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< Vol. 39 Issue 4 | Apr 2016 | pp. 147 - 210

Mechanical blood trauma in assisted circulation: sublethal RBC damage preceding hemolysis

Mechanical blood trauma in assisted circulation: sublethal RBC damage preceding hemolysis

Int J Artif Organs 2016; 39(4): 150 - 159

Article Type: REVIEW

DOI:10.5301/ijao.5000478

Authors

Salim E. Olia, Timothy M. Maul, James F. Antaki, Marina V. Kameneva

Abstract

After many decades of improvements in mechanical circulatory assist devices (CADs), blood damage remains a serious problem during support contributing to variety of adverse events, and consequently affecting patient survival and quality of life. The mechanisms of cumulative cell damage in continuous-flow blood pumps are still not fully understood despite numerous in vitro, in vivo, and in silico studies of blood trauma. Previous investigations have almost exclusively focused on lethal blood damage, namely hemolysis, which is typically negligible during normal operation of current generation CADs. The measurement of plasma free hemoglobin (plfHb) concentration to characterize hemolysis is straightforward, however sublethal trauma is more difficult to detect and quantify since no simple direct test exists. Similarly, while multiple studies have focused on thrombosis within blood pumps and accessories, sublethal blood trauma and its sequelae have yet to be adequately documented or characterized. This review summarizes the current understanding of sublethal trauma to red blood cells (RBCs) produced by exposure of blood to flow parameters and conditions similar to those within CADs. It also suggests potential strategies to reduce and/or prevent RBC sublethal damage in a clinically-relevant context, and encourages new research into this relatively uncharted territory.

Article History

  • • Accepted on 18/02/2016
  • • Available online on 30/03/2016
  • • Published in print on 15/06/2016

Disclosures

Financial support: Support was provided in part by the National Institutes of Health (NIH Grant R01 HL089456-01 Multi-scale Model of Thrombosis in Artificial Circulation) and the Cardiovascular Bioengineering Training Program (NIH Training Grant T32-HL076124 for Salim E. Olia).
Conflict of interest: None to disclose.

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Authors

  • Olia, Salim E. [PubMed] [Google Scholar] 1, 2, 3
  • Maul, Timothy M. [PubMed] [Google Scholar] 1, 2, 4
  • Antaki, James F. [PubMed] [Google Scholar] 1, 2, 5
  • Kameneva, Marina V. [PubMed] [Google Scholar] 1, 2, 6, * Corresponding Author ([email protected])

Affiliations

  •  McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA - USA
  •  Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA - USA
  •  Artificial Heart Program, University of Pittsburgh Medical Center, Pittsburgh, PA - USA
  •  Department of Cardiothoracic Surgery, Children’s Hospital of Pittsburgh, Pittsburgh, PA - USA
  •  Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA - USA
  •  Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA - USA

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