Red blood cell: barometer of cardiovascular health?

This editorial refers to ‘Suicidal erythrocyte death, eryptosis, as a novel mechanism in heart failure-associated anaemia’ by Mahmud et al ., pp. 37–46, this issue. Anaemia is an important risk factor in a number of conditions, including heart failure.1 The fact that not only the absolute haemoglobin level but also the change in haemoglobin level over time is related to outcome emphasizes the importance of the underlying mechanism leading to anaemia.1 Often anaemia is ascribed to reduced sensitivity of erythroid progenitors to erythropoietin,2 or bone marrow suppression by inflammatory cytokines such as tumour necrosis factor-alpha or interleukin-6.3 This focus on the production site may be prompted by the seemingly inert nature of the mature red blood cell. Mature red blood cells lack a nucleus and over 95% of their protein cargo consists of haemoglobin. The lack of a nucleus leaves little room to respond to changes in the environment by adjusting cell composition and the vast quantity of haemoglobin appears to underline that gas transport is the sole task of the red blood cell. However, specific properties of the circulating red cell, such as red cell distribution width, a measure of anisocytosis, are associated with outcome, independently of …