Endothelial cell alterations are considered to be a primary event in thrombosis and atherosclerosis. The adhesion of red cells from diabetic patients or patients with sickle cell anemia was measured using endothelial cell culture and a radiometric technique. The adhesion was significantly increased (P less than 0.001). Ultrastructure observation of red cells adhering to endothelial cells showed endothelial cell deformations, membrane modifications and formation of an anchoring device. Morphological changes support the hypothesis of an endothelial cell stimulation or damage during adhesion already suggested by the increased prostacyclin release during red cell adhesion.
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