Thromboembolic ischemic stroke changes red blood cell morphology

Background or Introduction: Stroke is one of the most debilitating diseases causing morbidity and mortality worldwide. During ischemic stroke, erythrocytes undergo oxidative and proteolytic changes resulting not only in inflammation but also in changes in cellular rheology. During the event, fibrin fibers, which are typically a fine net, clot abnormally to form a clot of dense matted deposits (DMDs). This atypical coagulum causes blood cells to be trapped in the mesh. Methods: Here we study red blood cell (RBC) ultrastructure in thromboembolic ischemic stroke using high resolution scanning electron microscopy. Results: We show that RBCs in patients change shape, with membrane extensions that form close interactions with the DMDs. Conclusions: We suggest that the RBC membrane changes and resulting DMD interactions play a pivotal role in the persistent presence of thrombi. This ultrastructural observation might open a renewed debate regarding possible additional structural and biochemical roles of RBCs in the circulatory system. (C) 2013 Elsevier Inc. All rights reserved.