Experimental intracerebral hemorrhage: effect of lysed erythrocytes on brain edema and blood-brain barrier permeability.

Understanding the mechanism of edema formation following intracerebral hemorrhage (ICH) is important for developing treatment protocols for this condition. This study examines the role of red blood cell (RBC) lysis and hemoglobin in edema formation following ICH. Significant brain edema developed after 24 hours in rats infused with lysed RBCs and this was associated with a 3-fold increase blood brain barrier (BBB) permeability to alpha-aminoisobutyric acid. We have previously shown that intracerebral injection of packed RBCs does not cause edema formation at one day but does at three days. In this study, we found that packed RBCs did not cause significant BBB disruption at one day but produced a 4-fold increase in BBB permeability at three days. These studies show that following ICH the leakage of substances inside the RBC, facilitated by cellular lysis, results in delayed edema. This was confirmed by both experimentally induced lysis and naturally occurring in-vivo lysis.