Changes in red blood cells associated with the development of cardiovascular complications in patients with COVID-19 coronavirus infection

Abstract

The purpose of the review is to highlight the most significant changes in the parameters of red blood cells associated with the development of thrombosis in patients with coronavirus infection. A search was carried out using keywords in the databases Scopus, Web of Science, PubMed according to literary sources of the last 3 years on changes in erythrocyte indices associated with thrombosis against the background of COVID-19 infection. Information is presented on the main shifts in red blood indicators during SARS-CoV-2 infection associated with the development of thrombosis: virus attachment and amplification of viral proteins in erythropoiesis progenitor cells; activation of stress erythropoiesis with an increase in nuclear erythrocyte cell content up to 45 %; activation of band 3 protein oxidation with its excessive cleavage, oxidation and cleavage of alpha-chains of spectrin, ankyrin; changes in the lipid architecture of the membrane and a decrease in the activity of erythrocyte antioxidant activity, which mediate violations of cell deformability and impaired release of ATP; a decrease in the ability of erythrocytes to secrete nitric oxide; a decrease in the level of sphingolipids of the erythrocyte membrane; excessive production of microvesicles with tissue factor; an increase in the rigidity of erythrocytes with impaired release of intra-erythrocyte nitric oxide due to an attack by the SARS-CoV-2 virus 1-hemoglobin beta chain and porphyrin capture with potential heme inhibition; an increase in activated complement components C3b and C4d, immunoglobulin IgG expression on erythrocyte surface, which worsens cell deformability; attachment of erythrocytes through Toll-like receptor 9 to neutrophil extracellular traps, which promotes thrombosis; increased presentation of phosphatidylcholine on erythrocyte membranes, which facilitates the assembly of the tenase complex and prothrombinase complex, contributing to the production of thrombin, an increase in intracellular calcium levels with stimulation of the formation of microvesicles with prothrombotic potential; activation of oxidative stress in erythrocytes under conditions of hypoxia with generation of reactive oxygen species, hemoglobin autooxidation. Conclusions. The data obtained indicate the active role of erythrocytes in the development of intravascular disorders and microcirculation disorders with the risk of cardiovascular complications in patients with COVID-19. Probably, the involvement of red blood cells causes the development of systemic hypoxia in those patients. A detailed study of the identified shifts makes it possible to identify new targets for therapy and improve the prognosis of patients with COVID-19.