Impairment of erythrocyte viscoelasticity is correlated with levels of glycosylated haemoglobin in diabetic patients

Abstract

Erythrocytes from diabetic patients exhibit impaired viscoelastic properties when estimated by various methods. We determined erythrocyte filterability through 5-microm pores, in 51 patients with non-insulin-dependent diabetes mellitus, 18 healthy controls, 15 patients with homozygous beta-thalassemia and 15 with beta-thalassemia traits. The filtration measurements were made with a Hemorheometer, which uses the "initial flow rate" principle. To determine the Index of Rigidity (IR) of the red blood cells, we measured the passage time of white blood cell-free erythrocyte suspensions, 8% per volume, through the filter. Diabetic patients had significantly increased IR in comparison to healthy controls and to patients with beta-thalassemia trait, but not at the level found in patients with homozygous beta-thalassemia. In diabetic patients, a strong correlation between IR and the percentage of glycosylated haemoglobin was found (r=0.737, P < 0.0001), and a weaker one with serum unconjugated bilirubin (r=0.363, P=0.0097) and serum total lipids (r=0.321, P=0.0286). Patients with severe retinopathy also had significantly increased IR, in comparison to those with or without mild retinopathy. Anaemic diabetic patients, especially those with the anaemia of chronic disease, also had significantly increased IR in comparison to non-anaemic diabetics. No correlation between IR, MCV, MCH, MCHC, RDW, RBC morphology, serum LDH or the presence of erythrocyte inclusions after incubation with nitrous sodium solution was found. Our findings suggest that glycosylation of skeletal proteins probably contributes significantly to the increased membrane rigidity of diabetic erythrocytes.

Role of red blood cells in haemostasis and thrombosis

“…Other diseases, including β-thalassemia, hemolytic anemias caused by RBC antibodies, and hereditary stomatocytosis, also commonly have RBCs with stiff membranes [23]. Some diseases, such as diabetes, hypertension, lower limb vein thrombosis, coronary heart disease, can secondarily alter the properties of RBCs, making them stiffer and prothrombotic [24]. Decreased RBC deformability reduces permeability of blood clots and thrombi, which may have implications for the penetration of fibrinolytic agents [25].…”

Dynamics of microvascular oxygen pressure during rest-contraction transition in skeletal muscle of diabetic rats

“…In addition, there is an enhanced RBC membrane protein glycosylation that serves to increase RBC rigidity (29,32). This increased RBC rigidity and hence decreased deformability will reduce the ability of RBCs to pass freely into the narrow capillaries that are present in muscle from diabetic rats (19,29).…”

“…In addition, there is an enhanced RBC membrane protein glycosylation that serves to increase RBC rigidity (29,32). This increased RBC rigidity and hence decreased deformability will reduce the ability of RBCs to pass freely into the narrow capillaries that are present in muscle from diabetic rats (19,29). The net effect of these structural and functional deficits present in skeletal muscle of diabetic rats constrains oxygen delivery (as assessed by F RBC ) by up to 50% at rest (19).…”

Investigation of the Effects of Sevoflurane and Desflurane on Erythrocyte Deformability in Transient Hyperglycemia

“…Also, calcium, sorbitol, and glycerol are observed to increase (5,6). These changes cause the decrease of erythrocyte lifespan due to membrane lipids imbalance and decrease of membrane permeability (3,7). As a consequence of these events due to hyperglycemia, reduction of erythrocyte deformability occurs.…”