PubMed: 28458720

Title
Role of red blood cells in haemostasis and thrombosis.
Journal
ISBT science series
Volume
12
Issue
None
Pages
176-183
Date
2017-02-01
Authors
Litvinov RI | Weisel JW

Evidence c4ced170f7

Another mechanism for platelet activation by RBC lysate is extracellular hemoglobin, which enhances platelet activation by lowering NO bioavailability [ 29].

Evidence 664e96ba5b

Because nitric oxide is known to prevent activation of endothelial cells and platelets, this nitric oxide deficiency promotes cellular activation.

Evidence 1b0c1ef8fa

Because of the large numbers of RBCs present in the blood, even a small fraction of RBCs with phosphatidylserine exposure can result in prothrombotic conditions.

Evidence 91790d411a

Under conditions of apoptosis or RBC damage, such as high shear rates, inflammation, or oxidative stress, RBCs can lose membrane asymmetry and expose phosphatidylserine [43].

Evidence fd73af3e8b

Phosphatidylserine externalization and shedding are mediated by increased cellular Ca-flux and play an important role in natural RBC senescence [44].

Evidence a2fc0004ad

An increase in RBC phosphatidylserine exposure in -thalassemia patients has been shown to be connected with eryptosis, the suicidal death of RBCs [49].

Evidence 42fcf39953

Free heme upregulates heme oxygenase activity, generates reactive oxygen species, and activates endothelial cells and macrophages directly[65].

Evidence cc5e5a1e4d

More rigid RBCs may be less able to squeeze through the capillaries and they also increase platelet margination described above, both of which increase the susceptibility to thrombosis [18].

Evidence bd5d2075b4

The most common pathological states in which RBCs interact with the endothelium include sickle cell disease [39], malaria [40], and diabetes [41].

Evidence 527f5c6ada

The RBC-platelet adhesive interaction may be important in pathological conditions associated with a high incidence of thrombosis, such as thalassemia [36] or sickle cell disease [37].

Evidence 0f26763409

At low shear rates or with stasis of blood, RBCs tend to form linear arrays of stacked cells (roleaux) or three-dimensional aggregates [16].

Evidence 20fcd47363

Stored RBCs undergo a complex structural and metabolic impairment that includes leakage of hemoglobin from the cells and hemolysis, reduced energy and NO production, formation of toxic products, such as lysophospholipids and free iron, phosphatidylserine exposure and shedding MPs [59].

Evidence e8dc9ad539

Stored RBCs exhibit altered biophysical characteristics, including higher cell rigidity that accounts in part for impaired blood flow hemodynamics and adverse effects of RBC transfusion [26].

Evidence 57d5671a2e

Clot contraction requires platelets and fibrin or fibrinogen.

Evidence 7053202bd7

Thrombin, calcium ions, the integrin IIb 3, non-muscle myosin IIa, factor XIIIa crosslinking, and platelet count all promote one or more phases of the clot contraction process.

Evidence 8b478e0dd8

In acute coronary syndrome, RBC transfusion increases platelet reactivity [31].

Evidence 5f58779359

The ability of cells to generate MPs in vivo is an important regulatory mechanism of physiologic reactions, a means for intercellular communications and a pathogenic component in many diseases that impact hemostasis and thrombosis [50, 51].

Evidence d09c774113

Formation of RBC-derived MPs is typical during the ex vivo storage of whole blood [52] and accumulation of MPs is thought to be responsible for an increased incidence of deep vein thrombosis after transfusion of “old” red cells [53].

Evidence 34734e24fb

Irrespective of their source, elevated plasma levels of MPs are associated with a reduced clotting time and a dose- and time-dependent increase in thrombin generation, suggesting that the MPs enhance hypercoagulability.

Evidence b05c75b586

The circulating MPs can internalize free heme and transfer it to vascular endothelium, promoting vaso-occlusion, or amplify systemic inflammation via thrombin mediated activation of the complement system [57].

Evidence d9e002bcf2

Damaged RBCs also release arginase that cleaves L-arginine, a substrate for NO production [29].

Evidence c5fadd20d2

When RBCs are damaged by high shear in continuous flow ventricular assist devices, free hemoglobin induces platelet aggregation, contributing to high risk of thrombotic complications [33].

Evidence 2acb7c8319

As a generality, incorporation of RBCs increases the lytic resistance and decreases the permeability of fibrin in a dose-dependent manner [79, 80].

Evidence fc8e519018

In contrast, RBCs impair contraction and reduce stiffness, while increasing the overall contractile stress generated by the platelet-fibrin meshwork [75, 76, 85].

Evidence ac43e7af9e

However, in the past few decades there has been increasing evidence that RBCs have a variety of active functions in hemostasis and thrombosis that are significant and need to be taken into account in assessing health and disease.

Evidence ad2b818521

A remarkable rheological effect of RBCs that affects platelets in hemostasis and thrombosis is that RBCs preferentially move down the center of blood vessel, causing margination of platelets, so that they are poised to adhere preferentially to the site of vessel-wall injury [10].

Evidence bbb16abb37

RBCs can modulate platelet reactivity directly through either chemical signaling or adhesive RBC-platelet interactions. RBCs promote platelet aggregation and degranulation by releasing ATP and ADP under low pO2, low pH and in response to mechanical deformation [27, 28].

Evidence 204f465a43

An increase of fibrinogen concentration can result in greater RBC aggregation, which is associated with a higher incidence of thrombosis.

Evidence 9b6ea8c30c

Another consequence of the axial RBC accumulation followed by reduction in local viscosity is a decrease of the wall shear stress causing a lesser local release of nitric oxide [15].

Evidence 0bc223f3d9

Such aggregates are difficult to disperse and they tend to increase the blood viscosity and hydrodynamic resistance in larger blood vessels with low shear, such as the veins in the lower limbs.

Evidence b46bd3fba9

RBC aggregation promotes thrombosis in veins, confirming the pathogenic importance of locally altered blood rheology in the development of venous thrombosis [17].

Evidence da366c87f8

Some diseases, such as diabetes, hypertension, lower limb vein thrombosis, coronary heart disease, can secondarily alter the properties of RBCs, making them stiffer and prothrombotic [24].

Evidence 752695058a

Thus the volume fraction of red cells may have a significant impact on hemostasis and thrombosis, with the nature of the effect related to the flow conditions [9].

Evidence 893eec84a2

Activation, aging, and apoptosis of various cells, including RBCs, are accompanied by formation of microscopic extracellular membranous structures named microvesicles or microparticles (MPs).

Evidence f7b593b26e

On the other hand, an abnormally high hematocrit is associated with thrombosis, and patients with polycythemia vera or taking erythropoietin are more susceptible to thrombosis and thromboembolism [4, 5].

Evidence f9defdbad9

High hematocrit results in an increase in blood viscosity that impedes the blood flow [6, 7].

Evidence 0ae1d76812

The hematocrit-related blood viscosity may have physical effects on the interaction between platelets and blood vessel surfaces.Under flow conditions, platelet adhesion increases greatly with hematocrit.

Evidence edf8edd396

Extracellular hemoglobin sequesters NO and thus promotes activation of endothelial cells and adhesion/aggregation of platelets [64].

Evidence 43cb854b1c

Besides the effects of intact RBCs, free extracellular hemoglobin prolongs clotting time of fibrinogen due to impaired polymerization [73].

Evidence 328ef5879c

Other diseases, including -thalassemia, hemolytic anemias caused by RBC antibodies, and hereditary stomatocytosis, also commonly have RBCs with stiff membranes [23].

Evidence decc7bd495

Third, hemolysis results in a massive release of procoagulant RBC-derived MPs [66].

Evidence 8b3a5b0a03

Second, immune hemolysis is accompanied by production of TNF- which induces tissue factor expression in endothelial cells and also decreases the endothelial expression of thrombomodulin, a potent modulator of thrombin activity [62].

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