Hereditary spherocytosis and other hemolytic anomalies distort diabetic control by glycated hemoglobin

Abstract

Glycated hemoglobin (%HbA1c) has become a well established and reliable long term parameter indicative of the mean glucose load of the preceding 8 -10 weeks. A normal life span of approximately120 days of the red blood cells (RBC) is an essential condition. Hemolytic affections are characterized by a shorter life span, reducing the overall glucose uptake and %HbA1c. Measured %HbA1c is no longer correlated with mean blood glucose of the preceding period, simulating false low values. Underestimation of this kind is demonstrated for several hemolytic conditions, among them hereditary spherocytosis (HS). This latter, often harmless anomaly may lead to serious underestimation of glucose load. Recent investigations show not only a much higher incidence of HS than hitherto admitted (approximately 1 in 250 persons) but also an abnormally high incidence of diabetes in this hemolytic affection. In the presence of hemolysis %HbA1c is to be interpreted with caution. This justifies systematic detection of HS in routine hematology using--if available--the increase of the percentage of hyperchromic RBC.