Estimation of mean erythrocyte age using HbA1c or HbA1c/glycated albumin for evaluation of anemia severity

BackgroundHemoglobin A1c (HbA1c) levels are low in patients with hemolytic anemia, as HbA1c reflects mean erythrocyte age (M-RBC). Erythrocyte creatine (EC) is a hemolytic indicator that also reflects M-RBC. We previously reported an equation for estimating M-RBC using EC (EC-M-RBC). AimsIn this study, EC-M-RBC was compared to the HbA1c level expressed in the International Federation of Clinical Chemistry and Laboratory Medicine units (iA1c) and to the iA1c/glycated albumin (GA) ratio to estimate M-RBC. MethodsThis study included 238 subjects, including patients with hemolytic anemia and/or type 2 diabetes mellitus (T2DM). ResultsIn non-diabetic individuals, both iA1c and iA1c/GA showed a strong positive correlation with EC-M-RBC (p < 0.0001). The equations to estimate iA1c-M-RBC and iA1c/GA-M-RBC derived from the regression equations between EC-M-RBC and iA1c, and EC-M-RBC and iA1c/GA in nondiabetic individuals were 1.45 x iA1c and 20.0 x iA1c/GA, respectively. iA1c-MRBC and iA1c/GA-MRBC in non-diabetic individuals without hemolytic anemia were 57.6 & PLUSMN; 4.0 and 57.1 & PLUSMN; 6.4 days, respectively, and iA1c/GA-MRBC in T2DM patients without hemolytic anemia was 56.0 & PLUSMN; 8.8 days.; no significant difference was seen in the comparisons. ConclusionsThe M-RBC can be estimated using iA1c or iA1c/GA in non-diabetic individuals, and iA1c/GA in T2DM patients.