Generation and Export of Red Blood Cell ATP in Health and Disease.

Metabolic homeostasis in animals depends critically on evolved mechanisms by which red blood cell (RBC) hemoglobin (Hb) senses oxygen (O) need and responds accordingly. The entwined regulation of ATP production and antioxidant systems within the RBC also exploits Hb-based O-sensitivity to respond to various physiologic and pathophysiologic stresses. O offloading, for example, promotes glycolysis in order to generate both 2,3-DPG (a negative allosteric effector of Hb O binding) and ATP.