Cord blood red cell osmotic fragility: a comparison between preterm and full-term newborn infants

BACKGROUND: The osmotic fragility of red blood cells reflects their membrane ability to maintain structural integrity. The osmolality at which the cells lyse is related to their shape, deformability, surface area/volume ratio and intrinsic membrane properties. In cord blood, there may be differences between premature and term infants, and be influenced by maternal medication and other factors. There have been no definitive findings on possible differences between preterm and full-term infant osmotic fragility. AIMS: To determine if cord blood erythrocyte osmotic fragility differs between premature and full-term newborn infants, using two parallel techniques. PATIENTS AND METHODS: Cord blood samples were obtained from preterm singletons (N=11), preterm multiple births (N=10), full-term infants (N=24), as well as adults (N=22), for comparison. An osmotic fragility test was used to determine the NaCl concentration at which 20%, 50% and 80% of hemolysis occurred using individual logistic curves. A glycerol lysis test determined the time needed to lyse 50% of red blood cells. RESULTS: Cord blood red cells of multiple birth premature infants were more hemolysis-resistant than erythrocytes from full-term infants or adults. Another index of osmotic fragility, the difference in NaCl concentration for 80% and 20% red cell hemolysis showed that premature infants had greater differences than full-term infants or adults. Glycerol lysis time revealed that both preterm and full-term infants had an erythrocyte subpopulation that took longer than adult blood to attain 50% hemolysis. Correlation between both tests was very significant (r=-0.603, P<0.0001, N=67). CONCLUSIONS: This study shows that erythrocytes of premature infants, although, in average, less osmotically fragile than those of healthy full-term infants, contain a more hemolysis-susceptible cell subpopulation.     

Membrane lipid fluidity and filterability of red blood cells from adults and newborns

Membrane lipid fluidity was reexamined in red blood cells and ghosts from adults and newborns. Fluorescence anisotropies of the hydrophobic probes 1,6-diphenyl-1,3,5-hexatriene (DPH) and perylene were significantly and substantially greater in fresh intact red cells from newborns than from adults; however, no significant difference was detected with the polar fluorophores, 12-(9-anthroyl) stearic acid and retinol. These results suggest that probes in the hydrophobic core of the membrane have less motional freedom in red cells from newborns than from adults, whereas probe motional freedom in the polar lipid headgroup regions of the membranes is similar for both cell types. DPH fluorescence anisotropy increased upon making white ghosts or upon storage of blood. Temperature studies indicated that DPH fluorescence anisotropy in fresh intact neonatal red cells is increased by an amount corresponding to that produced by cooling adult red cells by 22 degrees C. Elevated intracellular calcium decreased red cell filterability without affecting DPH fluorescence anisotropy of ghost membranes. This result suggests that the effect of calcium in reducing filterability is independent of alterations in membrane lipid motional freedom. It is unlikely that the decreased lipid motional freedom of red cells from newborns contributes significantly to their decreased filterability.     

Cellular dehydration and immunoglobulin binding in senescent neonatal erythrocytes

The life span of neonatal erythrocytes (60-80 days) is shorter than that of adult erythrocytes (120 days). We studied neonatal red blood cells separated on stractan density gradients to further characterize the aging process and to explore the possibility that senescence antigens play a role in the destruction of neonatal erythrocytes. Quantitation of membrane proteins 4.1a and 4.1b served as a marker for cell age and confirmed an enrichment for senescent red cells in the most dense layers of the gradients. Despite the shorter life span of neonatal erythrocytes, cord blood contained a larger percentage of very dense, K+-depleted red cells than did adult blood. ATP levels in dense neonatal and adult cells were decreased to 50-80% of normal values for unseparated red cells. Levels of reduced glutathione did not fall with increasing cell density. Sodium dodecyl sulfate polyacrylamide gel electrophoresis of red cell membrane proteins showed increased membrane-associated globin in senescent neonatal cells, but such gels run without reducing agents did not show oxidative protein cross-linking. Membrane bound immunoglobulins were detected on senescent neonatal and adult red cells by the rosetting antiglobulin test. We conclude that senescence antigens are revealed during the aging process of neonatal erythrocytes, thereby labeling them for antibody-mediated destruction in the reticuloendothelial system.     

Mechanical fragility of erythrocyte membrane in neonates and adults.

The shortened life span of neonatal red blood cells (RBC) is associated with accelerated membrane loss. The present study was designed to measure the critical shear force that causes membrane failure and the rate of membrane failure for neonatal and adult RBC. A micropipette technique was used to determine the membrane extensional (shear) elastic modulus (i.e. resistance of the membrane to extensional elastic deformation), the rate of extensional membrane deformation (i.e. surface viscosity), and the tension for local membrane fragmentation. A flow channel system was used to determine the critical shear force of plastic membrane deformation (i.e. beginning of membrane tether formation), the rate of plastic deformation, and the plastic shear viscosity coefficient. The extensional elastic modulus of neonatal RBC was 18% smaller and the rate of elastic deformation was 25% longer compared with adult cells (p less than 0.05). Membrane surface viscosity was similar for both cell types. The tension for local membrane fragmentation in the micropipette was 23% lower in neonates than in adults. However, the strain (i.e. extent of membrane deformation calculated as ratio of the stress resultant and the elastic modulus) at which membrane rupture in the micropipette occurred was similar for neonatal and adult RBC. This indicates that the smaller critical tension for neonatal RBC membrane failure was due to increased membrane elastic deformability.(ABSTRACT TRUNCATED AT 250 WORDS)     

Oxidation of hemoglobin F is associated with the aging process of neonatal red blood cells.

Previously, we reported that in cord blood there is a population of very dense, surface area-depleted red blood cells (RBC). We hypothesized that oxidative damage might account for the generation of this cell population because Hb F is known to be mildly unstable in vitro. Accordingly, we examined density-separated subpopulations of neonatal red cells searching for evidence of oxidant injury to Hb in vivo. Cord or adult RBC were separated into populations of varying density and an increased amount of membrane-associated globin was found in the densest fraction of cord RBC. Solubilized ghosts from each fraction were analyzed by thiol-disulfide exchange chromatography for the presence of oxidized Hb and spectrophotometrically for the presence of membrane-bound hemichrome. About four times more oxidized Hb was found in unseparated cord RBC than in adult RBC. This difference was most evident in the densest 10-15% RBC subfractions. Membrane-bound hemichrome levels in cord cells were twice those found in adult cells. We found that in cord membrane skeletons there was 2.5 to 9 times as much globin in the dense fraction as compared to the light fraction. Membrane skeletons from dense and light adult RBC differed little from one another. We postulate that membrane (and perhaps membrane skeleton)-associated oxidized Hb is a marker for more generalized oxidative damage, which may create the population of unusually dense cells found in cord blood and ultimately shorten their life span.     

In vivo lability of red cell phosphofructokinase in term infants: the possible molecular basis of the relative phosphofructokinase deficiency in neonatal red cells.

Cord blood erythrocytes from nine term infants were separated by density gradient centrifugation into cohorts of intact cells of progressively increasing density and compared with red cells treated in a similar manner from four healthy adults. Pyruvate kinase (PK), an age-dependent enzyme, progressively decreased in activity from the lightest to the heaviest fractions, in both neonatal and adult red cells, indicating that red cells from newborn infants exhibit the same relationship between red cell age and density that had previously been demonstrated in red cells from adults. The rate of decline of red cell PK activity was essentially the same in neonates and adults, whereas phosphofructokinase (PFK) activity in cord erythrocytes decreased at a significantly faster rate when compared to adults. These data suggest that PFK has an accelerated rate of in vivo decay in neonatal red cells and is an unstable enzyme in the newborn.     

Preeclampsia and Na,K-ATPase activity of red blood cell ghosts from neonatal and maternal blood

We determined Na,K-ATPase activity and cholesterol/phospholipid ratio of maternal and cord red blood cell ghosts from either normotensive or preeclamptic pregnant women. The Na,K-ATPase activity of the red cell ghosts from neonatal blood is significantly lower (25-32%) as compared with the ATPase activity of the maternal red cell ghosts, regardless of the presence or not of preeclampsia. This diminution in Na,K-ATPase activity of the neonatal red blood cell ghosts could be due to an increase in the cholesterol/phospholipid molar ratio of the membrane. The Na,K-ATPase activity of the red blood cell ghosts from pregnant women was unaffected by preeclampsia; however, fetal red blood cell ghosts from infants of preeclamptic mothers showed a significantly lower ATPase activity (20%) than fetal red blood cell ghosts from infants of normotensive mothers. A low Na,K-ATPase activity in the neonatal red blood cells from mothers with preeclampsia could be an indication of an important modification of the physiological role of this enzyme.     

Oxidative stress in newborn erythrocytes

Phenylhydrazine (PHZ) exposure is used to study in vitro red cell aging mechanisms dependent on Hb oxidation. The effect of PHZ on normal neonatal red blood cells was studied in unseparated blood and after separation into light and heavy cells. PHZ caused more extensive morphologic changes in neonatal than in adult red blood cells. PHZ exposure of neonatal cells caused less reduced glutathione depletion than in adult cells. Although we found the same total amount of oxidized Hb in both cells, a well-defined oxidation product of Hb was demonstrated by M?ssbauer spectra only in neonatal cells. This oxidation product was not methemoglobin but a trivalent, high-spin iron compound. All neonatal cell populations were more sensitive to PHZ than were adult ones, as demonstrated by the presence of Heinz bodies at low PHZ concentration, which did not affect adult cells. These studies demonstrate greater sensitivity of neonatal cells to PHZ in all density-separated populations.     

Abnormal membrane fluidity as a cause of impaired functional dynamics of chemoattractant receptors on neonatal polymorphonuclear leukocytes: lack of modulation of the receptors by a membrane fluidizer

Membrane properties associated with chemoattractant-mediated cellular responsiveness of neonatal polymorphonuclear leukocytes (PMN) were analyzed using n-formylmethionyl-leucyl-phenylalanine. Inasmuch as aliphatic alcohols as a membrane fluidizer can enhance the chemoattractant binding and affect subsequent cellular responsiveness in adult PMN, neonatal PMN were studied for such properties by their treatment with iso-propyl alcohol, an aliphatic alcohol. The alcohol (less than 2.5%) treatment enhanced the N-formylmethionyl-leucyl-phenylalanine binding to adult PMN, but there were no changes in the N-formylmethionyl-leucyl-phenylalanine binding to neonatal PMN. Although the N-formylmethionyl-leucyl-phenylalanine-induced subsequent responsiveness including migration, lysosomal enzyme release and superoxide anion production were modulated by the alcohol treatment in adult PMN, there was no such modulation in neonatal PMN. Because membrane fluidity is largely involved in the regulation of the receptor functions, the membrane fluidity of neonatal PMN was next measured by an excimer-forming lipid technique in flow cytometry. The membrane fluidity value (0.45 +/- 0.037) of neonatal PMN was lower than that (0.74 +/- 0.072) of adult PMN (p less than 0.01). Although the aliphatic alcohol enhanced the membrane fluidity of adult PMN, it did not affect the membrane fluidity of neonatal PMN. We conclude that there is abnormal membrane fluidity as a cause of impaired functional dynamics of the chemoattractant receptors, which appears to underlie the defective modulation of cell functions by the membrane fluidizer in neonatal PMN.     

Red Cell Membrane Lipid Peroxidation and Hemolysis Secondary to Phototherapy

ABSTRACT. The exposure of red cells to phototherapy light in the presence of a sensitizer (bilirubin) resulted in oxidative injury to the red cell membrane as manifested by a significant increase in the concentration of the products of lipid peroxidation (TBA reactants and diene conjugation) in the membrane and hemolysis. To induce a photo-oxidized membrane injury, the sensitizer (bilirubin) has to be membrane bound. Thus, by altering the availability of free bilirubin in the red cell suspension through changes in the molar concentration ratio of bilirubin to albumin, one is able to regulate the occurrence and extent of the oxidative red cell membrane injury. The clinical implications of these findings are discussed.     

Red cell membrane lipid peroxidation and hemolysis secondary to phototherapy

The exposure of red cells to phototherapy light in the presence of a sensitizer (bilirubin) resulted in oxidative injury to the red cell membrane as manifested by a significant increase in the concentration of the products of lipid peroxidation (TBA reactants and diene conjugation) in the membrane and hemolysis. To induce a photo-oxidized membrane injury, the sensitizer (bilirubin) has to be membrane bound. Thus, by altering the availability of free bilirubin in the red cell suspension through changes in the molar concentration ratio of bilirubin to albumin, one is able to regulate the occurrence and extent of the oxidative red cell membrane injury. The clinical implications of these findings are discussed.     

Erythrocyte deformability in the fetus, preterm, and term neonate

Deformability of red blood cells (RBC) is an important determinant of microcirculation, of oxygen transport and release to the tissues, and of RBC life span. Deformability of RBC from five fetuses, 20 preterm infants, 20 term neonates, and 20 adults was determined by direct microscopic observation of RBC subjected to shear stresses of 6 to 85 dyn/cm2 using a counter-rotating rheoscope. There was no significant difference in deformability among RBC from the fetuses, the preterm and term neonates, and the adults at any shear stress. More than 95% of fetal, neonatal, and adult RBC were capable of tank-tread motion. Compared to adults, the frequency distribution of RBC deformability was slightly broader in the fetuses and neonates because of the presence of more highly and poorly deformable RBC. The increased number of rigid RBC may contribute to the shortened life span of fetal RBC.     

Bupivacaine alters red blood cell properties: a possible explanation for neonatal jaundice associated with maternal anesthesia

Cord blood was incubated with lidocaine, mepivacaine, bupivacaine, or buffer and red blood cell filterability was determined. Only bupivacaine at either 1 or 2 micrograms/ml prolonged filterability by an average of 58 to 65% over red cells treated with buffer alone. Tritiated bupivacaine was bound to a greater extent to red cell ghosts from cord blood (24.6 +/- 5.8%) than to adult red cell ghosts (14.6 +/- 2.6%). Finally, we determined red cell survival in 13-day-old rats injected with bupivacaine or buffer. At 2 h after injection, buffer-treated animals had a red cell survival of 96.9 +/- 3.3%, whereas 2-h survival was reduced to 82.6 +/- 8.7% for the animals injected with bupivacaine. Our results suggest that the neonatal jaundice associated with maternal anesthesia, especially bupivacaine, may be related to the observations that these agents cross the placenta, bind to the red cell membrane and reduce its filterability, resulting in shortened red cell survival.     

Rheology of fetal and maternal blood

Rheological parameters were measured in 10 pairs of mothers and newborns. Whole blood viscosity was similar despite a higher fetal hematocrit (47.0 +/- 5.1 versus 35.5 +/- 12.0%, mean +/- SD, p less than 0.05). When the hematocrit of the suspension of red cells in plasma was adjusted to 45%, the viscosity was significantly lower in the fetal blood over a wide range of shear rates (0.52-208 S-1). The main reason for the lower viscosity in the fetal blood was the lower plasma viscosity as compared to the maternal blood (1.08 +/- 0.05 versus 1.37 +/- 0.08 centipoise, p less than 0.05); this in turn was attributable to a lower total plasma protein concentration (4.74 +/- 0.71 versus 6.47 +/- 0.64 g/dl, p less than 0.05). All protein fractions were lower in the fetal plasma. The assessment of red cell deformability by filtration through polycarbonate sieves revealed that the resistance of a fetal red cell was three times higher than that of a maternal red cell in a 2.6-micron pore, but there was no significant difference in resistance for these red cells in 6.9-micron pores. This higher filtration resistance of fetal red cells through the small pores was mainly due to their large volume (115.4 +/- 10.8 versus 93.5 +/- 5.9 fl, p less than 0.001). Measurements on membrane-free hemoglobin solutions indicated that the internal viscosity of these two types of red cells was not different.(ABSTRACT TRUNCATED AT 250 WORDS)     

Antioxidant and cytotoxic effects of bilirubin on neonatal erythrocytes

Bilirubin, the breakdown product of heme from erythrocytes, accumulates in the neonate in the first days of life. In recent years, the antioxidant properties of bilirubin have been demonstrated in vitro and in vivo, yet it is clear that bilirubin can be toxic to cells. To study the range in which bilirubin exerts its beneficial effect, we used erythrocytes derived from cord blood and incubated them with 0-60 mg/dL bilirubin combined with 3 g/dL BSA (bilirubin/BSA) to mimic physiologic and pathologic conditions. Oxidative stress was induced by incubating the erythrocytes with a solution of 0.6 mM H2O2 and 0.15 M CuSO4 to generate hydroxyl radical mediated injury. The loss of fluorescence of cis-parinaric acid and the degree of protein oxidation of erythrocyte membranes were assessed. Additionally, we determined erythrocyte membrane integrity, glucose-6 phosphate dehydrogenase activity, and adenosine triphosphatase activity before and after incubation with bilirubin/BSA. Incubation with bilirubin/BSA at concentrations up to 60 mg/dL and a bilirubin/BSA molar ratio of two was associated with dose-dependent protection of erythrocytes against lipid peroxidation. However, concentrations of bilirubin equal to or exceeding 30 mg/dL and a bilirubin:BSA ratio of one were associated with increased protein oxidation, decreased erythrocyte glucose-6 phosphate dehydrogenase and adenosine triphosphatase activity, and altered cell membrane integrity. We conclude that bilirubin, at physiologic concentrations, protects neonatal red blood cells against oxidative stress in the presence of physiologic concentrations of BSA but that bilirubin concentrations of 30 mg/dL or higher and a bilirubin:BSA ratio of greater than one are associated with significant cytotoxicity.     

Alterations in piglet small intestine after cholesterol deprivation

Mammalian cells require cholesterol for normal cell function. This requirement can be fulfilled by endogenous biosynthesis or by extracellular supplementation. Infants fed with human milk receive greater quantities of cholesterol than those fed commercial formulas. Whether this lack of cholesterol in commercial formulas poses a threat to normal neonatal cell function is not known. We compared small intestinal microvillus membrane fluidity, hydrolase activities, protein concentration, permeability to nonabsorbable markers, and weight gain in neonatal piglets receiving restricted intake of isocaloric formulas containing either normal amounts of cholesterol (145 mg/dl) or very low levels of cholesterol (less than 2 mg/dl). Using the fluorescent probe, diphenylhexatriene, and fluorescence polarization, microvillus membranes from cholesterol deprived piglets demonstrated higher fluidities than did microvillus membranes from animals fed normal concentrations of cholesterol. Cholesterol-deprived animals, even though their caloric intake was similar to cholesterol-fed animals, demonstrated a net weight loss per animal whereas the cholesterol-fed animals demonstrated a weight gain. These results demonstrate that in a pig model on a restricted intake, cholesterol deprivation alters the biophysical properties of the microvillus membrane.     

Markers of oxidative stress before and after exchange transfusion for neonatal sepsis

Oxidative status before and after ET was assessed in eight septic newborns who received exchange transfusion (ET). Short-term elevations of conjugated dienes (CDs) and thiobarbituric acid reactive substances (TBARSs) (p < 0.05) and increased serum antioxidant capacity (AOC) (p = 0.06) were noted. Chromatographic migration of the red blood cells (CM RBCs), a measure of RBC deformability, also improved after ET. ET for neonatal sepsis does not cause significant oxidative stress; rather, it may help to restore the antioxidant depots and improve RBC deformability and microcirculation.     

Molecular defect of spectrin in the family of a child with congenital hemolytic poikilocytic anemia

We present the study of a black family in which the proband suffered from a severe neonatal hemolytic anemia with poikilocytosis. Both the parents, sister's, and brother's proband were clinically normal. The presence of poikilocytes in proband led to a search for a red cell membrane skeleton defect. Owing to recent improvements in the erythrocyte membrane knowledge, it is now possible to approach the diagnosis by means of biochemical evaluation of both parents, even if they are asymptomatic. So, the first time discovery of a spectrin self-association defect in both parents allowed us to suspect double inheritance of this abnormality in the proband. A complete morphological and biochemical evaluation of the family allowed us to propound the diagnosis of heterozygous type I hereditary elliptocytosis (HE) for both parents and the sister and the diagnosis of homozygous type I HE for the proband owing to the following reasons: slight ovalocytosis was present in both parents and the sister; cell deformability ektacytometric studies gave the same profiles of curve as those observed in patients with HE. Defective spectrin dimer self-association found in both parents was also observed in the sister and proband, associated with the same abnormal spectrin digest pattern, namely a decrease in the amount of a 80,000-dalton peptide and a corresponding increase in a 74,000-dalton peptide. However, clinical presentation of the proband was consistent either with hereditary pyropoikilocytosis or homozygous hereditary elliptocytosis; erythrocyte thermal sensitivity studies in the proband could not be conclusive because of the presence of transfused cells. Both these diagnoses are discussed in detail.(ABSTRACT TRUNCATED AT 250 WORDS)     

ATP-sensitive potassium channels in neonatal and adult rabbit ventricular myocytes.

The properties of the ATP-sensitive potassium (KATP) current were studied in freshly isolated rabbit ventricular myocytes using the patch clamp technique. Removing ATP from the bath (intracellular) solution activated a large K+ conductance in patches from neonatal cells with properties similar to those of KATP channels in other preparations. In membrane patches from neonatal ventricular myocytes, the density of KATP channels was higher than the density of inwardly rectifying K+ channels and the mean patch KATP current was approximately 10 times that of the inwardly rectifying K+ current, at a patch membrane potential of -60 mV. Glibenclamide (10 microM) in the bath solution decreased the number of functional KATP channels, the open-state probability, and the mean patch membrane current. The single-channel conductance of the KATP channel was dependent on the external K+ concentration, and the relationship between channel conductance and external K+ concentration was fit by an exponential equation. In addition, the voltage dependence, channel density, and open-state probability of this channel were compared between neonatal and adult isolated ventricular myocytes. The single-channel conductance and channel density of the KATP channel in neonatal myocytes were significantly smaller than in adult cells. These results suggest that age-related changes occur in the properties of KATP channels.     

A longitudinal study of red cell enzymes in infants of low birth weight

A longitudinal study of red cell enzyme activity in newborn infants of low birth weight has been conducted over the first 2 months of life. The enzymes investigated are acetylcholinesterase (EC 3.1.3.7), an integral part of the red cell membrane and subnormal in AB0 hemolytic disease of the newborn; and glucose-6-phosphate dehydrogenase (EC 1.1.1.49), an intracellularly-located, sex-linked enzyme, implicated in neonatal jaundice and of significance in drug-induced hemolytic anemias. Acetylcholinesterase activity, which is lower in normal full-term newborn infants and in low birth weight infants than in adults, was further diminisched during the initial weeks of life of the infants of low birth weight and the higher levels of activity, characteristic of adult red cells, had not appeared by 2 months of age. By contrast, red cell glucose-6-phosphate dehydrogenase activity, which is higher in full-term newborn infants and in infants of low birth weight than in adults, did not diminish as a function of age and the lower adult levels were not discernible by 2 months of life.