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Red Cell Damage During Extracorporeal Life Support

Cristina A Figueroa Villalba1,2, Nabiha H Saifee2,3, Wayne L Chandler2,3

  • 1From the Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|July 1, 2024
PubMed

Insights

Sublethal damage during extracorporeal life support (ECLS) increases phosphatidylserine-positive red blood cells (RBCs), marking them for clearance. This RBC injury contributes to blood loss in pediatric ECLS patients.

Area of Science:

  • Hematology
  • Biomedical Engineering
  • Pediatric Critical Care

Background:

  • Sublethal damage to red blood cells (RBCs) can occur during extracorporeal life support (ECLS).
  • Quantifying RBC injury is crucial for understanding blood loss during ECLS.

Purpose of the Study:

  • To quantify sublethal RBC injury during pediatric ECLS.
  • To determine the contribution of phosphatidylserine-positive (PhS+) RBCs to RBC loss.
  • To compare RBC loss mechanisms during ECLS.

Main Methods:

  • Flow cytometry was used to quantify PhS+ RBCs and RBC extracellular vesicles.
  • RBC clearance half-life was estimated.
  • RBC loss during pediatric ECLS was analyzed.

Main Results:

  • ECLS patients had significantly higher PhS+ RBCs compared to normal subjects.
  • PhS+ RBCs were also elevated in stored RBC units.
  • PhS+ RBC clearance accounted for approximately 7% of RBC loss during ECLS, with a half-life of ~15 hours.

Conclusions:

  • Phosphatidylserine exposure on RBCs increases during ECLS, indicating sublethal injury.
  • PhS+ RBCs are cleared via extravascular mechanisms, contributing to RBC loss.
  • Increased PhS+ RBCs were associated with mortality in ECLS patients.

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