ObjectiveTo assess emotional fluctuations, physical and mental health status, and indicators closely related to red blood cells, such as RIO kinase 3 (Riok3), MAX interactor 1 (Mxi1), and microRNA 191 (miR191), in participants with different levels of red blood cells. MethodsParticipants who underwent physical examinations at Dongfang Hospital between April and October 2019 were divided into healthy, blood deficiency, and anemia groups (30 individuals in the healthy and blood deficiency group respectively, and 13 in the anemia group). The physical and mental conditions of the participants were evaluated through questionnaires, and emotional fluctuations were assessed through an emotion-inducing experiment, in which participants watched video segments designed to induce specific emotions. Relative expression levels of miR191, Riok3, and Mxi1 from venous blood samples were also determined. ResultsThe main psychological factors identified in the anemia and blood deficiency groups were obsessive-compulsive symptoms, depression, anxiety, and other negative emotions. Relative gene expression levels indicated that miR191 was upregulated and Riok3 and Mxi1 were downregulated in both the blood deficiency and anemia groups. Regarding the emotional score of disgust on video stage, the main effect was significant (F = 335.58, P < .001), which showed that watching the three videos caused participants to have a dominant emotion, and there is a difference on group (F = 5.35, P = .01), with higher disgust scores in the anemia and blood deficiency groups. The symptoms of blood deficiency and anemia, such as weakness in limbs were significantly negatively correlated with Riok3 and Mxi1 expression (r = −0.38 and −0.31 respectively), but was significantly positively correlated with miR191 expression (r = 0.29). ConclusionWe determined that a close relationship exists between red blood cell levels and emotional status. Our findings suggest that individuals with anemia and blood deficiency are more likely to experience psychological problems and negative emotions, particularly disgust. We also demonstrate that emotional regulation is related to mir191-Riok3-Mxi1 pathway activity, identifying these pathway components are potential targets for genetic therapies in combination with psychological therapy.