The Bessis reticular cell, the hemoglobin 'switch' and the role of fetal hemoglobin: a hypothesis

With the help of diverse factors, definitive erythropoiesis is induced by the junction of a pluripotential stem-cell with a specialized macrophage. In the normal adult marrow the latter becomes the reticular cell forming the core of an 'erythroblastic island'. It stays in close contact with all the erythroid cells descending from the stem-cell until their full maturation. While this contact lasts, only alpha and beta (delta) globin chains are produced. The production of gamma chains is inhibited. Stress forces the reticular cell to let the erythroid cells go. The stronger the stress, the earlier the separation. When free from the reticular cell, the erythroid cells stop producing beta chains and switch to form gamma ones. Increase in the volume of blood circulation is a potent stress. Since it is relatively enormous in the embryo and the fetus, most hemoglobin produced at these periods will be fatal. The important quality of fetal hemoglobin is its high oxidizability. It permits the senescent fetal red cell to be hemolysed intravascularly before any membrane alterations appear. The heme is dealt with by the placenta. Since no erythrophagocytosis has occurred, no bilirubin is formed. This process prevents bilirubin, which is toxic to the fetal liver, to reach it.