This work analyses the interaction of red blood cells (RBCs) with shock-induced and bubble-induced flows in shock wave lithotripsy (SWL), and calculates, in vitro, the lytic effects of these two flows. A well known experimentally observed fact about RBC membranes is that the lipid bilayer disrupts when subjected to an areal strain ( A/A) c of 3%, and a corresponding, critical, isotropic tension, T c , of 10 mN m −1 (1 mN m −1 = 1 dyne cm −1 ). RBCs suspended in a fluid medium tend to deform in

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... ccordance with the deformation of the surrounding fluid medium. The fluid flow-field is lytically effective if the membrane deformation exceeds the above threshold value. From kinematic analysis, motion of an elementary fluid particle can always be decomposed into a uniform translation, an extensional flow (e.g. u ∞ (x, y, z) = (k(t)x, −k(t)y, 0)) along three mutually perpendicular axes, and a rigid rotation of these axes. However, only an extensional flow causes deformation of a fluid particle, and consequently deforms the RBC membrane. In SWL, a fluid flow-field, induced by a non-uniform shock wave, as well as radial expansion/implosion of a bubble, has been hypothesized to cause lysis of cells. Both the above flow-fields constitute an unsteady, extensional flow, which exerts inertial as well as viscous forces on the RBC membrane. The transient inertial force (expressed as a tension, or force/length), is given by T iner ∼ ρr 3 c k/τ , where τ is a timescale of the transient flow and r c is a characteristic cell size. When the membrane is deformed due to inertial effects, membrane strain is given by A/A ∼ kτ . The transient viscous force is given by T visc ∼ ρ(ν/τ ) 1/2 r 2 c k, where ρ and ν are the fluid density and kinematic viscosity. For the non-uniform shock, the extensional flow exerts an inertial force, T iner ≈ 64 mN m −1 , for a duration of 3 ns, sufficient to induce pores in the RBC membrane. For a radial flow-field, induced by bubble expansion/implosion, the inertial forces are of a magnitude 100 mN m −1 , which last for a duration of 1 µs, sufficient to cause rupture. Bubble-induced radial flow is predicted to be