Anemi ve Glikolize Hemoglobin
Özet
Glikozile hemoglobin (HbA1c), Diyabetes Mellitus tanı ve takibinde glisemik kontrolün en önemli klinik göstergelerinden biridir. Ancak dünya genelinde yaygın bir halk sağlığı sorunu olan demir eksikliği anemisi (DEA), kan şekerinden bağımsız olarak HbA1c düzeylerinin hatalı şekilde yüksek ölçülmesine neden olabilmektedir. Bu durumun temel mekanizması, DEA'da eritrosit ömrünün uzamasıyla yaşlı hücre popülasyonunun glukoza daha uzun süre maruz kalması ve artan malondialdehit (MDA) seviyelerinin hemoglobin glikasyonunu hızlandırmasıdır. Literatürdeki çalışmalar, normoglisemik ve diyabetik bireylerde DEA varlığının HbA1c'yi yapay olarak yükselttiğini ve demir tedavisi sonrasında bu değerlerin anlamlı düzeyde düştüğünü göstermektedir. Özellikle doğurganlık çağındaki kadınlarda ve gebelerde bu etkileşim, yanlış veya eksik diyabet teşhislerine yol açma riski taşımaktadır. Bu sebeple Amerikan Diyabet Cemiyeti (ADA), DEA varlığında HbA1c yerine plazma glukoz kriterlerinin kullanılmasını önermektedir. Sonuç olarak, hatalı teşhislerin, gereksiz tedavilerin ve hipoglisemi riskinin önlenmesi amacıyla HbA1c ölçümleri değerlendirilirken hastanın demir durumu mutlaka göz önünde bulundurulmalı ve gerekirse öncelikle demir eksikliği tedavi edilmelidir.
Glycated hemoglobin (HbA1c) is one of the most crucial clinical indicators of glycemic control in the diagnosis and monitoring of Diabetes Mellitus. However, iron deficiency anemia (IDA), a widespread global public health issue, can cause erroneously high HbA1c measurements independently of blood glucose levels. The underlying mechanism involves prolonged erythrocyte survival in IDA, leading to an older cell population exposed to glucose for a longer duration, and elevated malondialdehyde (MDA) levels that accelerate hemoglobin glycation. Studies in the literature demonstrate that the presence of IDA artificially increases HbA1c in both normoglycemic and diabetic individuals, and these values decrease significantly following iron supplementation. This interaction poses a risk of misdiagnosis or underdiagnosis of diabetes, particularly in women of childbearing age and pregnant patients. Consequently, the American Diabetes Association (ADA) recommends using plasma glucose criteria instead of HbA1c for diagnosing diabetes in patients with IDA. In conclusion, to prevent misdiagnosis, unnecessary treatments, and the risk of hypoglycemia, iron status must be considered when evaluating HbA1c levels, and iron deficiency should be corrected beforehand.
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