Abstract: Objective To investigate the effects of acute hypervolemic hemodilution (AHH) and intraoperative blood salvage
(IOBS) on the morphology and biomechanics of erythrocytes using atomic force microscopy (AFM). Methods Blood samples
were collected from 20 patients undergoing orthopedic surgery before operation (T1), immediately after AHH (T2), and after
blood salvage (T3). AFM at nanometer resolution was used to examine the morphology and biomechanics of the collected
erythrocytes. Results The blood samples collected at T1 showed a significantly lower ratio of heteromorphous erythrocytes
than those collected at T2 and T3 [(2.6±1.3)% vs (19.3±1.6)% and (17.6±1.4)%, P<0.05]. AFM revealed significant differences in
the morphology and biomechanics of the single erythrocyte in salvaged blood and blood after AHH compared with those of
venous blood. Conclusion AHH and IOBS may cause significant changes in the morphology and biomechanics of erythrocytes
in the salvaged blood．