The recognition of abnormal lipoprotein metabolism that produces chronic hypocholesterolemia in myeloproliferative disorders and the known influence of altered plasma lipid levels on erythrocyte membranes prompted a study of erythrocyte susceptibility to lipid peroxidation in myeloproliferative disease. Malonyldialdehyde generation during an oxidant challenge of erythrocyte suspensions of standardized hemoglobin concentration with H2O2 was significantly greater in 32 patients with myeloproliferative disease than in 47 hematologically normal subjects. The myeloproliferative disease group had significantly lower plasma total, HDL-, and LDL-cholesterol, erythrocyte indices, and erythrocyte deformability, and higher reticulocyte counts and serum lactic dehydrogenase. In the myeloproliferative disease group, mean corpuscular hemoglobin concentration, reticulocyte count, and erythrocyte count were significant variables in accounting for the observed variation in peroxidation susceptibility. Erythrocytes of patients with myeloproliferative disease had elevated concentrations of reduced glutathione, normal glutathione stability, and normal alpha-tocopherol content. These studies demonstrate increased susceptibility to oxidative damage in myeloproliferative disease despite normal or increased concentrations of the major antioxidant compounds of the erythrocyte. The presence of reticulocytosis, elevated serum lactic dehydrogenase, and decreased erythrocyte deformability suggests that lipid peroxidation susceptibility is associated with in vivo hemolysis and may contribute to the anemia that complicates myeloproliferative disease.