Microfluidic technologies are commonly used for the manipulation of red blood cell (RBC) suspensions and analyses of flow-mediated biomechanics. To maximise the usability of microfluidic devices, understanding the dynamics of the suspensions processed within is crucial. We report novel aspects of the spatio-temporal dynamics of an RBC suspension flowing through a typical microchannel at low Reynolds number. Through experiments with dilute RBC suspensions, we find an off-centre two-peak (OCTP) profile of cells resembling the well-known "tubular pinch effect" which would arise from inertial effects. However, given the negligible inertia under our experimental condition, an alternative explanation is needed for this OCTP profile contrary to the centralised distribution commonly reported for low-inertia flows. Our massively-parallel simulations of RBC flow in real-size microfluidic dimensions using the immersed-boundary-lattice-Boltzmann method (IB-LBM) confirm the experimental findings and elucidate the underlying mechanism for the counterintuitive RBC pattern. By analysing the RBC migration and cell-free layer (CFL) development within a high-aspect-ratio channel, we show that such a distribution is co-determined by the spatial decay of hydrodynamic lift and the global deficiency of cell dispersion in dilute suspensions. We find a CFL development length greater than 46 and 28 hydraulic diameters in the experiment and simulation, respectively, exceeding typical lengths of microfluidic designs. Our work highlights the key role of transient cell distribution in dilute suspensions, which may negatively affect the reliability of experimental results if not taken into account. and immune cells. Pioneered by Chien and Skalak in the 1960s-1980s [1, 2, 3], there has been extensive research carried out theoretically, experimentally and numerically to elucidate the behaviour of single RBC and characterise the dynamics of RBC suspensions (see recent reviews [4,5,6,7,8]). However, despite major progress, a rigorous and quantitative connection between microscale RBC dynamics and macroscale haemorheology is still lacking [9]. Up to date, various factors affecting blood microrheology have been determined by theoretical/numerical models of RBCs or biomimetic vesicles, including (but not limited to): (i) viscosity contrast (between inner and outer fluids) [10], deformability [11], orientation [12] and initial position [13] of the cell; (ii) shear component (distinct in linear/quadratic flows) [14], suspending viscosity [15], flowline curvature [16] and wall confinement [17] of the flow; (iii) two-body or multi-body hydrodynamic interactions between cells [18]. Most studies focus on the individual dynamics/pairwise interaction of cells or the characteristic signatures of the overall suspension system, e.g., effective viscosity and normal stress differences.Much less attention has been paid to the collective behaviour of cells, e.g., their spatiotemporal organisation or local microstructures, at a realistic length scale in three-dimens...