[2] The phenomenon is now resolved as a complement-dependent binding reaction of erythrocytes to microorganisms where specific antibodies are engaged in the process.
[3] The reaction process is as follows: any microorganisms are bound with their specific antibodies, if they are produced, which activate the classical pathway of the complement system.
The cascade begins to work from C1 to C3b through C4b, C3b being further transformed to iC3b (inactive derivative of C3b), all of which, C4b and thereafter, remain to bind to the surface of the microbe.
[5] Immune complexes bound to erythrocytes are effectively removed from the circulation, which is presumed alternatively to prevent deposition at tissue sites, for example, the renal glomerulus.
Erythrocytes bearing immune complexes traverse sinusoids of the liver and spleen, where they encounter fixed phagocytes.