Maintenance of phospholipid organization in red blood cells. Reactive oxygen species (ROS) will modify the unsaturated fatty acyl side chains in phospholipids (PL). The oxidized lipids (oxPL) will have a different orientation in the bilayer and are recognized by phospholipases (PLA2) that remove the oxidized fatty acid to generate lysophospholipid (LPL). Fatty acid (FA) taken up from plasma is activated to fatty acyl CoA (FA-CoA) by acylCoA synthetase (ACSL6) using adenosine triphosphate (ATP) and Coenzyme A (CoA). FA-CoA pools are modulated by FA-CoA–binding protein (FA-CoABP). Lysophospholipid acylCoA acyltransferases (LPLAT) use FA-CoA and LPL to generate PL, completing the de-acylation/re-acylation repair cycle. The asymmetric distribution of phospholipids across the bilayer is maintained by the Magnesium ATP-dependent aminophospholipidtranslocase or flippase, which transfers PS and PE from outer to inner monolayer at the expense of ATP. Loss of phospholipid asymmetry and the exposure of PS is triggered by a phospholipid scrambling activity.