Erythrocytes (i.e., red blood cells, RBCs) are an important determinant of the rheological properties of blood because of their large number density (~ 5 × 10
6/mm
3), particular mechanical properties, and aggregation tendency. Typically, a human RBC has a biconcave shape of ~ 8
μm in diameter and ~ 2
μm in thickness, and is highly deformable [
1,
2]. The interior fluid (cytoplasm) has a viscosity of 6 cP, which is about 5 times of that of the suspending plasma (~ 1.2 cP). At low shear stress, RBCs can also aggregate and form one-dimensional stacks-of-coins-like rouleaux or three-dimensional (3D) aggregates [
1,
3,
4]. The process is reversible and particularly important in the microcirculation, since such rouleaux or aggregates can dramatically increase effective blood viscosity. RBCs may also exhibit reduced deformability and stronger aggregation in many pathological situations, such as heart disease, hypertension, diabetes, malaria, and sickle cell anemia [
1]. The underlying mechanism of RBC aggregation is still under debate [
1,
4].
As a consequence of red cell size, the nature of blood flow changes greatly with the vessel diameter. In vessels larger than 200
μm, the blood flow can be accurately modeled as a homogeneous fluid. However, in vessels smaller than this, such as arterioles and venules, and especially capillaries (4–10
μm, i.d.), the RBCs have to be treated as discrete fluid capsules suspended in the plasma. When flowing in microvessels, the flexible RBCs migrate toward the vessel central region, resulting in a RBC concentrated core in the center, and a cell free layer (CFL) is developed near the vessel wall. Such phenomena are important in microcirculation since they are closely related to the flow resistance and biological transport [
1]. Traditionally, to incorporate the CFL effects, microscopic blood flows are modeled as multiphase flows with an interface between the peripheral CFL and the RBC concentrated core [
5]. Using such an approach, it is difficult to incorporate the effects of cell properties on hemodynamics and it is not suitable for investigation of the microscopic flow structures.
Benefiting from advances in computer and simulation technologies, now it is possible to model individual RBCs as discrete particles suspended in the plasma media. For example, Pozrikidis and coworkers [
6–
8] have employed the boundary integral method for Stokes flows to investigate RBC deformation and motion in shear and channel flows; Eggleton and Popel [
9] have combined the immersed boundary method (IBM) [
10] with a finite element treatment of the RBC membrane to simulate large 3D RBC deformations in shear flow. Recently, a lattice Boltzmann approach has also been adopted for RBC flows in microvessels, where the RBCs were represented as two-dimensional (2D) rigid particles [
11]. Bagchi [
12] has simulated a large RBC population in vessels of size 20–300
μm. However, RBC aggregation, which has been demonstrated experimentally as an important factor in determining hemodynamic and hemorheological behaviors in microcirculation [
1,
3,
13], was not considered in these studies. Liu et al. [
14] modeled the intercellular interactions using a Morse potential, thus accounting for RBC aggregation. The cell membrane was modeled with 3D elastic finite elements. Therefore the empirical RBC membrane constitutive relationships, which assume the membrane is a 2D sheet, cannot be utilized directly. Bagchi et al. [
15] have extended the IBM approach of Eggleton and Popel [
9] to two-cell systems and introduced the intercellular interaction using a ligand-receptor binding model. For rigid particles, Chung et al. [
16] have studied the behavior of two rigid elliptical particles in a channel flow utilizing the theoretical formulation of depletion energy proposed by Neu and Meiselman [
17]. It has been noted that such a description yields a constant (instead of a decaying) attractive force with large separations, which is not physically realistic [
16]. Sun and Munn [
18] have also improved their lattice Boltzmann model by including an interaction force between rigid RBCs.
Recently, we have developed an integrated model to study RBC behaviors in both shear and channel flows [
19,
20]. This model combines the lattice Boltzmann method (LBM) for fluid flows and IBM for the fluid-membrane interaction. Crucial factors, including the membrane deformability, viscosity difference across the RBC membrane, and intercellular aggregation, have been carefully considered in the model. The aim of this study was to investigate the effect of different RBC deformabilities and aggregation strengths on CFL structure and flow resistance in microscopic blood flows. We also explored the process of RBC flow development upon the application of an external pressure gradient. Finally, our results are also compared to previous experimental observations and numerical simulations.