Decrease of red blood cell filterability seen in intensive care. II. Red blood cell crenelation "in vivo" as morphological evidence of increased red blood cell viscosity in low flow states.

Abstract

We have reported the finding of numerous spiculed erythrocytes in blood stored for 15-21 days with acid citrate dextrose, drawing attention to the possible decrease of stored red cell deformability because of the decrease of the surface to volume ratio. The presence of anisotropy with crenated spheres, equivalent to the internal crystallization of hemoglobin, is closely related to these altered red cell parameters. The increase of erythrocyte filtration time in blood stored with acid citrate dextrose correlated well with the duration of storage up to the 21st day, r = 0.74 greater than 3 Sr, y = 1.104x + 1.853, n = 47, as well as with the increase of the proportion of crenated red cells. Using higher magnification (X700-1000) of the microcirculation in the great omentum of shocked dogs, crenated spheres could be seen within the arterioles, venules and capillaries; during refractory shock, nearly all the red cells became crenated spheres. The observation of echinocytes "in vivo" is a morphological proof of the damage to deformability of normal red blood cells in low flow states.