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Vaso-occlusion by sickle cells: evidence for selective trapping of dense
red cells
DK Kaul, ME Fabry and RL Nagel
We have characterized the type of red cells from sickle cell patients that
were trapped in the course of sickle-cell vaso-occlusion. In addition, the
perfusion conditions (arterial perfusion pressure [Pa] and oxygen tension
[PO2]) leading to experimentally induced vaso- occlusion in the
artificially perfused, innervated mesocecum microvascular preparation were
determined. Microvascular obstruction was induced by decrease in Pa; the
lower the Pa, the greater the peripheral resistance as well as the extent
of obstruction. The cells involved in the obstruction were recovered by
vasodilation (secondary to denervation) and increase in Pa. Densitometric
analysis of density gradient-separated infused and trapped cells was
supplemented with morphological analysis to ascertain the involvement of
density classes as well as morphological types seen in oxy and deoxy sickle
blood. The trapping phenomenon was sensitive to PO2. Percentage of densest
gradient classes, ie, fraction 3 (F3; mainly dense unsicklable SS
discocytes [USDs]) and fraction 4 (F4; irreversibly sickled cells [ISCs]
and the densest discocytes), showed a significant increase in trapping when
perfusion was switched from oxy to deoxy perfusate. Morphological analysis
revealed that unsicklable SS discocytes are more effectively trapped when
deoxygenated. The deoxygenation of infused cells did not further change the
percentage of ISCs trapped, suggesting that ISCs are equally capable of
sequestration in the oxy and the deoxy states. The venous effluent showed a
selective and significant depletion of dense cells (F4) and ISC counts at
all Pa. We conclude that the progressive obstruction of the
microcirculation by sickle cells involves selective sequestration of the
densest classes of cells and that this mechanism might explain their
partial disappearance during painful sickle cell crisis.
Volume 68,
Issue 5,
pp. 1162-1166,
11/01/1986
Copyright © 1986 by The American Society of Hematology
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