The role of the surface charge of human red blood cells (RBC's) in affecting RBC aggregation by macromolecules was studied by comparing the behavior of normal RBC's with that of RBC's treated with neuraminidase, which removes the sialic acids from the cell membrane and reduces the zeta potential. RBC aggregation in dextrans with different molecular weights (Dx 20, Dx 40, and Dx 80) was quantified by microscopic observation, measurement of erythrocyte sedimentation rate, and determination of low-shear viscosity. Dx 20 did not cause aggregation of normal RBC's, but caused considerable aggregation of neuraminidase-treated RBC's. Neuraminidase-treated RBC's also showed stronger aggregation than normal RBC's in Dx 40 and 80. Together with the electron microscopic findings that the intercellular distance in the RBC rouleaux varies with the molecular size of dextrans used, the present study indicates that the surface charge of RBC's inhibits their aggregation by dextrans and that the electrostatic repulsive force between cell surfaces may operate over a distance of 20 nm.

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