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Role of red blood cells in the anemia‐associated bleeding under high shear conditions
Author(s) -
Yaoi H.,
Shida Y.,
Ogiwara K.,
Hosokawa K.,
Shima M.,
Nogami K.
Publication year - 2017
Publication title -
haemophilia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.213
H-Index - 92
eISSN - 1365-2516
pISSN - 1351-8216
DOI - 10.1111/hae.13252
Subject(s) - hemostasis , hematocrit , medicine , thrombus , von willebrand factor , bleeding time , red blood cell , anemia , red cell , platelet , immunology , platelet aggregation
Background Red blood cells ( RBC s) contribute to hemostasis under blood‐flow, and anemia might contribute to a hemorrhagic diathesis. The majority of current laboratory techniques to assess hemostasis do not consider the effects of RBC s. An assay to determine the role of RBC s in hemostasis could be beneficial for clinical management. Objectives To investigate the influence of RBC s in hemostasis. Methods Hemostasis was investigated using a novel microchip flow‐chamber system (T‐ TAS ® ) in an anemic patient with von Willebrand disease. Subsequently, the effects of RBC s in total thrombus analysis system (T‐ TAS ) were examined using reconstituted whole blood at various hematocrit levels. Results In vivo : When the patient was anemic and demonstrated persisted hemorrhagic symptoms despite the maintained adequate von Willebrand factor ristocetin cofactor activity levels, thrombus formation determined by T‐ TAS was delayed. However, transfusions of RBC s resolved bleeding symptom and, accordingly, the thrombus formation in T‐ TAS improved. In vitro : Thrombus formation determined by T‐ TAS at 1000 s −1 was dose‐dependent on hematocrit (the time to reach 10 kPa ( T 10 ): 10.0 ± 0, 9.5 ± 1.4, 6.7 ± 2.4, 2.8 ± 1.6 min at hematocrits of 0%, 12.5%, 25% and 50%, respectively). Markedly defective thrombus formation ( T 10 >10 min) was confirmed at a hematocrit <25% at 2000 s −1 . Conclusion Red blood cells play an essential role in hemostasis under high shear, and RBC transfusions could be effective for refractory bleeding in patients with anemia. T‐ TAS measurements appear to reflect the hemostatic consequences of diminished red cell numbers under blood‐flow, and could provide a valuable means for monitoring patients.