Osmotic hemolysis and fragility. A new model based on membrane disruption, and a potential clinical test.

Red cell osmotic hemolysis has traditionally been defined by the loss of hemoglobin, in response to reduced osmotic pressure, as measured spectroscopically. Previous work from this laboratory using resistive pulse spectroscopy (RPS) has shown that in a mixed population of hemolyzing cells, ghosts can be detected as being more deformable, and hence appearing distinctly smaller, than the remaining intact cells. Other researchers using similar methods have reported detection of ghosts as apparently smaller objects, resulting from their greater sensitivity to dielectric breakdown. We now confirm both of these results, and demonstrate by kinetic studies that changes which occur in the rheological and electrical properties of ghosts are independent phenomena. We include in our analysis the explicit calculation of ghost and intact spherocyte resistivity after dielectric breakdown. The two different characterizations for ghosts are integrated into a proposed model of osmotic hemolysis based on known red blood cell membrane and cytoplasmic properties. This work provides both a theoretical and a practical foundation for RPS-based measures of osmotic fragility, including a potential new clinical test, measures which provides very early detection of the ultimate fate of osmotically stressed red cells.