Effects of Aggregation on Blood Sedimentation and Conductivity

The erythrocyte sedimentation rate (ESR) test has been used for over a century. The Westergren method is routinely used in a variety of clinics. However, the mechanism of erythrocyte sedimentation remains unclear, and the 60 min required for the test seems excessive. We investigated the effects of cell aggregation during blood sedimentation and electrical conductivity at different hematocrits. A sample of blood was drop cast into a small chamber with two planar electrodes placed on the bottom. The measured blood conductivity increased slightly during the first minute and decreased thereafter. We explored various methods of enhancing or retarding the erythrocyte aggregation. Using experimental measurements and theoretical calculations, we show that the initial increase in blood conductivity was indeed caused by aggregation, while the subsequent decrease in conductivity resulted from the deposition of erythrocytes. We present a method for calculating blood conductivity based on effective medium theory. Erythrocytes are modeled as conducting spheroids surrounded by a thin insulating membrane. A digital camera was used to investigate the erythrocyte sedimentation behavior and the distribution of the cell volume fraction in a capillary tube. Experimental observations and theoretical estimations of the settling velocity are provided. We experimentally demonstrate that the disaggregated cells settle much slower than the aggregated cells. We show that our method of measuring the electrical conductivity credibly reflected the ESR. The method was very sensitive to the initial stage of aggregation and sedimentation, while the sedimentation curve for the Westergren ESR test has a very mild slope in the initial time. We tested our method for rapid estimation of the Westergren ESR. We show a correlation between our method of measuring changes in blood conductivity and standard Westergren ESR method. In the future, our method could be examined as a potential means of accelerating ESR tests in clinical practice.     

Osmolality dependence of erythrocyte sedimentation and aggregation in a strong magnetic field

In order to specify the major determinant of the magnetic enhancement of erythrocyte sedimentation observed previously, the dependence of erythrocyte sedimentation rate (ESR) on osmolality was measured under a strong magnetic field. Even at hypotonic osmolality, an increase in ESR due to aggregation was observed in plasma solution as compared with that without aggregation in saline solution. However, the magnetic field did not enhance ESR at hypotonic osmolality, when the cell shape was an isotropic sphere (spherocyte). Thus, we narrowed our search to a mechanism that would explain the enhanced ESR found specifically in anisotropic erythrocytes. It was concluded that the major determinant can only work for anisotropic erythrocytes and is a magnetic field-induced increase in an intermembrane adhesive area due to magnetic orientation of anisotropic erythrocytes.     

Mathematical model describing erythrocyte sedimentation rate. Implications for blood viscosity changes in traumatic shock and crush syndrome

Background  

The erythrocyte sedimentation rate (ESR) is a simple and inexpensive laboratory test, which is widespread in clinical practice, for assessing the inflammatory or acute response. This work addresses the theoretical and experimental investigation of sedimentation a single and multiple particles in homogeneous and heterogeneous (multiphase) medium, as it relates to their internal structure (aggregation of solid or deformed particles).     

Effects of a homogeneous magnetic field on erythrocyte sedimentation and aggregation

Effects of a homogeneous static magnetic field on erythrocyte sedimentation rate (ESR) have been assessed by using the standard Westergren method. A magnetic field of 6.3 T in the vertical direction only slightly enhanced ESR in saline solution, which was consistent with an effect on cell orientation. On the other hand, the magnetic field greatly enhanced ESR in plasma. It took a long time (about 20 min) for an ESR change to occur in plasma in response to the magnetic field. The effects in plasma were too large to originate only from cell orientation and were clearly distinct from a magnetic field-induced Boycott effect under an inhomogeneous magnetic field. A morphological examination and the nonlinear time course of the sedimentation in plasma indicated that the magnetic field increased cell aggregation and thereby enhanced ESR in plasma. Bioelectromagnetics 18:215–222, 1997. © 1997 Wiley-Liss, Inc.     

肠淋巴液引流对失血性休克大鼠红细胞流变性的影响

目的:观察肠淋巴液引流对失血性休克大鼠红细胞流变性指标以及血液黏度的作用。方法:Wistar雄性大鼠均分为假休克组、休克组(复制失血性休克模型)、引流组(复制失血性休克模型,自低血压1 h引流休克肠淋巴液)。在低血压3 h或相应时间,经腹主动脉取血,检测红细胞参数、红细胞电泳、红细胞沉降率(ESR)以及血液黏度,计算红细胞聚集指数、红细胞变形指数。结果:与假休克组比较,休克组红细胞数量、红细胞比积(HCT)、血红蛋白(Hb)、平均红细胞血红蛋白浓度(MCHC)、红细胞电泳率与迁移率、红细胞变形指数、全血黏度、全血低切与高切相对黏度和还原黏度显著降低,休克组平均红细胞体积、红细胞电泳时间、ESR、血沉方程K值与校正K值、红细胞聚集性指数、血浆黏度显著升高;引流组MCHC、红细胞电泳率与迁移率、全血黏度、全血低切与高切还原黏度均显著降低,引流组红细胞体积分布宽度(RDW-SD)显著增加。同时,引流组HCT、RDW-SD、红细胞变形指数、全血黏度、全血低切与高切相对黏度显著高于休克组;ESR、血沉方程K值与校正K值、红细胞聚集性指数、血浆黏度显著低于休克组。结论:休克肠淋巴液引流可改善失血性休克大鼠红细胞流变行为,从而改善血液流变性。     

Study of erythrocyte sedimentation behavior by piezoelectric crystal impedance sensor

Based on the impedance characteristic of erythrocytes at high frequency, the response of piezoelectric crystal impedance (PCI) sensor in the erythrocyte suspension was derived and verified experimentally. A method of using PCI sensor to investigate erythrocyte aggregation-sedimentation phenomenon was proposed. From the frequency response of the PCI sensor, the erythrocyte aggregation time and sedimentation rate could be obtained during erythrocyte aggregation and sedimentation. With the present method, the effects of the erythrocyte deformability, the osmotic pressure and the coexisting macromolecules on the erythrocyte sedimentation rate were studied. The results show that the PCI sensor possesses some advantages, such as good sensitivity, simplicity of use and no thermal effect for the impedance study of erythrocyte aggregation and sedimentation.     

The role of aggregation kinetics in the sedimentation of erythtocytes

The well-known S-shaped settling curves are obtained as solutions of an autonomic dynamical system deduced mathematically from the generalized Stokes formula, the blood volume conservation law, and the Smoluchowski theory of particle coagulation. Numerical computations and parametric analysis of the deduced two nonlinear differential equations for the plasma zone thickness and aggregate size are given. It is shown that the model presented makes it possible, on the basis of experimentally recorded sedimentation curves and aggregate size growth, to identify quantitatively the values of the essential physical parameters of the coupled processes of erythrocyte aggregation and sedimentation. This method of identification could be used as a diagnostic test in hematological laboratories.     

Graded alterations of RBC aggregation influence in vivo blood flow resistance

Although the effects of red blood cell (RBC) aggregation on low-shear rate blood viscosity are well known, the effects on in vivo flow resistance are still not fully resolved. The present study was designed to explore the in vivo effects of RBC aggregation on flow resistance using a novel technique to enhance aggregation: cells are covalently coated with a block copolymer (Pluronic F-98) and then suspended in unaltered plasma. RBC aggregation was increased in graded steps by varying the Pluronic concentration during cell coating and was verified by microscopy and erythrocyte sedimentation rate (ESR), which increased by 200% at the highest Pluronic level. RBC suspensions were perfused through an isolated in situ guinea pig hindlimb preparation while the arterial perfusion pressure was held constant at 100 mmHg via a pressure servo-controlled pump. No significant effects of enhanced RBC aggregation were observed when studies were conducted in preparations with intact vascular control mechanisms. However, after inhibition of smooth muscle tone (using 10(-4) M papaverin), a significant change in flow resistance was observed in a RBC suspension with a 97% increase of ESR. Additional enhancements of RBC aggregation (i.e., 136 and 162% increases of ESR) decreased flow resistance almost to control values. This was followed by another significant increase in flow resistance during perfusion with RBC suspensions with a 200% increase of ESR. This triphasic effect of graded increases of RBC aggregation is most likely explained by an interplay of several hemodynamic mechanisms that are triggered by enhanced RBC aggregation.     

Action of hydroxyethyl starch on the flow properties of human erythrocyte suspensions

Hydroxyethyl starch (HES) has often been used as a plasma expander, but questions still remain concerning the mechanisms by which it produces changes in the rheological properties of blood and erythrocyte (RBC) suspensions under various flow conditions. The present investigation has shown that the dynamic viscosity of HES (232,000 and 565,000 daltons) solutions rises in a nonlinear fashion with increasing HES concentration, and for a given concentration of HES exhibits Newtonian behavior at shear rates between 0.15 to 124 sec-1. At low (less than 0.9 sec-1) shear rates the apparent viscosity of a 40% RBC suspension increases with lower concentrations of HES because of RBC aggregation. At higher concentrations of HES, increases in suspension viscosity are due to an increase in the viscosity of the continuous phase since the RBC are largely disaggregated. At high (greater than 36 sec-1) shear rates the relative viscosity (eta/eta O) of RBC suspensions slowly decreases with increasing HES concentration. At low shear rates eta/eta O increases and then decreases with increasing HES concentration. Evidence of the concentration-dependent effects of HES on RBC aggregation is provided not only by the viscometric analysis but also from measurements of erythrocyte sedimentation rate (ESR) and the zeta sedimentation ratio (ZSR). HES is a more potent aggregating agent in phosphate buffered saline (PBS) than it is in plasma. Polymer size has only a slight effect on the extent of RBC aggregation produced, but does have a significant effect on the concentration of polymer at which maximum aggregation occurs. The viscosity-corrected electrophoretic mobility of RBC in HES rises monotonically with the concentration of HES in the suspending medium. Decreases in the extent of RBC aggregation with increasing polymer concentrations probably result from an increase in the electrostatic repulsive forces between the cells.     

A physical theory of erythrocyte sedimentation

A new physical theory of erythrocyte sedimentation is proposed. Various assumptions underlying Stokes' formula are first criticized. An explicit formula is proposed, taking into account some of the results of recent experimental investigations including the effect of upward flow of plasma and the time course of growth of aggregates. It is generally shown that the sedimentation curve without aggregation never becomes a sigmoid. Our formula is applicable to the increased ESR due to the aggregation of erythrocytes. The sedimentation velocity depends not only on the hematocrit and the ultimate size of the aggregates, but also on the retardation time of the growth of aggregates in conformity with the experimental result of Kernick et al.     

Effects of low frequency electric fields on the sedimentation rate of human blood. Preliminary observations

The erythrocyte sedimentation rate (ESR) of human blood samples exposed to electric fields at frequencies ranging from 1 Hz to 100 kHz was measured. Statistically significant differences in ESR were found between the exposed and the control samples at most of the frequencies used. The results suggest a possible nonlinear dependence of the effect on frequency, the threshold field strength varying from about 25 V/m to about 5 kV/m.     

肠系膜淋巴管结扎对急性失血大鼠红细胞流变性的影响

目的:观察结扎肠系膜淋巴管(MLD)对急性失血大鼠红细胞流变性的影响。方法:20只Wistar雄性大鼠随机均分为失血组与结扎组。所有大鼠经右侧颈总动脉匀速放血(失血量为全血量的1/4),结扎组失血后结扎MLD,失血组仅在MLD下穿线。记录24h存活情况。24h后,将存活大鼠经左侧颈总动脉迅速放血,测定实验前后的红细胞沉降率(ESR)、红细胞电泳、红细胞压积(Hct),计算红细胞聚集与变形指数。结果:急性失血后24h,结扎组大鼠存活情况(9只)略好于失血组(6只)。急性失血后24h,与实验前相比,失血组与结扎组的ESR、血沉方程K值、校正K值、红细胞电泳时间均显著升高或延长,红细胞变形性降低,失血组的红细胞聚集指数显著升高、红细胞电泳长度与迁移率均显著降低;结扎组的ESR、血沉方程K值、校正K值、红细胞聚集指数、电泳时间较失血组显著降低,红细胞电泳长度与迁移率、变形性较失血组显著升高。结论:急性失血导致大鼠红细胞聚集性升高、红细胞电泳能力及变形性降低,结扎MLD可改善急性失血导致的红细胞流变性异常。     

Effects of contrast media on erythrocyte aggregation during sedimentation

To evaluate the effects of contrast media (CMs) on erythrocyte aggregation, we measured the erythrocyte sedimentation with Westergren method at 25 degrees C. CMs were diatrizoate (Urografin 76%) for ionic CM and iopamidol (Iopamiron 370) for nonionic CM. Swine red blood cells (RBCs) were suspended in autologous plasma containing diatrizoate (URO), iopamidol (IOP), and saline (SAL) at 6.7% w/w, as well as in plasma alone (PLA), at 40% of the hematocrit. Sigmoid sedimentation curves were fitted to the Puccini et al. (1977) equation, and the average number of RBCs per aggregate m was calculated by Stokes' law against the time t. According to the Murata-Secomb (1988) theory we estimated the collision rate K between two aggregates from dm/dt in the stationary phase during sedimentation. Corresponding to the maximal ESR, the dm/dt (in cells/s) was 0.52 in PLA, 0.09 in SAL, 0.06 in URO and 0.03 in IOP, so that K also decreased in proportion to dm/dt from 145 fL/s in PLA to 8 fL/s in IOP. Both the ionic and nonionic CMs tend to inhibit the RBC aggregation more than that in SAL; the latter iopamidol appears to be inhibitory more than the former diatrizoate in autologous plasma.     

阿达木单抗注射液联合白芍总苷治疗甲氨蝶呤不耐受型类风湿关节炎的临床疗效

目的:探讨阿达木单抗注射液联合白芍总苷治疗甲氨蝶呤不耐受风湿关节炎患者的临床疗效。方法:收集我院治疗的86例甲氨蝶呤不耐受的类风湿关节炎患者,随机分为实验组和对照组,每组43例。对照组患者给予阿达木单抗注射液治疗,实验组患者在对照组基础上给予白芍总苷胶囊治疗。观察并比较两组患者的晨僵时间、血沉(ESR)、类风湿因子(FR)以及临床疗效进行检测并比较。结果:与治疗前相比,治疗后两组患者的晨僵时间、血沉(ESR)、类风湿因子(FR)水平均下降(P0.05);与对照组相比,实验组患者的晨僵时间、血沉(ESR)、类风湿因子(FR)水平较低(P0.05),临床治疗有效率较高(P0.05)。结论:阿达木单抗注射液联合白芍总苷能够降低甲氨蝶呤不耐受的类风湿关节炎患者的ESR、FR水平,改善患者的临床症状,临床疗效较好。     

Influence of fibrinogen and haematocrit on erythrocyte sedimentation kinetics

This study investigates the influence of haematocrit, fibrinogen concentration and fibrinogen availability (amount of fibrinogen per red blood cell) on erythrocyte sedimentation. The Westergren technique was applied to blood samples from 36 subjects and to their blood manipulated to haematocrits of 10, 20, 30 and 40%. Readings were taken every 10 minutes for 300 minutes. Previous studies indicate that erythrocyte sedimentation occurs in three phases. In this study, we show that haematocrit has little influence on either the rate of fall of particles in the first phase (m1) or the duration of the first phase. This is also true for fibrinogen availability and for fibrinogen concentration at low haematocrits. At high haematocrits m1 increases with fibrinogen concentration. The rate of fall of rouleaux during phase 2 (m2) and ESR60 both decrease exponentially with haematocrit and increase linearly with fibrinogen concentration. While m2 is more closely correlated to fibrinogen availability than to fibrinogen concentration or to haematocrit, this is not the case for ESR60. Thus haematocrit, fibrinogen concentration and fibrinogen availability are more important to the velocity of sedimentation in the second phase than to the sedimenting velocity during phase 1 or to the duration of phase 1.     

Complement receptor 1 gene variants are associated with erythrocyte sedimentation rate

The erythrocyte sedimentation rate (ESR), a commonly performed test of the acute phase response, is the rate at which erythrocytes sediment in vitro in 1 hr. The molecular basis of erythrocyte sedimentation is unknown. To identify genetic variants associated with ESR, we carried out a genome-wide association study of 7607 patients in the Electronic Medical Records and Genomics (eMERGE) network. The discovery cohort consisted of 1979 individuals from the Mayo Clinic, and the replication cohort consisted of 5628 individuals from the remaining four eMERGE sites. A nonsynonymous SNP, rs6691117 (Val→IIe), in the complement receptor 1 gene (CR1) was associated with ESR (discovery cohort p = 7 × 10(-12), replication cohort p = 3 × 10(-14), combined cohort p = 9 × 10(-24)). We imputed 61 SNPs in CR1, and a "possibly damaging" SNP (rs2274567, His→Arg) in linkage disequilibrium (r(2) = 0.74) with rs6691117 was also associated with ESR (discovery p = 5 × 10(-11), replication p = 7 × 10(-17), and combined cohort p = 2 × 10(-25)). The two nonsynonymous SNPs in CR1 are near the C3b/C4b binding site, suggesting a possible mechanism by which the variants may influence ESR. In conclusion, genetic variation in CR1, which encodes a protein that clears complement-tagged inflammatory particles from the circulation, influences interindividual variation in ESR, highlighting an association between the innate immunity pathway and erythrocyte interactions.     

Reference values for erythrocyte sedimentation rate of middlescent people as a function of altitude

The purpose of this paper is to provide a scientific basic for a unified standard for the reference value of middlescent people's erythrocyte sedimentation rate (ESR) in China. ESR measurements for healthy middlescent people were collected according to the Wintrobe method and the relationship between the reference value of middlescent people's ESR and altitude was tested in this paper It was found that the reference value of middlescent people's ESR decreases when the altitude gradually increases, and the relationship is quite significant. Univariate regression analysis was used to deduce two regression equations: Y1 = 13.14-0.00245X +/- 2.98 (males) and: Y2 = 22.00-0.00397X +/- 4.85 (females). If the altitude value of a particular area of China is known, the reference value of middlescent people's ESR can be calculated by means of these regression equations. Furthermore, depending on the altitude, China can be divided into three biogeographic districts: Qingzang District, Central District, and Eastern District.     

The mechanism of erythrocyte sedimentation in Westergren's examination.

The authors deduced the equation that describes the sedimentation of erythrocytes as the function of time, hematocrit, hemoglobin and some plasma protein concentrations and the citrate viscosity and density. This values served to describe plasma and erythrocyte density, plasma viscosity, erythrocyte aggregation and the influence of suspension concentration on the erythrocyte sedimentation rate. The influence of citrate on blood dilution (the reduction of hematocrit and plasma protein concentrations) was also considered. A good agreement between the observed and predicted values was obtained.     

分枝杆菌L型感染与肺癌患者红细胞免疫功能改变的相关性

目的:研究分枝杆菌L型血行感染与肺癌患者红细胞免疫功能改变的相关性.方法:溶血离心培养法和滴片法检测血液中的分枝杆菌L型,常规方法测定红细胞沉降率(ESR)、红细胞C3b受体花环率(C3bRR)、免疫复合物花环率(ICRR)、血清红细胞C3b受体花环促进率(RFER)和抑制率(RFIR).结果:TBL( )与TBL(-)肺癌患者相比,C3bRR和ICRR两项指标均明显降低.TBL( )肺癌与TBL(-)肺癌患者相比,ESR增快更为显著.TBL(-)较TBL( )之RFER值的降低更为明显.RFIR差异未见有显著性.结论:分枝杆菌L型血行感染影响肺癌患者血沉和红细胞免疫功能改变.