title: Mechanical blood trauma in assisted circulation: sublethal RBC damage preceding hemolysis.
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.
authors.affiliation: 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.
authors.forename: Salim E
authors.initials: SE
authors.lastname: Olia
authors.affiliation: McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA - USA.|Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA - USA.|Department of Cardiothoracic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA - USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Maul
authors.affiliation: McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA - USA.|Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA - USA.|Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA - USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Antaki
authors.affiliation: McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA - USA.|Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA - USA.|Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA - USA.
authors.forename: Marina V
authors.initials: MV
authors.lastname: Kameneva
mesh_terms: D001243:Assisted Circulation / Q000009:adverse effects*; D016923:Cell Death; D004912:Erythrocytes / Q000473:pathology*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006461:Hemolysis / Q000502:physiology*; D006801:Humans