Extracellular histones induce erythrocyte fragility and anemia

Farzaneh Kordbacheh, Connor H. O’Meara, Lucy A. Coupland, Patrick M. Lelliott and Christopher R. Parish

Key Points

  • Histones promote in vitro erythrocyte aggregation, sedimentation, fragility, and spleen retention in a concentration-dependent manner.

  • Histones induce in vivo anemia, an increase in splenic hemoglobin content, as well as thrombocytopenia and leukopenia within a few minutes.


Extracellular histones have been shown to play an important pathogenic role in many diseases, primarily through their cytotoxicity toward nucleated cells and their ability to promote platelet activation with resultant thrombosis and thrombocytopenia. In contrast, little is known about the effect of extracellular histones on erythrocyte function. We demonstrate in this study that histones promote erythrocyte aggregation, sedimentation, and using a novel in vitro shear stress model, we show that histones induce erythrocyte fragility and lysis in a concentration-dependent manner. Furthermore, histones impair erythrocyte deformability based on reduced passage of erythrocytes through an artificial spleen. These in vitro results were mirrored in vivo with the injection of histones inducing anemia within minutes of administration, with a concomitant increase in splenic hemoglobin content. Thrombocytopenia and leukopenia were also observed. These findings suggest that histones binding to erythrocytes may contribute to the elevated erythrocyte sedimentation rates observed in inflammatory conditions. Furthermore, histone-induced increases in red blood cell lysis and splenic clearance may be a significant factor in the unexplained anemias seen in critically ill patients.

  • Submitted June 12, 2017.
  • Accepted November 5, 2017.
View Full Text