The tendency of sickle cells to adhere to the endothelium reflects the surface features not
only of the red cells but also of the endothelial cells. Sickle cell disease is a prototype of a
condition where the erythrocyte is under stress, ischemic, oxidative, or shear stress, that
causes changes in the erythrocyte morphology. This change leads eventually to enhanced
erythrocyte-endothelial cell adhesion. Reactive oxygen species generated by cytokine-
activated inflammatory cells oxidize lipoproteins such as LDL and lipoprotein (a) within the …