Erythrocyte aging as a mechanism of anemia and a biomarker of device thrombosis in continuous-flow left ventricular assist devices

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:36

Article

Taimeh, Ziad¹  Koene, Ryan J.²  Furne, Julie³  Singal, Ashish²  Eckman, Peter M.⁴  Levitt, Michael D.³  Pritzker, Marc R.² 

[1] Baylor Coll Med, Texas Heart Inst, 6720 Benner Ave, Houston, TX 77030 USA

[2] Univ Minnesota, Sch Med, Lillehei Heart Inst, Minneapolis, MN 55455 USA

[3] Univ Minnesota, Sch Med, Minneapolis Vet Affairs Hosp, Minneapolis, MN 55455 USA

[4] Abbott NW Hosp, Minneapolis Heart Inst, Minneapolis, MN USA

关键词: erythrocyte lifespan;    exhaled carbon monoxide;    heart failure;    pump thrombosis;    red blood cell survival;    ventricular assist device;   

DOI  :  10.1016/j.healun.2017.02.007

来源: Elsevier

【 摘 要 】

BACKGROUND: 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. METHODS: 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. RESULTS: 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 (p < 0.0001). The lifespans in these 2 groups were significantly shorter compared with normal controls (96.0 +/- 24.9 days, both p < 0.0001). 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/d1), 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, p < 0.001), but not with reticulocyte count (r = 0.27, p = 0.32). CONCLUSIONS: 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. (C) 2017 International Society for Heart and Lung Transplantation. All rights reserved.

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