Extracorporeal Membrane Oxygenation-Induced Hemolysis: An In Vitro Study to Appraise Causative Factors

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Chan, Chris Hoi Houng
Ki, Katrina K
Zhang, Meili
Asnicar, Cooper
Cho, Hwajin
Ainola, Carmen
Bouquet, Mahe
Heinsar, Silver
Pauls, Jo Philipp
Li Bassi, Gianluigi
Suen, Jacky
Fraser, John F
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2021
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Abstract

In vitro hemolysis testing is commonly used to determine hemocompatibility of ExtraCorporeal Membrane Oxygenation (ECMO). However, poor reproducibility remains a challenging problem, due to several unidentified influencing factors. The present study investigated potential factors, such as flow rates, the use of anticoagulants, and gender of blood donors, which could play a role in hemolysis. Fresh human whole blood was anticoagulated with either citrate (n = 6) or heparin (n = 12; 6 female and 6 male blood donors). Blood was then circulated for 360 min at 4 L/min or 1.5 L/min. Regardless of flow rate conditions, hemolysis remained unchanged over time in citrated blood, but significantly increased after 240 min circulation in heparinized blood (p ≤ 0.01). The ratio of the normalized index of hemolysis (NIH) of heparinized blood to citrated blood was 11.7-fold higher at 4 L/min and 16.5-fold higher at 1.5 L/min. The difference in hemolysis between 1.5 L/min and 4 L/min concurred with findings of previous literature. In addition, the ratio of NIH of male heparinized blood to female was 1.7-fold higher at 4 L/min and 2.2-fold higher at 1.5 L/min. Our preliminary results suggested that the choice of anticoagulant and blood donor gender could be critical factors in hemolysis studies, and should be taken into account to improve testing reliability during ECMO.

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Membranes

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11

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5

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© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Chemical engineering

Environmental engineering

Civil engineering

anticoagulants

blood donor gender

blood trauma

flow rate

in vitro model

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Chan, CHH; Ki, KK; Zhang, M; Asnicar, C; Cho, H; Ainola, C; Bouquet, M; Heinsar, S; Pauls, JP; Li Bassi, G; Suen, J; Fraser, JF, Extracorporeal Membrane Oxygenation-Induced Hemolysis: An In Vitro Study to Appraise Causative Factors., Membranes, 2021, 11 (5), pp. 313

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