Red Blood Cells and CFS

The question of red blood cell (Erythrocytes) came up on my local Seattle CFS Group and I thought it would be good to summarize what we know in this area.

  • Reduced red cell distribution width

    • Note: Increased red cell distribution width in IBS and active IBD
  • Increased percentages of misshapen red blood cells
  • Percentage of deformed cells reduced with B12 injections within 24 hrs in responders [source]
  • Morning blood sample can be normal and the afternoon sample can be grossly abnormal
  • B12 injections improved blood appearance in 50% of patients
  • Changed red cell shape populations.
  • High values for flat blood-cells.
  • Reduced Red Blood Cell Volume [Bell]

For more reading see Red-Blood Distribution Width on PubMed.

Low Oxygen to Brain but normal Oxygen Levels?

Part of the model that I work off is hypercoagulation. This slows down blood flow so less blood gets pushed to the tissue per minute. If you take a sample of your blood — oxygen levels will appear normal.  This chart from a 2004 study shows that CFS patient has a lower rate of blood flow. The top chart shows up to 20% decreased speed for CFS patients (potentially 20% oxygen presented to tissue).

Blood flow Speed is less with CFS

Hypothesis of Cause

I believe that hyper-coagulation (“thick blood”) may account for the above. Soluble Fibrin Monomers can be viewed as a thickening agent to the blood. While the total volume stays the same, the volume of red blood cell is decreased. The fibrin fragments also act as mesh resulting in smaller cells (from them being forced thru it) as well as deforming them. Simpson reports that Ginko, Evening Primrose Oil and B12 improved the shape[source]; two of these are known anti-coagulants.

Can be microbiome be involved?

  • Some bacteroides  break down coagulation [1986], low bacteriodes may increase coagulation could be suspected.
  • Enterocolitis generates platelet-activating factor, and induces a coagulopathy. [2013] [1991]