Oxidative Injury to Erythrocytes, Cell Rigidity, and Splenic Hemolysis in Hemodialyzed Uremic Patients

Abstract

In 23 hemodialyzed patients the metabolic defect of erythrocytes related to uremia and potentiated by dialysis was studied to establish a possible link with the shortened erythrocyte survival. A highly significant correlation was found between sulfhemoglobin provoked by oxidative stress and erythrocyte rigidity measured by filterability. Impaired filterability also correlated with the degree of splenic sequestration. Both sulfhemoglobin and impaired filterability correlated with the degree of hemolysis. Finally, erythrocyte survival showed a highly significant correlation with the degree of anemia. From osmotic fragility, plasma trapping, erythrocyte ATP and 2,3-diphosphoglycerate (DPG), and serum phosphorus, calcium, and magnesium measurements it seems unlikely that either spheric transformation or sol-gel transformation of the membrane is causing the increased erythrocyte rigidity. In view of the impaired erythrocyte defense capacity against oxidative injury, cell content rigidity as mediated by reduced hemoglobin solubility is a more likely explanation. Our results give a rational basis for a trial of splenectomy in severely anemia hemodialyzed patients.

A simple method for measuring erythrocyte deformability.

“…Several comparative studies of filtering devices have been published (Nicolau et al, 1961;Gregersen et al, 1967;Forman et al, 1973;Rosenmund et al, 1975) (1971), who found it to be highly satisfactory and to give excellent correlation with a standard microbiological method. The other (RJH) has adapted the principle as a daily routine test for amino-hexose and also for several ,B-lactam antibiotics as well as for erythromycin, chloramphenicol, lincomycin, chlorolincomycin, fusidic acid, and the tetracyclines.…”

Red Blood Cell Osmotic Fragility in Chronically Hemodialyzed Patients

“…However, under pathological conditions, such as uremia, the abnormal environment produces alterations in various erythrocyte membrane functions such as osmotic fragility and deformability [10, 11, 12]. In our study, the room temperature was precisely controlled at 27°C throughout the study period in order to exclude the effects of temperature change and to isolate the effects of uremia.…”

N-Acetylcysteine for the Management of Anemia and Oxidative Stress in Hemodialysis Patients

“…The oxidation of polyunsaturated fatty acids on the RBC membrane [4,8,23] increases RBC rigidity and reduces their deformability [7,24,25], leading to greater susceptibility to hemolysis [8] and shorter survival. As mentioned in the previous study [10], decreased activities of the 2 RBC membranous reductases (ferricyanide reductase and metHb reductase) implied potential RBC damage secondary to lipid peroxidation.…”

“…By exac-erbating pro-inflammation and causing hemolysis via oxidative damage to the RBC membrane [7,8], ROS may aggravate uremic anemia and contribute to poor responsiveness to recombinant human erythropoietin (rHuEPO) therapy. Moreover, increased ROS oxidize low-density lipoproteins (LDL) and produce oxidized LDL (ox-LDL), which, in turn, may induce atherosclerosis and subsequent cardiovascular disease [9].…”