The Red Blood Cell Deformability in Patients Suffering from End Stage Renal Failure on Hemodialysis or Continuous Ambulatory Peritoneal Dialysis

Anemia is the main problem for patients suffering from end stage renal disease (ESRD). This study aimed to determine whether the index of rigidity (IR), that shows red blood cells (RBCs) deformability and the possible IR disturbances can provide an explanation about the cause of anemia, in patients undergoing maintenance hemodialysis (HD) or on peritoneal dialysis. The IR was determined in 39 hemodialyzed patients, who were already in dialysis for a period of time ranging from 16 to 120 months (mean ± SD = 41.8 ± 24.1) (Group A). Furthermore, the IR was measured in 32 patients on continuous ambulatory peritoneal dialysis (CAPD), who were in CAPD for a period of time ranging from 6 to 60 months (mean ± SD = 10.7 ± 9.9) (Group B). Finally, the IR was determined in 17 normal individuals (group C). The RBCs IR was measured twice in group A (before and after the end of a hemodialysis session) and once in groups B and C. The IR was determined by hemorrheometry (method of filtration), using special equipment. In group A the IR was increased in comparison to the control group (C) (17.9 ± 6.2 vs. 10.2 ± 1.8, p < 0.0001). This increase was even higher in the measurement at the end of the hemodialysis session (paired t‐test, p < 0.0001). The RBCs IR in CAPD patients was significantly lower than that of HD patients (12 ± 3.8 vs. 17.9 ± 6.2, p < 0.0001) and was not statistically different from the control group (12 ± 3.8 vs. 10.2 ± 1.8, p = 0.068). It is concluded from the study that: 1) in HD patients occur disturbances in the deformability of the RBCs, that are worsened by the hemodialysis session; 2) the index of rigidity of RBCs is significantly higher in the HD patients than in CAPD patients; 3) in patients on CAPD, the disturbance of deformability of the RBCs was less in comparison to the control group, which however does not reach the statistically significant levels.     

非风湿性房颤血栓前血清脂蛋白（a）、脂质过氧化物与红细胞变形能力的检测及临床意义

目的 :探讨非风湿性房颤患者血栓前血清脂蛋白 (a) [L P(a) ]、脂质过氧化物 (L PO)及红细胞变形能力(RCD- IF)的变化对房颤血栓形成的影响及临床意义。方法 :分别对 36例非风湿性慢性房颤患者、4 0例器质性心脏病窦性心律患者及 4 0例健康对照组其 L P(a)、L PO、RCD- IF三项指标进行测定。结果 :非风湿性慢性房颤患者 L P(a)、L PO的升高及 RCD- IF的降低与窦性心律组 (P<0 .0 5 )及对照组 (P<0 .0 1)均存在显著性差异 ;窦性心律组的三项指标与对照组比较其差异亦具显著性 (P<0 .0 5 )。房颤组、窦性心律组两组的 L PO与 RCD- IF均存在相关关系 ;而两组的 L P(a)与 L PO、RCD- IF间无相关关系。结论 :降低 L P(a)、L PO水平及提高 RCD- IF有利于防治房颤患者心房血栓的形成。     

糖尿病患者红细胞膜磷脂成分的改变

应用高效液相色谱法分析７２例ＮＩＤＤＭ患者红细胞膜磷脂成分。结果显示，ＮＩＤＤＭ患者红细胞膜磷脂酰乙醇胺、磷脂酰肌醇、磷脂酰丝氨酸、磷脂酰胆碱、神经鞘磷脂均显著降低，而溶血磷脂酰胆碱显著增高，并且红细胞膜磷脂成分的改变与空腹血糖、糖化血红蛋白、血脂及过氧化脂质有关。提示糖尿病代谢紊乱与脂质过氧化可能是导致红细胞膜磷脂成分改变的重要因素。     

Surgeons often underestimate the amount of blood loss in replacement surgeries

Objective：To assess the accuracy of the clinically estimated blood loss （EBL） when compared with the actual blood loss （ABL） in replacement surgeries.Methods：This prospective study was done in Sri Ramachandra Medical Centre from April 2011 to April 2013.Altogether 140 patients undergoing total hip replacement or total knee replacement were included with the inclusion criteria being patients with haemoglobin higher than 100 g/ml and coagulation profile within normal limits.Exclusion criteria were intake of antiplatelet drug or anti-coagulant,bleeding disorders,thrombotic episode,and haematological disorders.There were 65 men and 75 women.In this study,the consultants were free to use any clinical method to estimate the blood loss,including counting the blood-soaked mops and gauze pieces （estimating the volume of blood carded in all the mops and gauzes）,measuring blood lost to suction bottles and blood in and around the operative field.The ABL was calculated based on a modification of the Gross＇s formula using haematocrit values.Results：In 42 of the 140 cases,the EBL exceeded the ABL.These cases had a negative difference in blood loss （or DIFF-BL＜0） and were included in the overestimation group,which accounted for 30％ of the study population.Of the remaining 98 cases （70％）,the ABL exceeded the EBL.Therefore they were put into the underestimation group who had a positive difference in blood loss （DIFF-BL＞0）.We found that when the average blood loss was small,the accuracy of estimation was high.But when the average blood loss exceeded 500 ml,the accuracy rate decreased significantly.This suggested that clinical estimation is inaccurate with the increase of blood loss.Conclusion：This study has shown that using clinical estimation alone to guide blood transfusion is inadequate.In this study,70％ of patients had their blood loss underestimated,proving that surgeons often underestimate blood loss in replacement surgeries.     

Red blood cell and platelet microparticles in myocardial infarction patients treated with primary angioplasty

Background

Red blood cell and platelet microparticles (RBCm and PLTm, respectively) have drawn research attention as to their potential prothrombotic and vasoconstrictive effects in experimental settings. However, the relevance of circulating microparticles in clinical settings is largely undetermined.

Methods

Circulating microparticles were quantified with a flow cytometric method in blood samples from consecutive STEMI patients after primary PCI. A matched cohort of healthy volunteers was used to derive reference values for comparison. STEMI patients were followed for 6 months for a composite clinical endpoint.

Results

Fifty-one STEMI patients (age 59.8 ± 8.8 years) and 50 controls (age 56.2 ± 9.2 years; p = 0.155) were enrolled. RBCm concentration was 18,198 ± 6062/μl in the reference cohort versus 33,740 ± 21,169/μl in STEMI patients (p < 0.001). RBCm count was not correlated to total RBCs (standardized beta 0.018; p = 0.861). PLTm did not differ between groups (17,529 ± 16,292/μl in STEMI patients versus 14,372 ± 6211/μl in controls; p = 0.203). RBCm c-statistic was 0.832 (95% confidence interval 0.720 to 0.944), while PLTm prognostic value was not statistically significant (c-statistic 0.614, 95% confidence interval 0.444 to 0.784). In the multivariate analysis, RBCm concentration was independently associated with the occurrence of the clinical endpoint, after adjustment for age, ejection fraction, serum creatinine and presence of diabetes (adjusted p = 0.034).

Conclusions

The present study demonstrates for the first time that erythrocyte microparticles are elevated in patients with STEMI treated with primary PCI, with levels approximately double those measured in a reference population of healthy volunteers, and their concentrations appear to be positively associated with adverse clinical events.     

肿瘤坏死因子-α诱导红细胞衰亡的研究

目的 探讨肿瘤坏死因子-α（TN F-α）在红细胞衰亡中的作用.方法 将分离的小鼠红细胞经TNF-α（1 ng/ml）处理6、12、24、48、72 h或在不同质量浓度（0.1、1、10 ng/ml）处理24h后,利用流式细胞仪检测红细胞前向散射（FSC）值的变化、红细胞膜磷脂酰丝氨酸（PS）和神经酰胺的标记率.结果 经TNF-α处理后的小鼠红细胞较对照组于24h后出现FSC减小（（81.5±1.02）％比（87.6±0.55）％,P＜0.05）,膜的PS外露水平和神经酰胺含量增加（（5.5±1.07）％比（2.7±0.17）％,（2.1±0.23）％比（0.7±0.26）％）,差异均有统计学意义（P＜0.01）,且随着时间的推移变化趋势更加明显.结论 TNF-α可诱导红细胞体积缩小,促进红细胞膜PS外露以及神经酰胺的增加,是红细胞衰亡的触发因素.     

空调生存环境对豚鼠红细胞膜脂质变化的影响

目的通过动物实验,研究空调环境对机体红细胞膜脂质成分的影响,为进一步研究空调环境对红细胞变形性的影响提供实验依据。方法采用豚鼠作为实验动物。实验分两组,每组12只。对照组:豚鼠在通风房间中自由饮水和进食,喂养15 天。实验组:豚鼠在温度为22℃空调房间内饲养15天。15天后,用心脏穿刺法采集豚鼠血液5ml,肝素抗凝,分离红细胞制备红细胞膜悬液。用UV265紫外分光光度计测定红细胞膜胆固醇及磷脂的含量。结果空调环境下豚鼠红细胞膜中胆固醇含量比正常对照组显著增高(P<0．01),而磷脂含量比对照组显著降低(P<0．01)且胆固醇／磷脂也有显著差异(P<0．01)。结论空调环境能改变红细胞膜的脂质成分,从而影响红细胞变形性。