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The Effect of Sepsis on the Erythrocyte

Department of Medical Biophysics, University of Western Ontario, London, ON N6A 5C1, Canada
Department of Anesthesia and Critical Care Western, University of Western Ontario, London, ON N6A 5C1, Canada
Research Department of Clinical Physiology, Division of Medicine, University College London, London WC1E 6BT, UK
Bloomsbury Institute of Intensive Care Medicine, University College London, London WC1E 6BT, UK
Author to whom correspondence should be addressed.
Int. J. Mol. Sci. 2017, 18(9), 1932;
Received: 31 July 2017 / Revised: 31 August 2017 / Accepted: 4 September 2017 / Published: 8 September 2017
(This article belongs to the Special Issue Sepsis)
Sepsis induces a wide range of effects on the red blood cell (RBC). Some of the effects including altered metabolism and decreased 2,3-bisphosphoglycerate are preventable with appropriate treatment, whereas others, including decreased erythrocyte deformability and redistribution of membrane phospholipids, appear to be permanent, and factors in RBC clearance. Here, we review the effects of sepsis on the erythrocyte, including changes in RBC volume, metabolism and hemoglobin’s affinity for oxygen, morphology, RBC deformability (an early indicator of sepsis), antioxidant status, intracellular Ca2+ homeostasis, membrane proteins, membrane phospholipid redistribution, clearance and RBC O2-dependent adenosine triphosphate efflux (an RBC hypoxia signaling mechanism involved in microvascular autoregulation). We also consider the causes of these effects by host mediated oxidant stress and bacterial virulence factors. Additionally, we consider the altered erythrocyte microenvironment due to sepsis induced microvascular dysregulation and speculate on the possible effects of RBC autoxidation. In future, a better understanding of the mechanisms involved in sepsis induced erythrocyte pathophysiology and clearance may guide improved sepsis treatments. Evidence that small molecule antioxidants protect the erythrocyte from loss of deformability, and more importantly improve septic patient outcome suggest further research in this area is warranted. While not generally considered a critical factor in sepsis, erythrocytes (and especially a smaller subpopulation) appear to be highly susceptible to sepsis induced injury, provide an early warning signal of sepsis and are a factor in the microvascular dysfunction that has been associated with organ dysfunction. View Full-Text
Keywords: sepsis; erythrocyte; rheology; morphology and microcirculation sepsis; erythrocyte; rheology; morphology and microcirculation
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Bateman, R.M.; Sharpe, M.D.; Singer, M.; Ellis, C.G. The Effect of Sepsis on the Erythrocyte. Int. J. Mol. Sci. 2017, 18, 1932.

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