Integrin adhesion receptors mediate the adhesion of blood cells, such as leukocytes, to other cells, such as endothelial cells. Integrins also are critical for anchorage of hematopoietic precursors to the extracellular matrix. Blood cells can dynamically regulate the affinities of integrins for their ligands ("activation"), an event central to their functions. Here we review recent progress in understanding the mechanisms of integrin activation with a focus on the functions of blood cells. We discuss how talin binding to the integrin b cytoplasmic domain, in conjunction with the plasma membrane, induces long-range allosteric rearrangements that lead to integrin activation. Second, we review our understanding of how signaling events, particularly those involving Rap1 small guanosine triphosphate (GTP) hydrolases, can regulate the talin-integrin interaction and resulting activation. Third, we review recent findings that highlight the role of the Rap1-GTP-interacting adapter molecule (RIAM), encoded by the APBB1IP gene, in leukocyte integrin activation and consequently in leukocyte trafficking. (Blood. 2016;128(4):479-487) Introduction Circulating blood cells patrol the body to guard against pathogens and maintain homeostasis. The adhesive interactions of leukocytes with the blood vessel walls are transient and dynamic and serve a wide range of immune functions.1 Similarly, platelets do not stably adhere to the intact vessel wall; however, when the endothelium is disrupted, a rapid interaction between circulating platelets and the vessel leads to the formation of a platelet-leukocyte-fibrin aggregate that mediates hemostasis.2 Members of the integrin adhesion receptor family play important roles in these processes. Integrins are type 1 transmembrane receptors that mediate cell-cell and cell-extracellular matrix adhesion. 3 Each integrin heterodimer contains 1 a and 1 b subunit. In vertebrates, 18 a and 8 b subunits can form 24 integrins with characteristic tissue distributions and distinct ligand binding specificities. 3,4 Leukocyte integrins include aLb2 (LFA-1, CD11a/CD18), a4b1 (VLA-4), and aMb2 (Mac-1, CD11b/CD18), 5,6 whereas integrin aIIbb3 (GPIIbIIIa) is by far the most abundant platelet integrin. 7 Integrins sense chemical and physical properties of extracellular matrix and control signal transduction pathways that regulate cell adhesion, proliferation, differentiation, and apoptosis. 3 Mutations of integrin genes can lead to blood diseases such as leukocyte adhesion deficiency I syndrome, 8,9 due to mutations in the gene encoding integrin b2, or Glanzmann thrombasthenia, 10 due to mutations in the genes encoding aIIb or b3. Integrins in blood cells are usually in a low-affinity state until agonist stimulation induces a high-affinity form, a process operationally defined as "integrin activation." 6,[11][12][13] On platelet stimulation by agonists such as thrombin or collagen, activated aIIbb3 binds fibrinogen, fibronectin, and von Willebrand factor to enable both stable adherence to the vessel wal...