion of blood vessels. Recently, it has been shown that the addition of red blood cells to plasma has a significant effect on the structural and mechanical properties of fibrin clots and is associated with lytic resistance of thrombi.

Whole blood was collected from pre-ischaemic control Sprague Dawley rats and those in which experimental cerebral ischaemia was induced by hyperglycaemic two-vessel occlusion, for the ultrastructural investigation of whole blood thrombi by scanning electron microscopy. Post-ischaemic groups were terminated at 2h, 24h and 48h subsequent to reperfusion; which were time points selected for the demonstration of initial inflammation upon neural injury, maximal neural injury and onset of regeneration.

Subsequent to ischaemic insult, red blood cells transformed from normal discoid shape to form projections which allowed them to interact both with each other and with fibrin fibres in various manners. Researches have in recent years shown that inclusion of red blood cells in experimental coagula results in delayed fibrinolysis and lytic resistance. This paper shows the morphological alterations at cellular level which may elucidate the structural and mechanical strength of these clots.

Through the extension of projections, red blood cells become intertwined within a thrombus to stabilise and strengthen its structure. The tighter these mechanical bonds, the more resistant thrombi are to lysis, an established characteristic of thrombi in cerebral ischaemia.