We have examined the kinetics of changes in the deformability of deoxygenated sickle red blood cells when they are exposed to oxygen (O(2)) or carbon monoxide. A flow-channel laser diffraction technique, similar to ektacytometry, was used to assess sickle cell deformability after mixing deoxygenated cells with buffer that was partially or fully saturated with either O(2) or carbon monoxide. We found that the deformability of deoxygenated sickle cells did not regain its optimal value for several seconds after mixing. Among density-fractionated cells, the deformability of the densest fraction was poor and didn't change as a function of O(2) pressure. The deformability of cells from the light and middle fraction increased when exposed to O(2) but only reached maximum deformability when equilibrated with supraphysiological O(2) concentrations. Cells from the middle and lightest fraction took several seconds to regain maximum deformability. These data imply that persistence of sickle cell hemoglobin polymers during circulation in vivo is likely, due to slow and incomplete polymer melting, contributing to the pathophysiology of sickle cell disease.

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