made recently to find out predictors of early post-operative complications in TOF patients depending on the
One of the main problems of patients, who undergone cardiosurgery, in particular the ones with
congenital heart defects due to impaired blood circulation, is a considerable change in delivery of O2 to tissues
[4, 8]. Unfortunately, adequate attention has not been paid so far to the change in the hemorheology status and
transfusion indicators during post-operative adaptive transformation of hemodynamics as well as to the
methods of their evaluation and monitoring.
The research was focused on evaluating the efficiency of thick-drop technique of scanning electron
microscopy in predicting and monitoring the hyperfunction of subclavian-pulmonary anastomosis in TOF
patients at the early post-operative period.
MATERIAL AND METHODS
Eighty one TOF patients aged 1 - 22 years (mean age 8.7 ± 0.9), including 43 males (53%), 38 females (47%), have
been operated in Republican Specialized Center of Surgery named after academician V.Vakhidov (Tashkent,
Uzbekistan) from 2015 to 2017. In all the cases, the modified subclavian-pulmonary anastomosis (SPA) was
performed. Artificial lung ventilation was carried out to the SPA patients in the standard regimes in early post-
operative period. The relative predictors of intensive care unit (ICU) stay and morbidity were age and weight of
the patients, while the surgery profile suggested the duration of mechanical ventilation. Hyperfunction of the
anastomosis in the early post-operative period developed in 14 patients (17.3%). The median duration of their
mechanical ventilation was 19 hours. The ICU stay ranged from 2 to 14 days. Five of these patients were
randomly selected to form the study group; 8 patients with no SPA hyperfunction were matched by age, sex and
concomitant conditions to compose the comparison group.
To monitor the RBC status, scanning electronic microscopy (SEM) was used since it enables to
differentiate and count precisely normal RBCs having the shape of biconcave discocytes (D) from pathologically
shaped RBCs (PS RBC). Usually, the most frequent PS RBCs found are echinocytes, i.e. RBCs with numerous
processes, stomatocytes, RBCs with a ridge-like structure, and considerably changed PS RBCs or so called
Most scanning electron microscopes are comparatively easy to operate, with user-friendly interfaces.
Many applications require minimal sample preparation and data acquisition is rapid (less than 5 min/image).
The thick-drop express-technique (TDET) has been elaborated at the NSCS for practical and research purposes.
This technique and relevant software have been developed and patented in Uzbekistan [3, 6]. One of advantages
of the technique is that it preserves the natural condition of RBCs and quickly evaluates the correlation of D/ PS
RBCs (for 10-15 min).
The review board and ethics committee of Republican Specialized Center of Surgery named after
academician V.Vakhidov approved the study protocol and gave permission for study.
RESULTS AND DISCUSSION
The TDET enabled to monitor the RBCs morphologic condition and evaluate the hemodynamic changes in the
early post-operative period of 14 TOF patients, in particular the development of hypervolemia of the pulmonary
circulation and pulmonary edema. The proportion of the PS RBCs in TOF-SPA patients’ blood significantly
increased. Studying the RBC profile in patients with cyanotic TOF (CTOF) demonstrated that the discocyte
count in the early post-operative period made 40% with 85% reference value. The most part of the rest RBCs
(60%) was presented by the population of pathologicaly-shaped and lysed cells (Figures 1 and 2).
The echinocyte population of adult patients with CTOF was more remarkable; it included 26% of
echinocytes of class I; 8% of the second class echinocytes and 5% of the third class cells. The number of
stomatocytes and hydrocytes proved to be larger than in children with CTOF. It made 3% of stomatocytes of
class I, while the stomatocytes of the second and third classes made 7% and 5%, respectively. The population of
discocytes with a ridge-like structure was distributed as follows: small ridges were found in 1.5-2%, the
medium-sized ones were found in 1-1.5%, and 0.5% of the discocytes had large ridges.
To cite this paper: Ibadov R.A., Baybekov I.M., Abralov Kh.K., Strijkov N.A., Julamanova D.I., Khamdamovich I.S., Ravshanovich I.R. 2018. Red Blood
Cells Morphology Monitoring to Predict Hyperfunction of Subclavian-Pulmonary Anastomosis in Patients with Fallot Tetralogy. J. Life Sci. Biomed. 8(2): 37-