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Red blood cell (RBC) aggregation was investigated in a rat model of sepsis with special emphasis on RBC-related factors. Sepsis was produced by cecal ligation/ puncture while another group had only laparatomy (sham-operation); blood samples were also obtained from control, unoperated animals. RBC aggregation was measured in autologous plasma and in 3 % dextran 70, 18 hours after the operations, using a Myrenne Aggregometer system and the Zeta Sedimentation Ratio (ZSR) method. RBC aggregation in autologous plasma was found to be enhanced in both sham-operated and septic animals, and was consistent with their increased plasma fibrinogen levels. However, RBC aggregation in dextran was significantly higher than control only in the sepsis group. RBC from septic animals also aggregated more in septic plasma compared to RBC from control animals. In the sepsis group, RBC deformability was significantly decreased while RBC lipid peroxidation was significantly increased. Our results thus confirm the known increase of RBC aggregation in septicemia, and in addition, demonstrate marked alterations of intrinsic RBC properties which further enhance red cell aggregation