Anaemia and HbA1c

Iron-deficiency anaemia can lead to rises in HbA1c of up to 2% that can then subsequently be reversed by iron treatment.7276 The reason for this rise is not fully known, but since iron deficiency is such a common finding, especially in pre-menopausal women, it could influence the diabetes management of many patients. There is also some evidence in pre-menopausal women without overt anaemia that a low mean cell haemoglobin is also associated with higher HbA1c values.77 Reassuringly, however, the overall relationship between MPG and HbA1c in the population of pre-menopausal women participating in the DCCT was no different to that of men, suggesting that overt anaemia needs to be present to have marked effects on HbA1c measurement.78

Haemolytic anaemia has the opposite effect to iron deficiency by reducing HbA1c in affected individuals. This is simply a consequence of reduced red cell survival, meaning a reduction in the availability of haemoglobin for glycation.79 All causes of this form of anaemia (including immune haemolytic anaemia, haemoglobinopathies and chronic renal failure) are affected.


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