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The retina is particularly vulnerable, often resulting in sickle cell retinopathy (SCR) or sickle cell maculopathy (SCM). The precise underlying mechanisms are unclear, though various factors are suggested to contribute. This study explored the role of whole blood viscosity and red blood cell (RBC) deformability in SCR and SCM. Adult HbSS (<jats:italic>n<\/jats:italic>\u2009=\u200934) and HbSC patients (<jats:italic>n<\/jats:italic>\u2009=\u200934) were offered an ophthalmic examination to determine SCR stage. A venous ethylenediaminetetraacetic acid (EDTA) sample was collected from each participant. Whole blood viscosity was measured using a Brookfield viscometer and RBC deformability was assessed using the Oxygenscan feature of the Laser Optical Rotational Red Cell Analyser as a function of the (varying) partial oxygen pressure. HbSC patients with proliferative sickle cell retinopathy (PSCR) had a lower delta elongation index (<jats:italic>p<\/jats:italic>\u2009=\u20090.012) and point of sickling (<jats:italic>p<\/jats:italic>\u2009=\u20090.002) than those without PSCR, suggesting that RBC sickling might not play a central role in the pathogenesis of PSCR in HbSC patients. Despite hyperviscosity being a commonly proposed mechanism, no associations were found between blood viscosity, SCR and SCM. These results point to alternative mechanisms contributing to SCR and SCM, highlighting the complexity and need for further research to fully understand the underlying factors.<\/jats:p>","DOI":"10.1111\/bjh.20124","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T03:45:55Z","timestamp":1745898355000},"page":"1796-1805","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The role of red blood cell characteristics and viscosity in sickle cell retinopathy and maculopathy"],"prefix":"10.1111","volume":"206","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2947-4598","authenticated-orcid":false,"given":"Rajani P.","family":"Brandsen","sequence":"first","affiliation":[{"name":"Department of Ophthalmology Amsterdam UMC  Amsterdam The Netherlands"},{"name":"Department of Haematology Amsterdam UMC  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roselie M. H.","family":"Diederen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Amsterdam UMC  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingeborg","family":"Klaassen","sequence":"additional","affiliation":[{"name":"Ocular Angiogenesis Group Department of Ophthalmology, Amsterdam UMC  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn","family":"Veldthuis","sequence":"additional","affiliation":[{"name":"Laboratory for Red Blood Cell Diagnostics Sanquin  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herbert","family":"Korsten","sequence":"additional","affiliation":[{"name":"Department of Product and Process Development Sanquin Blood Bank  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob","family":"van Zwieten","sequence":"additional","affiliation":[{"name":"Laboratory for Red Blood 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Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4426-5743","authenticated-orcid":false,"given":"Bart J.","family":"Biemond","sequence":"additional","affiliation":[{"name":"Department of Haematology Amsterdam UMC  Amsterdam The 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