Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Real and artefactual erythrocyte swelling in hyperglycaemia

Summary

The mean erythrocyte volume of patients with acute diabetic decompensation was determined by Coulter measurement and found to be elevated above normal (mean increase 5.5 μ3). Experiments in vitro revealed this to be an artefact associated with Coulter determination. A more reliable estimate of in vivo erythrocyte volume can be obtained from centrifugated haematocrit and erythrocyte count. With this method, true erythrocyte swelling parallel to glucose concentration was observed when erythrocytes were exposed to isotonic glucose-NaCl solutions. This volume increase resulted from decreased sodium concentration and was in the order of 0.5–1.0 μ,3 per mmol/l of sodium. Glucose was osmotically ineffective. Similar volume changes were documented in a diabetic patient parallel to his daily variations of blood glucose. In severe diabetic decompensation, dehydration usually prevents an increase in erythrocyte volume. We conclude that hyperglycaemia is associated with erythrocyte swelling if total serum tonicity remains within the normal range.

References

  1. 1.

    Mohr CF (1938) The size of the red blood corpuscule in diabetes mellitus. Am J Med Sci 196: 67–75

  2. 2.

    Lorusso G (1950) La formula eritrocitometrica nei diabetici e nei familiari. Folia Endocrinol Pisa 3: 825–839

  3. 3.

    Davidson RJ, Evan-Wong LA, Stowers JM (1981) The mean red cell volume in diabetes mellitus. Diabetologia 20: 583–584

  4. 4.

    Strauchen JA, Alston W, Anderson J, Gustafson Z, Fajardo LF (1981) Inaccuracy in automated measurement of hematocrit and corpuscular indices in the presence of severe hyperglycaemia. Blood 57: 1065–1067

  5. 5.

    Evan-Wong LA, Davidson RJ (1983) Raised coulter mean corpuscular volume in diabetic ketoacidosis, and its underlying association with marked plasma hyperosmolarity. J Clin Pathol 36: 334–336

  6. 6.

    Beautyman W, Chir B, Bills T (1975) Hematocrit unchanged by hemodilution. New Engl J Med 293: 45 (Letter)

  7. 7.

    Sen AK, Widdas WF (1962) Determination of the temperature and pH dependence of glucose transfer across the human erythrocyte membrane measured by glucose exit. J Physiol 160: 392–403

  8. 8.

    Beautyman W (1982) Red cell volume in diabetes. Diabetologia 22: 220 (Letter)

  9. 9.

    Holt JT, DeWandler MJ, Arvan DA (1981) Spurious elevation of the electronically determined mean corpuscular volume and hematocrit caused by hyperglycemia. J Clin Pathol 77: 561–567

  10. 10.

    Jacquez JA (1984) Red blood cell as glucose carrier: significance for placental and cerebral glucose transfer. Am J Physiol 246: R289-R298

  11. 11.

    Levinksy NG (1983) Fluids and electrolytes. In: Petersdorf RG, Adams RA, Braunwald E, Isselbacher KJ, Martin JB, Wilson JD (eds) Harrison's principles of internal medicine, 9th edn McGraw-Hill, New York, pp 220–236

  12. 12.

    Katz MA (1973) Hyperglycaemia-induced hyponatremia, calculation of expected serum sodium depression. New Engl J Med 288: 843–844

  13. 13.

    Zerbe RL, Vinicor F, Robertson GL (1979) Plasma vasopressin in uncontrolled diabetes mellitus. Diabetes 28: 503–508

  14. 14.

    Schmid-Schönbein H, Volger E (1976) Red-cell aggregation and red-cell deformability in diabetes. Diabetes 25 (Suppl 2): 897–902

  15. 15.

    McMillan DE, Utterback NG, La Puma J (1978) Reduced erythrocyte deformability in diabetes. Diabetes 27: 895–901

  16. 16.

    Juhan I, Buonocore M, Jouve R, Vague Ph, Moulin JP, Vialettes B (1982) Abnormalities of erythrocyte deformability and platelet aggregation in insulin-dependent diabetics corrected by insulin in vivo and in vitro. Lancet 1: 535–537

  17. 17.

    Caimi G (1983) Blood viscosity and erythrocyte filterability: their evaluation in diabetes mellitus. Horm metabol Res 15: 467–470

  18. 18.

    Reid HL, Barnes AJ, Lock PJ, Dormandy JA, Dormandy TL (1976) A simple method for measuring erythrocyte deformability. J Clin Pathol 29: 855–858

Download references

Author information

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bock, H.A., Flückiger, R. & Berger, W. Real and artefactual erythrocyte swelling in hyperglycaemia. Diabetologia 28, 335–338 (1985). https://doi.org/10.1007/BF00283139

Download citation

Key words

  • MCV
  • Coulter
  • hyperglycaemia
  • hyponatremia
  • diabetes mellitus
  • macrocytosis