Abstract
In vitro hemolysis testing is commonly used to determine hemocompatibility of ExtraCorporeal Membrane Oxygenation (ECMO). However, poor reproducibility remains a challenging problem, due to several unidentified influencing factors. The present study investigated potential factors, such as flow rates, the use of anticoagulants, and gender of blood donors, which could play a role in hemolysis. Fresh human whole blood was anticoagulated with either citrate (n = 6) or heparin (n = 12; 6 female and 6 male blood donors). Blood was then circulated for 360 min at 4 L/min or 1.5 L/min. Regardless of flow rate conditions, hemolysis remained unchanged over time in citrated blood, but significantly increased after 240 min circulation in heparinized blood (p ≤ 0.01). The ratio of the normalized index of hemolysis (NIH) of heparinized blood to citrated blood was 11.7-fold higher at 4 L/min and 16.5–fold higher at 1.5 L/min. The difference in hemolysis between 1.5 L/min and 4 L/min concurred with findings of previous literature. In addition, the ratio of NIH of male heparinized blood to female was 1.7-fold higher at 4 L/min and 2.2-fold higher at 1.5 L/min. Our preliminary results suggested that the choice of anticoagulant and blood donor gender could be critical factors in hemolysis studies, and should be taken into account to improve testing reliability during ECMO.
Highlights
ExtraCorporeal membrane oxygenation (ECMO) is a life-saving technology used to provide temporary cardiopulmonary venoarterial (VA) or pulmonary venovenous (VV) support for critically ill patients with refractory cardiogenic or pulmonary failure, respectively [1]
normalized index of hemolysis (NIH) is defined as grams of Plasma–free hemoglobin (pf Hb) released per 100 L of blood pumped and taking into account of hematocrit, flow rate, sampling time point, and blood volume in the loop used for standard practice for comparison of hemolytic device performance testing [24]
No significant differences in red blood cells (RBCs) counts, hematocrit, red blood cell distribution width (RDW), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) were found among the different flow conditions, blood anticoagulants, and gender (Figure 2A,B)
Summary
ExtraCorporeal membrane oxygenation (ECMO) is a life-saving technology used to provide temporary cardiopulmonary venoarterial (VA) or pulmonary venovenous (VV) support for critically ill patients with refractory cardiogenic or pulmonary failure, respectively [1] Despite these benefits, ECMO-induced hemolysis remains a challenging complication and is associated with increased morbidity and mortality [2,3]. Plasma–free hemoglobin (pf Hb), which seeps into the blood plasma from ruptured red blood cells (RBCs), has been commonly used to appraise the level of hemolysis This assay has been used to test the hemocompatibility of novel ECMO devices [4,5,6]. We designed a comprehensive in vitro study, using fresh human whole blood, to investigate the effects of different anticoagulants, blood donor gender, and high vs low blood flow conditions on hemolysis
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