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In vertebrates, oxygen transport is primarily carried out by red blood cells (erythrocytes). Red blood cells pick up oxygen in the lungs (or gills in fish) and release it to body tissues as they pass through capillaries. This function depends on hemoglobin, an iron-containing protein in the red cell cytoplasm that binds oxygen reversibly; oxygen diffusion across the red cell membrane supports the exchange. Hemoglobin also helps transport carbon dioxide indirectly by carrying some CO2 while most CO2 is returned to the lungs as bicarbonate in blood plasma. Red blood cell structure and microstructure vary across vertebrates but are generally optimized for gas exchange. Most vertebrates have nucleated red blood cells, while mature mammalian red blood cells are anucleate and lack organelles, allowing more space for hemoglobin. The biconcave shape of mammalian red cells increases surface-area-to-volume ratio and supports deformability, enabling them to squeeze through very narrow capillaries and efficiently unload oxygen. Membrane composition (glycocalyx, lipid bilayer, and membrane skeleton) and membrane proteins contribute to deformability, stability, and interactions with immune cells and the vascular endothelium, all of which support effective oxygen delivery. Oxygen transport is clinically important and measurable through hemoglobin-related properties such as color changes used in pulse oximetry. Red cell abnormalities or altered membrane/lipid/protein function can impair circulation and oxygen delivery, contributing to disease. Transfusion medicine relies on red cell preparation and compatibility testing to restore oxygen-carrying capacity when needed.
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