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 the red blood cells using special equipment, such as the IBM 2991 cell processor in a similar manner to washing RBCs. The processing (often termed "manufacture", since the end result is deemed a biologic biopharmaceutical product) and the storage can occur at a collection center and/or a blood bank. RBCs are mixed with an anticoagulant and storage solution which provides nutrients and aims to preserve viability and functionality of the cells (limiting their so-called "storage lesion"), which are stored at refrigerated temperatures for up to 42 days (in the US), except for the rather unusual long-term storage in which case