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Detection of altered membrane phospholipid asymmetry in subpopulations of
human red blood cells using fluorescently labeled annexin V
FA Kuypers, RA Lewis, M Hua, MA Schott, D Discher, JD Ernst and BH Lubin
Children's Hospital Oakland Research Institute, CA 94609, USA.
The phospholipids of the human red cell are distributed asymmetrically in
the bilayer of the red cell membrane. In certain pathologic states, such as
sickle cell anemia, phospholipid asymmetry is altered. Although several
methods can be used to measure phospholipid organization, small
organizational changes have been very difficult to assess. Moreover, these
methods fail to identify subpopulations of cells that have lost their
normal phospholipid asymmetry. Using fluorescently labeled annexin V in
flow cytometry and fluorescent microscopy, we were able to identify and
quantify red cells that had lost their phospholipid asymmetry in
populations as small as 1 million cells. Moreover, loss of phospholipid
organization in subpopulations as small as 0.1% of the total population
could be identified, and individual cells could be studied by fluorescent
microscopy. An excellent correlation was found between
fluorescence-activated cell sorter (FACS) analysis results using annexin V
to detect red cells with phosphatidylserine (PS) on their surface and a
PS-requiring prothrombinase assay using similar red cells. Cells that bound
fluorescein isothiocyanate (FITC)-labeled annexin V could be isolated from
the population using magnetic beads covered with an anti-FITC antibody.
Evaluation of blood samples from patients with sickle cell anemia under
oxygenated conditions demonstrated the presence of subpopulations of cells
that had lost phospholipid asymmetry. While only a few red cells were
labeled in normal control samples (0.21% +/- 0.12%, n = 8), significantly
increased (P < .001) annexin V labeling was observed in samples from
patients with sickle cell anemia (2.18% +/- 1.21%, n = 13). We conclude
that loss of phospholipid asymmetry may occur in small subpopulations of
red cells and that fluorescently labeled annexin V can be used to quantify
and isolate these cells.
Volume 87,
Issue 3,
pp. 1179-1187,
02/01/1996
Copyright © 1996 by The American Society of Hematology

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