SOME LESSONS FROM THE RED BLOOD CELL

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Abstract
The red blood cell is a complex, highly organized, living cell. Disturbances in metabolism within red cells have only recently been recognized as essential features in the pathogenesis of certain hemolytic states. Particular reference is made to hereditary spherocytosis and to drug-induced hemolytic anemias, both of which serve as models to illustrate the interaction of heredity and environment in pathogenesis. With respect to the blood groups, two important lessons are cited. One is the role of 3 pairs of modifying genes in affecting the expression of the A, B and O genes which control development of A, B and H antigens in red cells and body fluids. The second interesting lesson is the recent demonstration of the acquisition of the B antigen by group A red cells in certain individuals, most of whom were elderly and/or suffering from cancer. The red cell currently leads the parade of demonstrations of heterogeneity or differentiation of abnormal states formely thought to be homogeneous. Fascinating examples are to be found among the hemoglobinopathies, hereditary methemoglobinemias, spherocytosis and thalassemia. Certain metabolic abnormalities common to many cells of the body may be demonstrated much more easily in the red cell because it is more easily sampled. Excellent examples are to be found in thiamine deficiency and in galactosemia. Since aging must presumably be explained in part at the cellular level, the recent studies on aging of red cell populations and on differences in red cells with respect to age of the donor are worthy of note.
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