OBJECTIVETo establish a new method for detection of red blood cell osmotic fragility by using flow cytometry.

METHODSThe hypotension salt solution of different concentrations (0.70 ml normal saline+0.3 ml deionized water, 0.60 ml normal saline+0.40 ml deionized water and 0.55 ml normal saline+0.45 ml deionized water) were prepared with normal saline and deionized water, in which the red blood cells were suspended, and the residual red blood cells were detected by flow cytometer.

RESULTSThere was no significant difference in percentage of residual red blood cells between different time points detected by flow cytometer in 3 different hypotonic salt solutions. The percentage of residual red blood cells in B+C+D+E+F+G detected time region was different among 3 NaCl dilution groups. The percentage of residual red blood cells in normal control was lower than that in hemoglobinopathy group. The percentage of residual red blood cells in hereditary spherocytosis (HS) group was obviously lower than that in hemoglobinopathy and normal control groups. The comparison of 3 different dilution concentrations found that the second concentration (0.60 ml normal saline+0.40 ml deionized water) is more suitable to screen HS by FC500 flow cytometer.

CONCLUSIONThe detection of red cell osmotic fragility by using flow cytometry is a simple, rapid, objective and economic way that can be an effective screening method for diagnose the HS.

Erythrocytes ; cytology ; Flow Cytometry ; Humans ; Osmotic Fragility ; Spherocytosis, Hereditary ; physiopathology

BACKGROUND: Hereditary spherocytosis (HS) is a chronic hemolytic anemia characterized by microspherocytes in the peripheral blood and increased erythrocyte osmotic fragility (EOF). This study evaluated the cryohemolysis test (CHT); initial hemolysis (IH); immediate and incubated hemolysis percentage in 5.5 g/L NaCl (H5.5); mean corpuscular hemoglobin concentration (MCHC); red blood cell distribution width (RDW); and Hb/MCHC, Hb/RDW, and MCHC/RDW ratios for the diagnosis of HS. METHODS: Data from 13 patients with HS were evaluated at the Instituto de Bioquímica Aplicada and compared with data from 14 unaffected individuals and 11 patients with anemia due to another etiology. Total blood and reticulocyte counts, CHT, and immediate and incubated EOF were performed in all subjects; sensitivity, specificity, efficiency, and Youden index (YI) were calculated. RESULTS: Eight patients with HS had MCHC ≥345 g/L, 10 had RDW ≥14.5%, 12 had IH >5.0 g/L, 11 had immediate H5.5 ≥5%, and 13 had incubated H5.5 ≥50% (the cut-off value to consider HS). The efficiency and YI were: immediate H5.5 (0.94–0.85), incubated H5.5 (0.89–0.82), IH (0.89–0.78), MCHC (0.87–0.62), CHT (0.84–0.54), and Hb/MCHC (0.71–0.56), respectively. The calculated ratios could distinguish subjects with HS from unaffected individuals (P < 0.05), but not those with anemia of another etiology (P>0.05). CONCLUSION: Although the CHT and supplementary hematimetric indexes were useful to differentiate individuals with SH from healthy controls, they cannot distinguish from anemias of other etiology. CHT and MCHC, in addition to EOF, are recommended for diagnosing HS patients because of their low cost and efficiency.
Anemia ; Anemia, Hemolytic ; Diagnosis* ; Erythrocyte Indices ; Erythrocytes* ; Hemolysis ; Humans ; Osmotic Fragility* ; Reticulocyte Count ; Sensitivity and Specificity

We report a case of prolonged extreme reactive thrombocytosis in a post-splenectomy patient with hereditary spherocytosis. A 29-year-old female patient presented with gall stones detected incidentally by abdominal ultrasonography. Her laboratory findings showed hemolytic anemia with spherocytosis on the peripheral blood smear and increased osmotic fragility. She was diagnosed with hereditary spherocytosis and underwent a laparoscopic cholecystectomy and splenectomy. After undergoing surgery, the hemolytic anemia was resolved but thrombocytosis was newly detected. Nineteen months after the splenectomy, the thrombocytosis was still persistent and extremely high. To our knowledge, this is the first report of a prolonged extreme reactive thrombocytosis after a splenectomy in Korea.
Adult ; Anemia, Hemolytic ; Cholecystectomy, Laparoscopic ; Female ; Gallstones ; Humans ; Korea ; Osmotic Fragility ; Spherocytosis, Hereditary ; Splenectomy ; Thrombocytosis

The effects of amphotericin B, an antifungal antibiotic, on erythrocyte volume and cation permeability were investigated by measuring the hematocrit, cell volume, cation content, fragility and osmotic behavior in rat erythrocytes, in vitro. 1. When erythrocytes were incubated in a Ringer solution containing amphotericin B (5-25 microgram/ml) the hematocrit and the cell volume increased, the effect being proportional to the concentration of the drug and the incubation time period. 2. Amphotericin B increased the Na content and decreased the K content of the erythrocyte. In normal Ringer solution (NaCl-Ringer)containing amphotericin B the magnitude of cellular Na gain was greater than that of K loss. Therefore, the total cellular cation content increased. On the other hand, when cells were incubated in the amphotericin B containing Ringer solution in which NaCl was replaced by Na2SO4 (Na2SO4-Ringer) the magnitude of cellular K loss exceeded that of cellular Na gain. Consequently, the total cellular cation content was reduced. 3. Amphotericin B increased cell volume (hematocrit) when erythrocytes were incubated in the Na2SO4-Ringer solution. 4. The fragility of erythrocytes increased when cells were preincubated in the amphotericin B containing normal Ringer solution, whereas it decreased in tile cells preincubated in the amphotericin B containing Na2SO4-Ringer solution. 5. The cell volume was linearly related to the reciprocal of medium osmolality(200 to 900 mOsm/kg H2O) in both NaCl-and Na2SO4-Ringer solutions, and the linearity was not altered by amphotericin B. The antibiotic did not change the slope of the correlation line (V vs. 1/OSM). It, however, increased the intercept of the line with the ordinate in normal Ringer solution and decreased that in the Na2SO4-Ringer solution. These results indicate that amphctericin B alters the cell volume by changing the permeability of Na and K across the membrane.
Amphotericin B/pharmacology* ; Animal ; Erythrocyte Volume/drug effects* ; Erythrocytes/analysis* ; In Vitro ; Osmotic Fragility/drug effects ; Potassium/blood* ; Rats ; Sodium/blood*

This study was purposed to evaluate the effect of trehalose-loading on physiological and biochemistry properties of red blood cell (RBC) membrane. The samples were divided into the control group (RBC without trehalose loading) and the test group (RBC with trehalose loading). Osmotic fragility reaction was used to determine the osmotic fragility change of loaded RBC membrane in NaCl solution of different osmotic concentration. Flow cytometry and deformeter were used to assay the integrality and deformability of the RBC, respectively. The results showed that the NaCl solution osmotic concentrations were 160 mOsm and 121.4 mOsm, respectively when the haemolysis rate was 50% of the control group and the test group. Flow cytometry data demonstrated that incubation of RBC in a hypertonic trehalose solution resulted in a fraction of cells with different complexity that attached to little Annexin V-FITC, and that it could be removed by washing and resuspending the RBC in an iso-osmotic (300 mOsm PBS) medium. The deformability of the loaded RBC descend, the statistical difference was significant between control and test groups (P < 0.01). It is concluded that the membrane physiological and biochemistry stability and membrane integrality of RBC in a hyper osmotic pressure can be retained after trehalose loading.
Blood Preservation ; methods ; Cryopreservation ; methods ; Erythrocyte Membrane ; drug effects ; Erythrocytes ; drug effects ; Humans ; Osmotic Fragility ; drug effects ; Trehalose ; pharmacology

Gilbert syndrome is the most common inherited disorder of bilirubin glucuronidation. It is characterized by intermittent episodes of jaundice in the absence of hepatocellular disease or hemolysis. Hereditary spherocytosis is the most common inherited hemolytic anemia and is characterized by spherical, osmotically fragile erythrocytes that are selectively trapped by the spleen. The patients have variable degrees of anemia, jaundice, and splenomegaly. Hereditary spherocytosis usually leads to mild-to-moderate elevation of serum bilirubin levels. Severe hyperbilirubinemia compared with the degree of hemolysis should be lead to suspicion of additional clinical conditions such as Gilbert syndrome or thalassemia. We present the case of a 12-year-old boy with extreme jaundice and nausea. The diagnosis of hereditary spherocytosis was confirmed by osmotic fragility test results and that of Gilbert syndrome by genetic analysis findings.
Anemia ; Anemia, Hemolytic ; Bilirubin ; Child* ; Diagnosis ; Erythrocytes ; Gilbert Disease* ; Hemolysis ; Humans ; Hyperbilirubinemia ; Jaundice* ; Male ; Nausea ; Osmotic Fragility ; Spleen ; Splenomegaly ; Thalassemia

To observe the erythrocyte fragility and morphological changes of erythrocytes caused by roller pump. Ten tests were divided into two groups, Polystan pediatric pump group A (n = 5) and COBE pump group B (n = 5). Ten whole blood samples (each 400 ml) were circulated in the roller pump for 16 h. Erythrocyte fragility and free hemoglobin were measured before pumping and at every 2 hours during pumping. The possible morphological changes of erythrocytes caused by roller pump were observed by scanning electron microscope. The electron microscopic observation was made before pumping and at every 4 hours throughout pumping. Results showed that the erythrocyte fragility of two groups was not increased during a long period of pumping. The number of acanthocytes of two groups was 1.77/1.81% in the samples before pumping and 6.12/7.13, 9.18/8.73, 13.21/12.89, 16.53/17.21% at 4 h, 8 h, 12 h, and 16 h respectively. The free hemoglobin level of two groups was increased linearly during a long duration of pumping and the index of hemolysis of two groups was 0.296 mg/L/h and 0.3993 mg/L/h respectively. The result shows: 1. the erythrocyte fragility was not increased during a long period of pumping; 2. the erythrocyte membrane was injured or broken by roller pump directly; 3. the morphological changes of erythrocytes would be the basis of post operative hemolysis.
Erythrocyte Deformability ; Heart-Lung Machine ; adverse effects ; Hemoglobins ; analysis ; Hemolysis ; Humans ; In Vitro Techniques ; Osmotic Fragility ; Time Factors

Hemolysis in blood pumps has been measured by various in vitro tests, in which normalized index of hemolysis (NIH) was established. As NIH is complicated and difficult to calculate, erythrocyte fragment count (EFC) is proposed in the present study to predict hemolysis in roller pumps. Five paired in vitro tests were conducted using the POLYSTAN pediatric pump (group A) and COBE pump (group B). Ten whole blood samples (400ml) were circled in the roller pump for 16 hours. Erythrocyte fragments count and plasma-free hemoglobin (FHb) were measured before pumping and every 2 hours through circulation after 4 hours pumping. The morphological changes of erythrocyte were observed by scanning electron microscope. Simple linear regression analysis showed the two groups' EFC and FHb levels increased linearly during a long period of pumping, and the coefficient of determination (R2) was 0.64. These data suggested that Erythrocyte fragments count could be used as an index in evaluating the in vitro hemolytic properties of blood pumps.
Erythrocyte Deformability ; Erythrocytes ; ultrastructure ; Heart-Lung Machine ; adverse effects ; Hemoglobins ; analysis ; Hemolysis ; physiology ; Humans ; Microscopy, Electron, Scanning ; Osmotic Fragility ; Time Factors

OBJECTIVETo investigate oxidative stress, hemoglobin percentage and erythrocyte osmotic fragility in various aging groups.

METHODSA total of 200 healthy volunteers of both genders between age group 20-65 years were selected by random method. Determination of hemoglobin percentage was done employing modified cyanide method of Dacie and Lewis. The erythrocyte lysis was observed in hypotonic solution of buffered saline at varying concentrations and optical density was measured at 540 nm. The extent of lipid peroxidation in form of malondialdehyde was measured by thiobarbituric acid method.

RESULTSThe study found a significant decrease in hemoglobin percentage, increase in erythrocyte osmotic fragility and increased lipid peroxidation in form of malondialdehyde with increasing age.

CONCLUSIONSSupplementation of antioxidants may prevent the oxidative injury in elderly group of subjects.

Adult ; Aged ; Aging ; physiology ; Erythrocytes ; chemistry ; Female ; Hemoglobins ; analysis ; Humans ; Lipid Peroxidation ; physiology ; Male ; Malondialdehyde ; analysis ; metabolism ; Middle Aged ; Osmotic Fragility ; Oxidative Stress ; Young Adult

In patients with hemolytic anemia associated with spherocytosis, differential diagnosis has to be made whether the hemolysis is immune-mediated or of non-immune origin. We report a case of hereditary spherocytosis in a 12-yr-old male child, in whom flow-assisted diagnosis was made. In this case, diagnosis was not determined because routine laboratory workups for hereditary spherocytosis yielded discrepant RESULTS: positive osmotic fragility test, positive direct antiglobulin test, and normal result in the red cell membrane protein sodium dodecyl succinimide polyacrylamide gel electrophoresis. However, all flow cytometry-based tests, such as osmotic fragility, direct antiglobulin, and eosin 5-maleimide binding test, yielded results compatible with hereditary spherocytosis. Additionally, in family study, the results of eosin 5-maleimide binding test suggested his disease being hereditary. In cases with diagnostic difficulties, flow cytometry may be used as an alternative tool, which can provide additional information in the differential diagnosis of hemolytic anemia with spherocytosis.
Anemia, Hemolytic/complications/*diagnosis ; Child ; Coombs' Test ; Diagnosis, Differential ; Eosine Yellowish-(YS)/analogs & derivatives/chemistry ; Erythrocytes/immunology/metabolism ; Flow Cytometry ; Humans ; Male ; Osmotic Fragility ; Spherocytosis, Hereditary/complications/*diagnosis