Erythrocyte aging as a mechanism of anemia and a biomarker of device thrombosis in continuous-flow left ventricular assist devices
| Autor: | Ziad Taimeh, Julie K. Furne, Michael Levitt, Ashish Singal, Peter Eckman, Marc R. Pritzker, Ryan J. Koene |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty Erythrocytes Anemia medicine.medical_treatment 0206 medical engineering 02 engineering and technology 030204 cardiovascular system & hematology Ventricular Function Left 03 medical and health sciences 0302 clinical medicine In vivo Internal medicine medicine Humans Aged Retrospective Studies Heart Failure Transplantation business.industry Red blood cell distribution width Thrombosis Erythrocyte Aging Middle Aged equipment and supplies medicine.disease 020601 biomedical engineering Surgery Prosthesis Failure Heart failure Ventricular assist device Cardiology Etiology Erythrocyte Count Biomarker (medicine) Female Heart-Assist Devices Cardiology and Cardiovascular Medicine business Biomarkers |
| Zdroj: | The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 36(6) |
| ISSN: | 1557-3117 |
| Popis: | Blood trauma caused by continuous-flow left ventricular assist devices (CF-LVADs) has been associated with device thrombosis and anemia. Accurate in vivo quantification of erythrocyte turnover and its contribution to CF-LVAD complications have yet to be elucidated.We investigated the age (lifespan) of circulating erythrocytes in subjects with CF-LVAD. Erythrocyte lifespan is a quantitative indicator of in vivo erythrocyte turnover that can be accurately derived from measurement of the exhaled carbon monoxide (CO) level. Sixty non-smoking subjects were prospectively enrolled: 25 had a CF-LVAD without thrombosis; 10 had a CF-LVAD with thrombosis; and 25 were normal controls. End-tidal breath CO levels were measured and used to calculate erythrocyte lifespan.The mean erythrocyte lifespan was significantly shorter in CF-LVAD subjects with (29.7 ± 14.9 days) compared to those without (65.0 ± 17.3 days) device thrombosis (p0.0001). The lifespans in these 2 groups were significantly shorter compared with normal controls (96.0 ± 24.9 days, both p0.0001). A receiver operator curve demonstrated high sensitivity-specificity for use of erythrocyte lifespan to detect device thrombosis (AUC = 0.94). In addition, all CF-LVAD subjects had low hemoglobin (11.8 ± 2.0 g/dl), and their anemia was normochromic normocytic with elevated mean reticulocyte counts. Erythrocyte lifespan correlated significantly with mean corpuscular hemoglobin concentration (r = 0.56, p = 0.0005) and red cell distribution width (r = -0.65, p0.001), but not with reticulocyte count (r = 0.27, p = 0.32).Erythrocyte lifespan is substantially reduced in subjects with a CF-LVAD, which was more pronounced in the presence of device thrombosis. The etiology of anemia in CF-LVAD was primarily due to accelerated erythrocyte aging. Further studies are needed to determine whether erythrocyte lifespan could provide a practical means of detecting subtle pre-clinical thrombosis. |
| Databáze: | OpenAIRE |
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