Novel concepts in red blood cell clearance

Silvia Neri, Dorine W. Swinkels, Hanke L. Matlung, Robin van Bruggen

Research output: Contribution to JournalReview articleAcademicpeer-review


Purpose of reviewRed 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 findingsBesides 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.SummaryRecent studies on RBC clearance have expanded our knowledge on their destruction in different contexts.
Original languageEnglish
Pages (from-to)438-444
Number of pages7
JournalCurrent Opinion in Hematology
Issue number6
Publication statusPublished - 1 Nov 2021


  • anemia of inflammation
  • homeostasis
  • immune-mediated destruction
  • red blood cell clearance

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