Analyzing red blood cell-deformability distributions.

BACKGROUND Red blood cells (RBCs) must deform to pass the smallest capillaries of the microcirculation. Available techniques for measuring RBC deformability often provide an indication of the mean deformability. The latter may be decreased either by a slight overall deformability reduction or by the presence of a small fraction of rigid cells. A distinction between these two cases can be made with a RBC-deformability distribution (RBC-DD). METHODS This paper explores RBC-DDs of healthy individuals and of cells with anomalous mechanical properties (sickle cell disease, dialysis patients, elliptocytosis, and cultivated malaria tropica). The distributions were measured with an automated rheoscope, which uses advanced image analysis techniques to obtain the deformability index of a large number of individual cells subjected to simple shear flow. RESULTS The RBC-DD of healthy volunteers is close to a normal distribution. In the investigated patients, distributions were markedly different and yielded significant changes in the mean, in the standard deviation, or in both. The presence of hypodeformable and hyperdeformable cell fractions can qualitatively and quantitatively be assessed from the deformability distribution (DD). In elliptocytosis, cells orient differently with respect to the streamlines, compared to normal cells. This causes the DD to be biased. CONCLUSIONS The RBC-DD is a powerful representation to establish subpopulations with anomalous deformability. Fractions of hypodeformable and hyperdeformable cells and the standard deviation of the DD are new and excellent quantitative parameters to assess alterations in RBC deformability.