Evaluation of Serum Hba1c Levels in Premenopausal Women with Iron Deficiency Anemia

Abstract

The effects of iron deficiency anemia (IDA) on HbA1c levels have not been elucidated. Possible causes include changes in the quaternary structure of hemoglobin and the possibility of facilitating glucose in the β globin chain in the patients with IDA. In our study, it was planned to investigate the effect of IDA on HbA1c in non-diabetic individuals. Ninety-five premenopausal patients aged between 18-46 years who were admitted to our outpatient clinic were included in our study. Forty-five patients with hemoglobin value below 12 mg/dl were classified as patient group and forty-six healthy subjects with hemoglobin value upper 12 mg/dl were classified as control group. The relationship between the hemogram and other iron parameters (iron, total iron binding capacity, ferritin, transferrin saturation) of the study groups were investigated. The mean age of the patients included in our study was 32±10 years in the patient group and 30 ± 8 years in the control group. The HbA1c level was %5.6±0.2 in the IDA group and %5.1±0.2 in the control group.HbA1c level of the control group was The difference between the groups was statistically significant (p <0.001). In our study, HbA1c level was significantly higher in the group with IDA. As a result of our study, it was concluded that IDA and other possible sources of error should be considered when interpreting HbA1c levels. It is thought that effective treatment of RIA will eliminate the negative effects of anemia and the errors that will occur in the interpretation of HbA1c.

Keywords

• Iron deficiency anemia,HbA1c,ferritin,anemia

Demir Eksikliği Anemisi Olan Premenapozal Kadınlarda Serum HbA1c Düzeylerinin Değerlendirilmesi

Abstract

Yapılan araştırmalarda demir eksikliği anemisi (DEA)’nin HbA1c düzeylerine etkisi tam olarak aydınlatılamamıştır. Muhtemel nedenler arasında hemoglobinin kuarterner yapısındaki değişimler ve β globin zincirindeki glukasyonun DEA hastalarında kolaylaşmış olması ihtimali üzerinde durulmaktadır. Çalışmamızda diyabetik olmayan premenopozal kadınlarda DEA’nin HbA1c düzeyine olan etkisinin araştırılması planlanmıştır. Çalışmamıza merkezimiz iç hastalıkları polikliniğine başvuran 18-46 yaş arası premenopozal 91 hasta dahil edildi. Bu bireylerden hemoglobin değeri 12 mg/dl altında olan 45 birey hasta grup, hemoglobin değeri 12 mg/dl ve üzerinde olan sağlıklı 46 birey ise kontrol grubu olarak sınıflandırıldı. Çalışmaya alınan grupların hemogram ve diğer demir parametrelerinin (demir, demir bağlama kapasitesi, total demir bağlama kapasitesi, ferritin, transferrin satürasyonu) HbA1c ile arasındaki ilişki araştırıldı. Çalışmamıza dahil edilen hastaların yaş ortalaması DEA’si olan grupta 32±10 yıl,  kontrol grubunda ise 30±8 yıl idi. Demir eksikliği anemisi olan grubun serum HbA1c düzeyi, kontrol grubunun serum HbA1c düzeyinden yüksek olarak bulundu (sırasıyla; 5.6±0.2 ve 5.1±0.2, p<0.001). Çalışmamızda HbA1c düzeyi DEA olan grupta istatiksel olarak anlamlı yüksek saptanmıştır. Çalışmamız sonucunda HbA1c düzeyleri yorumlanırken DEA ve diğer olası hata kaynakları konusuna dikkat edilmesi gerektiği kanaatine varılmıştır. DEA’nin etkin tedavisinin aneminin olumsuz etkilerini ve HbA1c yorumlanmasında oluşacak hataları ortadan kaldıracağı düşünülmektedir.

Keywords

• Demir Eksikliği Anemisi,HbA1c,ferritin,anemi

References

1. 1. Ünal S, Yetgin S. Demir eksikliği anemisi. Sosyal pediatri. Katkı dergisi 2003;(3): 327-345.
2. 2. Acharya J, Punchard NA, Taylor JA, Thompson PR, Pearson TC. Red cell lipid peroxidation and antioxidant enzymes in iron deficiency. Eur J Haematol 1991;47: 287-91.
3. 3. Neyzi O, Ertuğrul T. Pediatri. Cilt 1.2.B. İzmir: Nobel Tıp Kitapevleri; 1993. s.373.
4. 4. Ali R. Demir eksikliği anemisi. In Dolar E. İç hastalıkları. 1.B. İstanbul; Nobel Tıp Kitapevleri: 2005.s.553- 57.
5. 5. American Diabetes Association. Standards of medical care in diabetes-- 2010. Diabetes Care. 2010 Jan;33 Suppl 1: S11-61.
6. 6. Harris RA, Crabb D. W. Metabolic Interrelationships. In Devlin TM. Textbook of Biochemistry with Clinical Correlations, New York: Wiley-Liss, 2002: 862-902.
7. 7. Calbreath DF. Carbohyrate biochemistry. In: Calbreath DF, edition. Clinical Chemistry A Fundamental Text book. Philadelphia: WB Saunders, 271‐2, 1992.
8. 8. Sacks DB, Path FR. Carbohydrates. In Carl A. Burtis, Edward R. Ashwood, David E. Bruns. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, Philadelphia: Elsevier Saunders, 2006: 837-902.

9. 9. Başkal N. Diabetes Mellitusun Sınıflandırılması. İçinde; Koloğlu. Endokrinoloji Temel ve Klinik; Prof Dr. Gürbüz Erdoğan (Editör), MN Medikal and Nobel. Ankara. 2005: 342-348.
10. 10. American Diabetes Association. Report of The Expert Comittee on The Diagnosis Classification of DM. Diabetes Care, 2000;23(Supl): 4-9.
11. 11. Jovanovic L, Peterson CM. The clinical utility of glycosylated hemoglobin. Am J Med. 1981 Feb;70(2): 331-8.
12. 12. Gram-Hansen P, Mourits-Andersen HT, Eriksen JE, Olesen LL. [Glycosylated hemoglobin (HbA1c) and acute hemolytic anemia]. Ugeskr Laeger. 1990 Feb 12;152 (7): 477-9.
13. 13. Jiao Y, Okumiya T, Saibara T, Park K, Sasaki M. Abnormally decreased HbA1c can be assessed with erythrocyte creatine in patients with a shortened erythrocyte age. Diabetes Care. 1998 Oct;21(10): 1732-5.
14. 14. American Diabetes Association: Tests of glycemia in diabetes. Diabetes Care. 106-108, 2003.
15. 15. Burtis, A., Edward, D. R., Ashwood, M. D. Tietz textbook of clinical chemistry. Third Edition.790-796, 2003.
16. 16. Koloğlu, S. Endokrinoloji Temel ve Klinik. 2. Baskı, MN Medikal ve Nobel, İstanbul,155-280, 2005.
17. 17. Genc S, Omer B, Aycan-Ustyol E, Ince N, Bal F, Gurdol F. Evaluation of turbidimetric inhibition immunoassay (TINIA) and HPLC methods for glycated haemoglobin determination. J Clin Lab Anal. 2012 Nov;26(6): 481-5. doi: 10.1002/jcla.21550.
18. 18. Harris RA. Carbohydrate Metabolism I: Major Metabolic Pathways and Their Control In Devlin T.M. Textbook of Biochemistry with Clinical Correlations, New York: Wiley-Liss, 2002: 598-664.
19. 19. Dinçol G, Pekçelen Y, Atamer T. Klinik Hematoloji. Nobel Tıp Kitapevi İstanbul 2003.
20. 20. Alıcı S, Dülger HH. Hemoglobinlerin nonenzimatik glikozilasyonu. Van Tıp Dergisi.2001;8(3): 105-110.
21. 21. Sluiter WJ, van Essen LH, Reitsma WD, Doorenbos H. Glycosylated haemoglobin and iron deficiency. Lancet 1980;6;2: 531-2.
22. 22. Mitchell TR, Anderson D, Shepperd J. Iron deficiency, haemochromatosis, and glycosylated haemoglobin. Lancet 1980; 4;2: 747.
23. 23. Tietz textbook of clinical chemistry. Carl A.Burtis, Ph.D.Edward .Ashwood,M.d.Third EDİtion.2003.790-796.
24. 24. Harrison’s principles of internal medicine. Braunwald,Faunci, Kasper, Hause R, Longo, Jarneson, 2019-2025,15th edition.
25. 25. Glycosylatedhemoglobin.https://ahdc.vet.cornell.edu/clinpath/modules/chem/glycos.htm Roerdinkholder-Stoelwinder
26. 26. Sucu V, Yıldırmak S, Durmuşcan M, Yetişkinlerde Demir eksikliği Anemisi ve Hemoglobin A1c Düzeyleri Arasındaki İlişki Türk Klinik Biyokimya Derg 2015;13(1): 7-14.
27. 27. Gram-Hansen P, Eriksen J, Mouritis-Andersen T, Olesen L. Glycosylated haemoglobin Deficiency (HbA1c) in iron- and vitamin B12. lntern Med 1990;227: 133-36.
28. 28. Alıcı S, Vural H, Ecirli Ş. Demir Eksikliği Anemisinde HbA1c ve Fruktozamin Değerleri.http://www.ichastaliklaridergisi.org/managete/fu__folder/1997-06/html/1997-4-6-371-375.html Erişim Tarihi:20.06.2013.
29. 29. Erkan C, Mustafa O, Aysen T. Effect of iron deficiency anemia on the levels of Hemoglobin A1c in nondiabetic patients. Acta Haematol 2004;112: 126-8.
30. 30. Shanthi B, Revathy C, Manjula Devi AJ, Subhashree. Effect of iron deficiency on glycation of haemoglobin in nondiabetics. J Clin Diagn Res 2013;7: 15-7.
31. 31. Kim C, Bullard KM, Herman WH, Beekles GL. Association Between Iron Deficiency and HbA1c Levels Among Adults Without Diabetes İn the National Health and Nutrition Examination Survey, 1999-2006 Diabetes Carel 2010;33: 780-5.
32. 32. El-Agouza I, Abu Shahla A, Sirdah M. The effect of iron deficiency anaemia on the levels of haemoglobin subtypes: possible consequences for clinical diagnosis. Clin Lab Haem 2002;24: 285–9.
33. 33. Van Heyningen C, Dalton RG. Glycosylated hemoglobin in iron deficiency anemia. Lancet 1985;1: 874.
34. 34. Sinha N, Mishra TK, Singh T and Gupta N. Effect of Iron Deficiency Anemia on Hemoglobin A1c Levels. Ann Lab Med 2012;32: 17–22.
35. 35. Ford ES, Cowie CC, Li C, Handelsman Y, Bloomgarden ZT. Iron-deficiency anemia, non-iron-deciency anemia and HbA1c among adults in the US. J Diabetes 2011;3(1): 67-73.
36. 36. Brooks AP, Metcalfe J, Day JL, Edwards MS. Iron deficiency and glycosylated haemoglobin A1. Lancet 1980 Jul 19;2(8186): 141.
37. 37. Rai KB, Pattabiraman TN: Glycosylated haemoglobin in iron- deficiency anaemia. Indian J Med 1986; 83:234-6. 37. Madhikarmi NL, Murty KR. Antioxidant enzymes and oxidative stres in the erythrocytes of iron deficiency anemic patients supplemented with vitamins. Iran Biomed J 2014;18: 82-7.
38. 38. Christy AL, Manjrekar PA, Babu RP, Hegde A, Rukmini MS. Influence of Iron Deficiency Anemia on Hemoglobin A1C Levels in Diabetic Individuals with Controlled Plasma Glucose Levels. Iran Biomed J 2014;18: 88–93.