Red blood cell survival: Normal values and measurement
- Stanley L Schrier, MD
Stanley L Schrier, MD
- Editor-in-Chief — Hematology
- Section Editor — Myeloproliferative Disorders
- Section Editor — Red Cell Disorders
- Professor of Medicine
- Stanford University School of Medicine
During its approximately four-month lifespan, the human red blood cell (RBC) travels approximately 300 miles, making approximately 170,000 circuits through the heart, enduring cycles of osmotic swelling and shrinkage while traveling through the kidneys and lungs, and an equal number of deformations while passing through capillary beds [1,2]. It has been speculated that accumulated damage to the RBC, especially to its membrane, renders the aging RBC unfit to circulate, leading to its destruction, via mechanisms that are poorly understood.
The normal time of RBC senescent (age-related) death in adults is approximately 110 to 120 days. Hemolysis can therefore be arbitrarily defined as a shortening in the survival of circulating RBCs to a value of less than 100 days.
This topic will review the mechanisms of normal RBC destruction and the methods used to measure RBC survival, which may be used in the evaluation of patients with suspected hemolysis . Approaches to the patient with hemolytic anemia and with anemia in general are presented separately. (See "Approach to the diagnosis of hemolytic anemia in the adult" and "Approach to the adult patient with anemia".)
MECHANISMS OF RBC DESTRUCTION
In normal subjects, RBCs are destroyed by two different mechanisms, one related to increasing RBC age (senescence) and the other to a random process that destroys intact RBCs, or portions of an intact RBC (eg, vesicles) independent of their age (random hemolysis). These two processes may not be fully independent of one another .
Senescence — Virtually all RBCs in normal subjects die of processes associated with "wear and tear" associated with prolonged circulation within the intravascular space. These processes include, but are not limited to :
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- MECHANISMS OF RBC DESTRUCTION
- Random RBC death
- DETERMINATION OF RBC LIFESPAN
- Utility of RBC survival studies
- Estimation of red cell survival from the reticulocyte count
- Random label RBC survival method
- - RBC half-time
- Time of RBC senescence
- - Sites of RBC destruction
- Cohort labeling technique
- Quantitative erythrokinetic studies
- Endogenous carbon monoxide production