Red blood cell endothelial cells. Exposure of red blood cells to physiological levels of shear stress activates nitric oxide synthase and export of nitric oxide, which may contribute to the regulation of vascular tonus. Red blood cells can also produce hydrogen sulfide, a signalling gas that acts to relax vessel walls. It is believed that the cardioprotective effects of garlic are due to red blood cells converting its sulfur compounds into hydrogen sulfide. Red blood cells also play a part in the body's immune response: when lysed by pathogens such as bacteria, their hemoglobin releases free radicals, which break down the pathogen's cell
Packed red blood cells are kept with a minimal amount of fluid. Generally, an additive solution of citrate, dextrose, and adenine is mixed with the cells to keep them alive during storage. This process is sometimes done as automated apheresis, where the centrifuging and mixing take place at the donation site. Red blood cells are sometimes modified to address specific patient needs. The most common modification is leukoreduction, where the donor blood is filtered to remove white cells, although this is becoming increasingly universal throughout the blood supply (over 80% in the US, 100% in Europe). The blood may also be irradiated, which destroys