Intrahematic crystallization of hemoglobin related to blood preservation with acid citrate dextrose and shock.

In 480 investigations and 40 samples of blood stored liquid with acid citrate dextrose, under adequate conditions for morphological study, many crenated cells of echinocyte types II-III were observed. In 17 samples of blood within 17-21 days of preservation 80-100% crenated red cells were observed including spherocytes. The filterability test performed with significant differences of P < 0.001. In 45 critically ill patients filterability was increased by more than 50%, P < 0.001. Some samples of stored blood appear anisotropic in polarized light microscopy, proving internal crystallization of hemoglobin, the only compound in the blood from some patients in shock and following massive transfusion of 3.5-4 liters. The phenomenon, undoubtedly could give evidence for the participation of internal crystallization of hemoglobin in the late stages of transformation of red cells into crenated shape with two possible factors being incriminated: the participation of membrane or crystallization of Hb. Anisotropic, birefringent, red cells indicate great modification in the specific viscosity of erythrocytes in above conditions. The data are in keeping with the findings of Taube, Massuda and Shoemaker (1973) who suggested that changes in the viscosity of the blood in traumatized patients may be related to alterations in the internal viscosity of the red cell.