Type 2 Diabetes Mellitus is causing red blood cell hemolysis

Abstract

Background: Diabetes mellitus is a metabolic disease and its complications are interlinked andusually have a common soil. The clinical effect of diabetes on erythropoiesis is alwaysinteresting as the production of red cells is always at high rate and continuous, yet the red cellmean life span of 120 days is of an appropriate length, making it an excellent candidate fortests to detect the effect of diabetes and its complications and monitor for the response totreatment.Aim of the study: To determine the level of reticulocyte percent in patients with uncomplicated type 2Diabetes Mellitus and to evaluate the effect of folic acid treatment on this percent.Patients, controls and methods: 140 patients with type 2 Diabetes Mellitus were included in thisstudy. The exclusion criteria from this study were anemia, pregnancy, personal and familyhistory of hemolytic anemia, overt microvascular complications of DM (retinopathy,neuropathy and nephropathy), acute infection and/or inflammation and history of chronicdisease other than diabetes. The patient medical record was reviewed and peripheral bloodspecimen withdrawn for determination of hemoglobin concentration, PCV %, reticulocyte %and HbA1c. A subgroup of (82) patients (45 males and 37 females) were chosen whoconsented on not to change their treatment for the next coming one month except for theaddition of daily one 5mg tablet of folic acid. PCV %, hemoglobin concentration, reticulocytes% were tested for using manual techniques. HbA1c % was measured using automated HPLCmachine.Results: This study revealed increased red cell destruction in type 2 diabetics in comparison to healthycontrol subjects of the same sex and age. Also the reticulocyte increment was more in thosewith higher HbA1c %, although it was not in linear relationship with it. These findings aresuggesting that the initiating event for red cell hemolysis is the increased blood glucose level.Conclusion: Type 2 diabetes patients are subject to oxidative stress as a result of hyperglycemia. Thisstudy suggests that the addition of folic acid treatment to the regime of type 2 diabetic patientscan be useful.