International Journal of Physiology

Incidence and prevalence of diabetes is increasing all over the world. Increased blood glucose level is an important risk factor in the development of diabetic microvascular and macrovascular complications. Hyperglycemia induces biochemical and haematological changes. Erythrocyte deformability improves blood flow in microvessels. Both persistent and variable hyperglycemia causes various changes in the RBC membrane and its cytoplasm. This leads to modification in the deformability of RBC membrane. With prolonged exposure of RBCs to hyperglycemic conditions, the deformability of RBCs is further decreased, and its aggregation increases. This makes whole blood more viscous and responsible for microvascular complications. This decreased deformability is reflected as anisocytosis in peripheral smear. This study is aimed at finding the correlation between hyperglycemia and anisocytosis and educating the diabetic population about the importance of maintaining the blood glucose levels under control.

This study was done in 150 subjects in the age group 25 to 50 years (50 control (25 male and 25 female)with normal fasting blood glucose level 70–110 mg/dl, 50 subjects (25 male and 25 female) having blood glucose level between 126–200 mg/dl and 50 subjects (25 male and 25 female) having blood glucose levels between 200–300 mg/dl of Annapoorana Medical college hospitals. Patients with anaemia, malnutrition, and other chronic diseases whose RBCs may show anisocytosis were excluded. Fasting blood glucose level was measured. Peripheral smear was prepared and stained with Leishman's stain. Smear was focused under oil immersion objective, and the image was captured using a digital camera. Image was transferred to the computer system and RBC diameter was measured using UTHSCA image tool software. Variation in size of the RBCs between control and subjects was compared using Pearson's product moment correlation coefficient and Paired sample t test.

Graded increase in the variation in the size of RBCs (anisocytosis) was observed with graded increase in blood glucose levels. By using Pearsons product moment correlation coefficient, significant r value of 0.5, 0.8 and 0.95 were got in male control group, mild hyperglycemic(125–200 mg/dl) group and moderate hyperglycemic (200–300 mg/dl) group and r value of 0.4, 0.7 and 0.76 were got in female control, moderate hyperglycemic and severe hyperglycemic group. Comparing blood glucose and anisocytosis using Paired sample t test, significant p value of ˂ 0.01 was got in male and female mild hyperglycemic and moderate hyperglycemic group.

Erythrocytes of diabetes mellitus patients are floating in hyperglycemic environment during their life span. Hyperglycemia induces the production of ROS(Reactive Oxygen Species) causing oxidative stress as well as lipid peroxidation which may accelerate vascular complications in diabetes. This induces the changes in erythrocyte deformability and causes the aggregation of RBCs, in turn, affects their flow properties in the blood vessels. This accelerate the vascular complication in diabetics.