Red Blood Cell Morphodynamics in Patients with Polycythemia Vera and Stroke

Abstract

Polycythemia vera (PV) is a Ph-negative myeloproliferative neoplasm (MPN) which is characterized by erythrocytosis and a high incidence of thrombotic complications, including stroke. The study aimed to evaluate red blood cell (RBC) morphodynamic properties in PV patients and their possible association with stroke. We enrolled 48 patients with PV in this cross-sectional study, 13 of which have a history of ischemic stroke. The control group consisted of 90 healthy subjects. RBC deformability and aggregation analysis were performed using a laser-assisted optical rotational red cell analyzer. The following parameters were calculated: aggregation amplitude (Amp), RBC rouleaux formation time constant (Tf), time of formation of three-dimensional aggregates (Ts), aggregation index (AI), rate of complete disaggregation (y-dis), and the maximal elongation of RBC (EImax). Statistical analysis was performed with the R programming language. There were significant differences in RBCs morphodynamics features between patients with PV and the control group. Lower EImax (0.47 (0.44; 0.51) vs. 0.51 (0.47; 0.54), p < 0.001) and γ-dis (100 (100; 140) vs. 140 (106; 188) sec−1, p < 0.001) along with higher amplitude (10.1 (8.6; 12.2) vs. 7.7 (6.6; 9.2), p < 0.001) was seen in patients with PV compared with control. A statistically significant difference between PV patients with and without stroke in aggregation amplitude was found (p = 0.03). A logistic regression model for stroke was built based on RBC morphodynamics which performed reasonably well (p = 0.01). RBC alterations may be associated with overt cerebrovascular disease in PV, suggesting a possible link between erythrocyte morphodynamics and increased risk of stroke.

Deregulated calcium signaling in blood cancer: Underlying mechanisms and therapeutic potential

“…The deformability and stability of RBCs were reduced and RBC aggregation was increased. These alterations correlated with the incidence of ischemic stroke in 13 of these patients, suggesting a link between abnormal RBC morphodynamics and the increased risk of arterial thrombosis in PV, although this requires confirmation in larger studies (119). Mechanisms and consequences of deregulated calcium signaling in red cells and erythroid precursors.…”

“…Most previous work into PV-associated thrombosis focused on the role of a high hematocrit, white cell and platelet activation, coagulation factors and inflammation ( 118 ). However, a recent study used a laser-assisted optical rotational red cell analyzer to demonstrate abnormal RBC morphodynamics in 48 patients with PV ( 119 ). The deformability and stability of RBCs were reduced and RBC aggregation was increased.…”

Advances in Microfluidics for Single Red Blood Cell Analysis

“…Other studies covered RBCs aggregation and morphodynamics in patients with polycythemia vera and stroke [123] and COVID-19, which patients were reported to have RBC aggregation increased, along with blood viscosity despite lower hematocrit that heathy individuals while oxygen supplemented patients had even higher aggregation and blood viscosity than those without [124].…”

The atherogenic index of plasma complicates the thrombotic tendency of chronic myeloproliferative disorders: A retrospective cohort study

“…Thrombosis is responsible for 45% of the deaths in those patients with CMPD. [7][8][9] Thrombosis of the greater arteries is an important cause of mortality due to ET or can trigger severe neurological, cardiac or peripheral arterial events. 10,11 Anemia is detected in most of the cases at the time of diagnosis in PMF.…”