The human erythrocyte has developed the biconcave disc shape to optimise the flow properties of the blood in the large vessels.

The human erythrocyte adopts a distinctive biconcave disc form in vivo. The question as to why the red blood cell should have this particular profile remains unresolved. It has been suggested that this shape maximises the surface area to volume ratio and thus expedites diffusion. This hypothesis, however does not stand up to examination. Maximal diffusion occurs in the small vessels. In order to pass through the microvasculature the erythrocyte becomes distorted and deviates from the biconcave disc shape [Branemark PI, Lindstrom J. The shape of circulating blood corpuscles. Biorheology 1963;1:139; Guest MM, Bond TP, Cooper RG, Derrick JR. Red blood cells: change in capillaries. Science 1963;142:1319-21]. Here, it is suggested the haemodynamic factors have dictated the peculiar shape of the discocyte. The deleterious nature of turbulent flow on the cardiovascular system suggests that the biconcave disc form has evolved out of a necessity to maximise laminar flow, minimise platelet scatter which in turn suppress atherogenic activity in the large vessels [Yoshizumi M, Abe J, Tsuchiya K, Berk BC, Tamaki T. Stress and vascular responses: athero-protective effect of laminar fluid shear stress in endothelial cells: possible and mitogen-activated protein kinases. J Pharmacol Sci 2003;9:172-6]. The biconcave profile of the discocyte means that much of the mass is distributed in the periphery. This increases the moment of inertia of the cell and subsequently renders the erythrocyte less prone to rotation during flow in the large vessels. Here it is suggest that this reduction in rotation promotes laminar flow and discourages platelet scattering by minimising the "Eddy currents" and it thus anti-atherogenic. A number of pathological mutations result in the red blood cell adopting a spherical shape as opposed to the biconcave disc profile. The sphere has a smaller moment of inertia when compared to the discocyte, as much of the mass is distributed round the centre. The spherocyte is hence much more prone to rotation during flow in the large vessels. There is evidence to suggest that asplenic individuals suffering from spherocytosis are at increased risk of atherogenic cerebrovascular and cardiovascular large-vessel disease, when compared with their asplenic haematological normal counterparts [Schilling RF. Spherocytosis, splenectomy, strokes and heart attacks. Lancet 1997;350:1677-8; Robinnette CD, Fraumeni Jr JF. Splenectomy and subsequent mortality in veterans of the 1939-1945 war. Lancet 1977;ii:127-9].