Sensorless Viscosity Measurement in a Magnetically-Levitated Rotary Blood Pump.

Controlling the flow rate in an implantable rotary blood pump based on the physiological demand made by the body is important. Even though various methods to estimate the flow rate without using a flow meter have been proposed, no adequate method for measuring the blood viscosity, which is necessary for an accurate estimate of the flow rate, without using additional sensors or mechanisms in a noninvasive way, has yet been realized. We have developed a sensorless method for measuring viscosity in magnetically levitated rotary blood pumps, which requires no additional sensors or mechanisms. By applying vibrational excitation to the impeller using a magnetic bearing, we measured the viscosity of the working fluid by measuring the phase difference between the current in the magnetic bearing and the displacement of the impeller. The measured viscosity showed a high correlation (R(2) > 0.992) with respect to a reference viscosity. The mean absolute deviation of the measured viscosity was 0.12 mPa·s for several working fluids with viscosities ranging from 1.18 to 5.12 mPa·s. The proposed sensorless measurement method has the possibility of being utilized for estimating flow rate.

New generation extracorporeal membrane oxygenation with MedTech Mag-Lev, a single-use, magnetically levitated, centrifugal blood pump: preclinical evaluation in calves.

We have evaluated the feasibility of a newly developed single-use, magnetically levitated centrifugal blood pump, MedTech Mag-Lev, in a 3-week extracorporeal membrane oxygenation (ECMO) study in calves against a Medtronic Bio-Pump BPX-80. A heparin- and silicone-coated polypropylene membrane oxygenator MERA NHP Excelung NSH-R was employed as an oxygenator. Six healthy male Holstein calves with body weights of about 100 kg were divided into two groups, four in the MedTech group and two in the Bio-Pump group. Under general anesthesia, the blood pump and oxygenator were inserted extracorporeally between the main pulmonary artery and the descending aorta via a fifth left thoracotomy. Postoperatively, both the pump and oxygen flow rates were controlled at 3 L/min. Heparin was continuously infused to maintain the activated clotting time at 200-240 s. All the MedTech ECMO calves completed the study duration. However, the Bio-Pump ECMO calves were terminated on postoperative days 7 and 10 because of severe hemolysis and thrombus formation. At the start of the MedTech ECMO, the pressure drop across the oxygenator was about 25 mm Hg with the pump operated at 2800 rpm and delivering 3 L/min flow. The PO2 of the oxygenator outlet was higher than 400 mm Hg with the PCO2 below 45 mm Hg. Hemolysis and thrombus were not seen in the MedTech ECMO circuits (plasma-free hemoglobin [PFH] < 5 mg/dL), while severe hemolysis (PFH > 20 mg/dL) and large thrombus were observed in the Bio-Pump ECMO circuits. Plasma leakage from the oxygenator did not occur in any ECMO circuits. Three-week cardiopulmonary support was performed successfully with the MedTech ECMO without circuit exchanges. The MedTech Mag-Lev could help extend the durability of ECMO circuits by the improved biocompatible performances.

Evaluation of platelet aggregability during left ventricular bypass using a MedTech MagLev VAD in a series of chronic calf experiments.

The impact of continuous flow left ventricular assist device (LVAD) pumping on platelet aggregation was investigated in animal experiments utilizing six calves. A single-use MagLev centrifugal blood pump, MedTech MagLev, was used to bypass the calves' hearts from the left atrium to the descending aorta at a flow rate of 50 ml/kg/min. The LVAD's impact on blood coagulation activities was evaluated based on the platelet aggregability, which was measured with a turbidimetric assay method during the preoperative, operative, and postoperative periods. Heparin and warfarin were used for anticoagulation, while aspirin was used for the antiplatelet therapy. A decrease in platelet aggregation immediately after the pump started was observed in the cases of successful long-term pump operation, while the absence of such a decrease might have caused coagulation-related complications to terminate the experiments. Thus, the platelet aggregability was found to be significantly affected by the pump, and its initial trend may be related to the long-term outcome of the mechanical circulatory support.

Alterations in red blood cell volume and hemoglobin concentration, viscoelastic properties, and mechanical fragility caused by continuous flow pumping in calves.

In this study, we have analyzed the changes in mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), and the dynamic deformability and mechanical fragility of red blood cells (RBCs) in five male Holstein calves (body weight: 95.6 ± 10.8 kg) whose circulation was partially supported with a novel magnetically levitated extracorporeal centrifugal blood pump MedTech Dispo. One hour after the pumping has started, the MCV increased and the MCHC decreased by 1.064 ± 0.006 and 0.906 ± 0.050 times, respectively, as compared with those of the prepumped blood (P < 0.05). The deformability index L/W, where L and W are the long and short axes of the two-dimensional RBC images, respectively, sheared by a cyclically reversing shear flow increased indicating that the RBCs pumped for 1 h exhibited more elastic characteristics (P < 0.05). In addition, when the pumped blood cells were sheared for 30 min with a uniform shear stress of 25.38 Pa, the hemolysis level decreased dramatically as compared with the control blood, as more fragile RBCs were destroyed by pumping, leaving behind less fragile RBCs. All these characteristics of the RBCs exposed to continuous flow resemble those of young RBCs having larger MCV, lower MCHC, higher elasticity, and lower fragility. In conclusion, during continuous flow pumping, the RBCs having relatively lower threshold for hemolysis to mechanical shear stress generated by continuous flow blood pump (CFBP) are destroyed first and removed from circulation in the early stage of application of CFBP, thus leaving behind less fragile and stronger RBCs.

One-month biocompatibility evaluation of the pediatric TinyPump in goats.

The TinyPump is an extracorporeal, magnetically driven centrifugal blood pump with its impeller suspended magnetically and hydrodynamically to provide short-term mechanical circulatory support for children and infants. We have previously demonstrated that the in vivo experiments of the experimental TinyPump showed acceptable stable performance at pump flows averaging around 1.0 L/min with low hemolytic and thrombogenic properties for up to 2 weeks. We present here the 1-month in vivo evaluation of the TinyPump, whose design was modified further for more durable operation. The pump was implanted as a left ventricular assist device in five goats (12.5-26.7 kg), with inflow inserted into the left ventricular apex and outflow anastomosed to the descending aorta. Five animals were supported for 110 pump days, with mean pump flow of 1.19 ± 0.03 L/min at a pump speed of 2679 ± 97 rpm. Two animals reached the scheduled end point of 30 days without device failure, and mean plasma-free hemoglobin was 1.7 ± 0.8 mg/dL. Hematologic and biochemical data of these two animals showed no evidence of cardiovascular, renal, or hepatic dysfunction. Although further experiments are needed, the modified TinyPump offers promise as a short-term mechanical circulatory support device in pediatric population.

In vivo evaluation of the "TinyPump" as a pediatric left ventricular assist device.

Pediatric patients with end-stage heart failure require mechanical circulatory support (MCS) just as adults do. In order to meet the special requirements for neonates' and infants' MCS, pediatric circulatory support devices must be compact with low priming volume, easily controllable with low flow, less traumatic for blood cells and tissues, and biocompatible with minimum anticoagulation. We have designed and developed a miniature rotary centrifugal blood pump, "TinyPump," with a priming volume of 5 mL, which has already demonstrated its controllable performance for low flow and durability in vitro. To evaluate the feasibility of the TinyPump as a left ventricular assist device (LVAD) suitable for neonates and infants, we have examined the biocompatibility and hemodynamic performance of the TinyPump in a pediatric animal model using Shiba goats. The TinyPump is a miniaturized centrifugal pump weighing 150 g comprising a disposable pump head with a 30-mm diameter impeller having six straight-vanes and a reusable motor driver. The impeller in the pump head is supported by a hydrodynamic bearing at its center and is driven by radial magnetic force coupled to the motor driver. TinyPump implantations were performed in 22 Shiba goats (17 female and 5 male), with body weights ranging from 8.4 to 27.2 kg. Under gas anesthesia, via left lateral thoracotomy, a 22 Fr inflow cannula was inserted through the left ventricular apex, while a 6-mm outflow graft was anastomosed to the descending aorta, which were then connected to a TinyPump mounted on the animal's back. Postoperative hemodynamic monitoring included heart rate, arterial and central venous pressure, pump flow, and rotation speed. Target pump flow in all animals was maintained at 0.9 ± 0.1 L/min, which is approximately half the normal pulmonary artery flow measured in control animals. Blood samples were collected to evaluate peripheral organ functions, hemolysis, and thrombosis. Goats were divided into three groups-acute phase (6 h; n = 4), subchronic phase (6 h 2 postoperative days [POD]; n = 11), and chronic phase (3 POD-16 POD; n = 8)-based on their survival duration. In the early experiments, hemolysis and thrombi formation at the impeller bearing resulted in termination of the study. Subsequent modifications of the bearing design, pump housing design, and magnetic coupling force helped to minimize the hemolysis and thrombi formation, prolonging the survival duration of the Shiba goats to 2 weeks with minimum adverse effects on the blood components and organ functions. With further experiments and improvements in pump durability and hemocompatibility, the TinyPump can serve as a suitable circulatory support device for neonates and infants bridging to heart transplantation as well as to heart recovery.

Prediction of the external work of the native heart from the dynamic H-Q curves of the rotary blood pumps during left heart bypass.

The ventricular performance is dependent on the drainage effect of rotary blood pumps (RBPs) and the performance of RBPs is affected by the ventricular pulsation. In this study, the interaction between the ventricle and RBPs was examined using the pressure-volume (P-V) diagram of the ventricle and dynamic head pressure-bypass flow (H-Q) curves (H, head pressure: arterial pressure minus ventricular pressure vs. Q, bypass flow) of the RBPs. We first investigated the relationships in a mock loop with a passive fill ventricle, followed by validation in ex vivo animal experiments. An apical drainage cannula with a micro-pressure sensor was especially fabricated to obtain ventricular pressure, while three pairs of ultrasonic crystals placed on the heart wall were used to derive ventricular volume. The mock loop-configured ventricular apical-descending aorta bypass revealed that the external work of the ventricle expressed by the area inside the P-V diagrams (EW(Heart) ) correlated strongly with the area inside dynamic H-Q curves (EW(VAD)), with the coefficients of correlation being R² = 0.869 ∼ 0.961. The results in the mock loop were verified in the ex vivo studies using three Shiba goats (10-25 kg in body weight), showing the correlation coefficients of R² = 0.802 ∼ 0.817. The linear regression analysis indicated that the increase in the bypass flow reduced pulsatility in the ventricle expressed in EW(Heart) as well as in EW(VAD) . Experimental results, both mock loop and animal studies, showed that the interaction between cardiac external work and H-Q performance of RBPs can be expressed by the relationships "EW(Heart) versus EW(VAD) ." The pulsatile nature of the native heart can be expressed in the area underneath the H-Q curves of RBPs EW(VAD) during left heart bypass indicating the status of the level of assistance by RBPs and the native heart function.

Disposable MagLev centrifugal blood pump utilizing a cone-shaped impeller.

To enhance the durability and reduce the blood trauma of a conventional blood pump with a cone-shaped impeller, a magnetically levitated (MagLev) technology has been applied to the BioPump BPX-80 (Medtronic Biomedicus, Inc., Minneapolis, MN, USA), whose impeller is supported by a mechanical bearing. The MagLev BioPump (MagLev BP), which we have developed, has a cone-shaped impeller, the same as that used in the BPX-80. The suspension and driving system, which is comprised of two degrees of freedom, radial-controlled magnetic bearing, and a simply structured magnetic coupling, eliminates any physical contact between the impeller and the housing. To reduce both oscillation of the impeller and current in the coils, the magnetic bearing system utilizes repetitive and zero-power compensators. In this article, we present the design of the MagLev mechanism, measure the levitational accuracy of the impeller and pressure-flow curves (head-quantity [HQ] characteristics), and describe in vitro experiments designed to measure hemolysis. For the flow-induced hemolysis of the initial design to be reduced, the blood damage index was estimated by using computational fluid dynamics (CFD) analysis. Stable rotation of the impeller in a prototype MagLev BP from 0 to 2750 rpm was obtained, yielding a flow rate of 5 L/min against a head pressure in excess of 250 mm Hg. Because the impeller of the prototype MagLev BP is levitated without contact, the normalized index of hemolysis was 10% less than the equivalent value with the BPX-80. The results of the CFD analysis showed that the shape of the outlet and the width of the fluid clearances have a large effect on blood damage. The prototype MagLev BP satisfied the required HQ characteristics (5 L/min, 250 mm Hg) for extracorporeal circulation support with stable levitation of the impeller and showed an acceptable level of hemolysis. The simulation results of the CFD analysis indicated the possibility of further reducing the blood damage of the prototype MagLev BP.

Development of a disposable magnetically levitated centrifugal blood pump (MedTech Dispo) intended for bridge-to-bridge applications--two-week in vivo evaluation.

Last year, we reported in vitro pump performance, low hemolytic characteristics, and initial in vivo evaluation of a disposable, magnetically levitated centrifugal blood pump, MedTech Dispo. As the first phase of the two-stage in vivo studies, in this study we have carried out a 2-week in vivo evaluation in calves. Male Holstein calves with body weight of 62.4­92.2 kg were used. Under general anesthesia, a left heart bypass with a MedTech Dispo pump was instituted between the left atrium and the descending aorta via left thoracotomy. Blood-contacting surface of the pump was coated with a 2-methacryloyloxyethyl phosphorylcholine polymer. Post-operatively, with activated clotting time controlled at 180­220 s using heparin and bypass flow rate maintained at 50 mL/kg/min, plasma-free hemoglobin (Hb), coagulation, and major organ functions were analyzed for evaluation of biocompatibility. The animals were electively sacrificed at the completion of the 2-week study to evaluate presence of thrombus inside the pump,together with an examination of major organs. To date, we have done 13 MedTech Dispo implantations, of which three went successfully for a 2-week duration. In these three cases, the pump produced a fairly constant flow of 50 mL/Kg/min. Neurological disorders and any symptoms of thromboembolism were not seen. Levels of plasma-free Hb were maintained very low. Major organ functions remained within normal ranges. Autopsy results revealed no thrombus formation inside the pump. In the last six cases, calves suffered from severe pneumonia and they were excluded from the analysis. The MedTech Dispo pump demonstrated sufficient pump performance and biocompatibility to meet requirements for 1-week circulatory support. The second phase (2-month in vivo study) is under way to prove the safety and efficacy of MedTech Dispo for 1-month applications.

Japanese guidance for ventricular assist devices/total artificial hearts.

To facilitate research and development (R&D) and to expedite the review processes of medical devices, the Ministry of Health, Labor and Welfare (MHLW) and the Ministry of Economy, Trade and Industry (METI) founded a joint committee to establish guidance for newly emerging technology. From 2005 to 2007, two working groups held discussions on ventricular assist devices and total artificial hearts, including out-of-hospital programs, based on previous guidance documents and standards. Based on this discussion, the METI published the R&D Guidelines for innovative artificial hearts in 2007, and in 2008 the MHLW published a Notification by Director regarding the evaluation criteria for emerging technology.

A new pulse duplicator with a passive fill ventricle for analysis of cardiac dynamics.

A new pulse duplicator was designed for evaluation of the performance of ventricular assist devices through pressure-volume (P-V) diagrams of the native heart. A linear drive system in combination with a pusher-plate mechanism was designed as a drive system to implement the passive fill mechanism during diastole of the mock ventricle. The compliances of the native heart during both diastole and systole were simulated by placing a ventricle sack made of soft latex rubber in a sealed chamber and by varying the air-to-fluid volume ratio inside the chamber. The ratio of the capacities of the systemic venous and pulmonary circuits was adjusted to properly reflect the effects of volume shift between them. As the air-to-fluid volume ratio was varied from 1:12.3 to 1:1.58, the contractility of the ventricle expressed by E (max) varied from 1.75 to 0.56 mmHg/ml with the mean V (0) of 4.58 ml closely mimicking those of native hearts (p < 0.05). Because the E (max) value of the normal human heart ranges from 1.3 to 1.6, with a value below 1.0 indicating heart failure, the mock ventricle is applicable in simulating the dynamics of the normal heart and the sick heart. The P-V diagram changes seen with rotary blood pump assistance revealed changes similar to those reported by other workers. The effects of the ventricular assist device, either pulsatile or continuous flow, on cardiac dynamics can be easily simulated with this system to derive design criteria for clinical circulatory assist devices.

Hemocompatibility of new magnetically-levitated centrifugal pump technology compared to the CentriMag adult pump.

The specific hemocompatibility properties of mechanical-circulatory-support (MCS)-pump technologies have not previously been described in a comparable manner. We thus investigated the hemocompatibility-indicating marker of a new magnetically-levitated (MagLev) centrifugal pump (MT-Mag) in a human, whole-blood mock-loop for 360 min using the MCS devices as a driving component. We compared those results with the CentriMag adult (C-Mag) device under the same conditions according to ISO10993-4. Blood samples were analyzed via enzyme-linked-immunosorbent-assay (ELISA) for markers of coagulation, complement system, and the inflammatory response. The time-dependent activation of the coagulation system was measured by detecting thrombin-anti-thrombin complexes (TAT). The activation of the complement system was determined by increased SC5b-9 levels in both groups. A significant activation of neutrophils (PMN-elastase) was detected within the C-Mag group, but not in the MT-Mag group. However, the amount of PMN-elastase at 360 min did not differ significantly between groups. The activation of the complement and coagulation system was found to be significantly time-dependent in both devices. However, coagulation activation as determined by the TAT level was lower in the MT-Mag group than in the C-Mag group. This slight disparity could have been achieved by the optimized secondary flow paths and surface coating, which reduces the interaction of the surface with blood.

Glucose depletion enhances sensitivity to shear stress-induced mechanical damage in red blood cells by rotary blood pumps.

The metabolic process in red blood cells (RBCs) is anaerobic. The life-dependent adenosine triphosphate (ATP) for survival of cells is produced through glycolytic process. The aim of the study was to evaluate the effects of the glucose level on the mean corpuscular volume, mean corpuscular hemoglobin concentration, and hemolysis rate during hemolysis study by rotary blood pumps. The shear stress generated by rotary blood pumps may enhance glucose utilization by RBCs with depletion of glucose affecting ATP production and, consequently, cell size, shape, and morphology. The shear stress increases metabolism of RBCs consuming more energy ATP which is produced anaerobically from glycolytic process. Hence, in the closed circuit testing of rotary blood pumps, depletion of glucose might occur after prolonged pumping, which in turn affects metabolic process of RBCs by changing their size, shape, and morphology. It is thus suggested to monitor and control the glucose level of the fluid that suspends RBCs depending on the study duration.

Development of a disposable maglev centrifugal blood pump intended for one-month support in bridge-to-bridge applications: in vitro and initial in vivo evaluation.

MedTech Dispo, a disposable maglev centrifugal blood pump with two degrees of freedom magnetic suspension and radial magnetic coupling rotation, has been developed for 1-month extracorporeal circulatory support. As the first stage of a two-stage in vivo evaluation, 2-week evaluation of a prototype MedTech Dispo was conducted. In in vitro study, the pump could produce 5 L/min against 800 mm Hg and the normalized index of hemolysis was 0.0054 +/- 0.0008 g/100 L. In in vivo study, the pump, with its blood-contacting surface coated with biocompatible 2-methacryloyloxyethyl phosphorylcholine polymer, was implanted in seven calves in left heart bypass. Pump performance was stable with a mean flow of 4.49 +/- 0.38 L/min at a mean speed of 2072.1 +/- 64.5 rpm. The maglev control revealed its stability in rotor position during normal activity by the calves. During 2 weeks of operation in two calves which survived the intended study period, no thrombus formation was seen inside the pump and levels of plasma free hemoglobin were maintained below 4 mg/dL. Although further experiments are required, the pump demonstrated the potential for sufficient and reliable performance and biocompatibility in meeting the requirements for cardiopulmonary bypass and 1-week circulatory support.

Absolute transmitted light plethysmography for assessment of dental pulp vitality through quantification of pulp chamber hematocrit by a three-layer model.

After confirming that the gingival circulation had little effect on transmitted light plethysmography measurement in the upper central incisor in both in vivo experiments and numerical Monte Carlo simulation studies, a three-layer model comprising of a pulp chamber sandwiched between two dentin layers has been introduced to quantify the pulp chamber hematocrit (Hctp) from the measured optical density. Two-flux theory was utilized to derive a mathematical equation for transmitted intensity in terms of tooth dimensions, Hctp, and light-source wavelength. Each layer was assumed homogeneous so as to represent its optical properties by the bulk absorption and scattering constants. The mean error between the Hctp estimate based on the three-layer-model equation and the Hctp actual in the extracted model tooth was -0.00115 with standard deviation (SD) of 0.00733 at 522 nm wavelength, while for 810 nm +0.09157 and 0.02493. The Hctp estimate of the upper central incisor in 10 young volunteers at 522 nm using the three-layer model ranged from 0.002 to 0.061 with the mean of 0.032. The Hctp change reflects blood volume shift in the pulp microcirculation to possibly indicate dental pulp vitality.

Development of a reflected optical fiber system for measuring oxygen saturation in an integrated artificial heart-lung system.

The purpose of this study was to develop a blood oxygen saturation (OS) monitoring system for use with an integrated artificial heart-lung system (IAHLS). The OS monitoring system consists of two paired optical fiber probes (OFPs) and a measurement system. To investigate the effect of the OFP configuration and incident light wavelength on the relationship between OS and the reflectance ratio for wavelengths of 810 and 645 nm, we performed theoretical analyses of the relationship between OS and R810/R645 using a diffusion equation. The prototype OFP located on the blood outlet port of our IAHLS housing was evaluated using an in vitro test. An OS range of 65-100% was adjusted to supply oxygen and nitrogen gas to the IAHLS. The blood flow rate was maintained at 3 L/min by the rotational speed of an impeller in the IAHLS. The OS-corrected blood from the IAHLS was measured using a commercial gas analyzer. The correlation coefficients (r(2)) between the theoretical ratio of R810/R645 and OS, and between measured OS and the reflectance ratio of R810/R645 were 0.97 and 0.78, respectively. In conclusion, we confirmed that the development of this oximetry system is applicable for IAHLS.

A magnetically levitated centrifugal blood pump with a simple-structured disposable pump head.

A magnetically levitated centrifugal blood pump (MedTech Dispo) has been developed for use in a disposable extracorporeal system. The design of the pump is intended to eliminate mechanical contact with the impeller, to facilitate a simple disposable mechanism, and to reduce the blood-heating effects that are caused by motors and magnetic bearings. The bearing rotor attached to the impeller is suspended by a two degrees-of-freedom controlled radial magnetic bearing stator, which is situated outside the rotor. In the space inside the ringlike rotor, a magnetic coupling disk is placed to rotate the rotor and to ensure that the pump head is thermally isolated from the motor. In this system, the rotor can exhibit high passive stiffness due to the novel design of the closed magnetic circuits. The disposable pump head, which has a priming volume of 23 mL, consists of top and bottom housings, an impeller, and a rotor with a diameter of 50 mm. The pump can provide a head pressure of more than 300 mm Hg against a flow of 5 L/min. The normalized index of hemolysis of the MedTech Dispo is 0.0025 +/- 0.0005 g/100 L at 5 L/min against 250 mm Hg. This is one-seventh of the equivalent figure for a Bio Pump BPX-80 (Medtronic, Inc., Minneapolis, MN, USA), which has a value of 0.0170 +/- 0.0096 g/100 L. These results show that the MedTech Dispo offers high pumping performance and low blood trauma.

Mechanical damage of red blood cells by rotary blood pumps: selective destruction of aged red blood cells and subhemolytic trauma.

In this study, mean cell volume (MCV), mean cell hemoglobin concentration (MCHC), and mean cell hemoglobin (MCH) were measured to quantify RBC damage by rotary blood pumps. Six-hour hemolysis tests were conducted with a Bio-pump BPX-80, a Sarns 15200 roller pump, and a prototype mag-lev centrifugal pump (MedTech Heart) using fresh porcine blood circulated at 5 L/min against a 100 mm Hg head pressure. The temperature of the test and noncirculated control blood was maintained at 37 degrees C. The normalized index of hemolysis (NIH) of each pump was determined by measuring the plasma-free hemoglobin level. The MCV was measured with a Coulter counter, and MCHC was derived from total hemoglobin and hematocrit. MCH was derived from MCV and MCHC. A multivariance statistical analysis (ANOVA) revealed statistically significant differences (n = 15, P < 0.05) in MCV, MCHC, and MCH between the blood sheared by the rotary blood pumps and the nonsheared control blood. Normalized to the control blood, the Bio-pump BPX-80 showed an MCV of 1.04 +/- 0.03, an MCHC of 0.95 +/- 0.04, and an MCH of 0.98 +/- 0.02; the mag-lev MedTech Heart had an MCV of 1.02 +/- 0.02, an MCHC of 0.97 +/- 0.02, and an MCH of 0.99 +/- 0.01; and the roller pump exhibited an MCV of 1.03 +/- 0.03, an MCHC of 0.96 +/- 0.03, and an MCH of 0.99 +/- 0.01. Per 0.01 increase in NIH, the BPX-80 showed a normalized MCV change of +10.1% and a normalized MCHC change of -14.0%; the MedTech Heart demonstrated a +6.9% MCV and -9.5% MCHC change; and the roller pump had a +0.5% MCV and -0.6% MCHC change. Due to shear in the pump circuits, the RBC increased while the MCHC decreased. The likely mechanism is that older RBCs with smaller size and higher hemoglobin concentration were destroyed fast by the shear, leaving younger RBCs with larger size and lower hemoglobin concentration. Subhemolytic trauma caused the intracellular hemoglobin to decrease due to gradual hemoglobin leakage through the micropores formed in the thinned membrane. In conclusion, the rate of change in MCV and MCHC with respect to NIH change provides useful information relating to selective destruction of RBCs, while the MCH level reflects subhemolytic damage.

Deformability of human red blood cells exposed to a uniform shear stress as measured by a cyclically reversing shear flow generator.

Red blood cells (RBCs) suspended in a dextran solution were at first loaded with a uniform shear stress of 21, 43 and 64 Pa for the duration of 0, 10, 20, 30, 45 and 60 min, respectively, followed with measurement of the dynamic deformation in terms of stretching and recovery, using a cyclically reversing sinusoidal shear flow with the peak stress of 128 Pa at 2 Hz. The L/W value, where L and W were the major and minor axis length of the RBC images, was derived to compare the effects of the uniform shear stress level and the exposure time. The exposure to the uniform shear stress of 21 Pa for the duration of as long as 60 min caused statistically insignificant L/W change in comparison to the control RBCs with L/W of 4.6 +/- 0.1. The exposure to 43 and 64 Pa for longer than 45 and 20 min, respectively, induced statistically significant change in the maximal L/W when compared to that of 21 Pa (p < 0.05). The composition of the maximal L/W values varied depending on the stress level and exposure time; with 21 Pa, the majority of cells exhibited the maximal L/W larger than 4.0 and few cells less than 2.0, whereas with the increase in the stress level to 43 and 64 Pa, cells having less than 2.0 exceeded 50%. Cyclic reversing shear flow is a useful means to measure dynamic deformation capability of RBCs which may be sub-hemolytically sheared without lysis.