Abstract 20304: Erythrocyte Aging as a Mechanism of Anemia and a Biomarker of Device Thrombosis in Continuous-Flow Left Ventricular Assist Devices
Background: Blood injury caused by continuous-flow left ventricular assist devices (CF-LVAD) has been associated with device thrombosis and anemia. Accurate in-vivo quantification of erythrocyte turnover, and its contribution to CF-LVAD complications, is yet to be elucidated.
Methods: We investigated the effect of CF-LVAD on circulating erythrocyte via in-vivo measurements of erythrocyte lifespan. Erythrocyte lifespan is a quantitative indicator of erythrocyte turnover that can be accurately derived from measurement of the exhaled carbon monoxide (CO) level. Sixty non-smoking subjects were prospectively enrolled. Twenty-five subjects had a CF-LVAD without thrombosis, 10 had a CF-LVAD with thrombosis, and 25 were normal controls. End-tidal breath CO levels were measured and used to calculate erythrocyte lifespan.
Results: The mean erythrocyte lifespan was significantly shorter in CF-LVAD subjects with (29.7±14.9 days) compared to those without (65.0±17.3 days) device thrombosis (p<0.0001). The lifespans in these 2 groups were significantly shorter compared to normal controls (96.0±24.9 days, both p<0.0001). CF-LVAD subjects had low hemoglobin (11.8±2.0 g/dL), and their anemia was normochromic normocytic with elevated mean reticulocyte counts. Erythrocyte lifespan correlated significantly with mean corpuscular hemoglobin concentration (r=0.56, p=0.0005) and red cell distribution width (r= -0.65, p<0.001), but not with reticulocyte count (r=0.27, p=0.32).
Conclusion: CF-LVAD induced significant erythrocyte injury, which was more pronounced in the presence of device thrombosis. The etiology of anemia in CF-LVAD was primarily accelerated erythrocyte aging. Further studies are needed to determine if erythrocyte lifespan could provide a practical means of detecting subtle pre-clinical thrombosis.
Author Disclosures: Z. Taimeh: None. R. Koene: None. J. Furne: None. A. Singal: None. P. Eckman: Consultant/Advisory Board; Modest; St Jude Medical. M. Levitt: None. M. Pritzker: None.
- © 2016 by American Heart Association, Inc.