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Review
. 2021 Nov 1;28(6):438-444.
doi: 10.1097/MOH.0000000000000679.

Novel concepts in red blood cell clearance

Silvia Neri  1 , Dorine W Swinkels  2 , Hanke L Matlung  1 , Robin van Bruggen  1
Affiliations
Review

Novel concepts in red blood cell clearance

Silvia Neri et al. Curr Opin Hematol. .

Abstract

Purpose of review: Red blood cell (RBC) clearance has been studied for decades in many different pathologies, which has revealed different routes of RBC degradation, depending on the situation. This review summarizes the latest mechanistic insights on RBC clearance in different contexts; during homeostatic removal, immune-mediated destruction, and systemic inflammation.

Recent findings: Besides the recognition of a variety of potential 'eat me' signals on RBCs, recent evidence suggests that normal RBC degradation is driven by the increase of the adhesive properties of RBCs, mediating the retention in the spleen and leading to RBC hemolysis. Furthermore, immune-mediated degradation of RBCs seems to be fine-tuned by the balance between the density of the antigens expressed on RBCs and the presence of 'don't eat me' signals. Moreover, besides RBC clearance by macrophages, neutrophils seem to play a much more prominent role in immune-mediated RBC removal than anticipated. Lastly, RBC clearance during systemic inflammation appears to be driven by a combination of extreme macrophage activity in response to proinflammatory cytokines as well as direct damage of RBC by the inflammation or inflammatory agent.

Summary: Recent studies on RBC clearance have expanded our knowledge on their destruction in different contexts.

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References

    1. Mebius RE, Kraal G. Structure and function of the spleen. Nat Rev Immunol 2005; 5:606–616.
    1. Nairz M, Theurl I, Swirski FK, Weiss G. Pumping iron’-how macrophages handle iron at the systemic, microenvironmental, and cellular levels. Pflugers Arch Eur J Physiol 2017; 469:397–418.
    1. Pirenne F. The cause and pathogenesis of hemolytic transfusion reactions in sickle-cell disease. Curr Opin Hematol 2019; 26:488–494.
    1. Barcellini W, Fattizzo B. The changing landscape of autoimmune hemolytic anemia. Front Immunol 2020; 11:946.
    1. Weiss G, Ganz T, Goodnough LT. Anemia of inflammation. Blood 2019; 133:40–50.

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