Abstract
Background: Hemoglobin A1c (HbA1c) levels are low in patients with hemolytic anemia, as HbA1c reflects mean erythrocyte age (MRBC). Erythrocyte creatine (EC) is a hemolytic indicator that also reflects MRBC. We previously reported an equation for estimating MRBC using EC (EC‐MRBC).Aims: In this study, EC‐MRBC was compared to the HbA1c level expressed in the International Federation of Clinical Chemistry and Laboratory Medicine units (iA1c) and to the iA1c/glycated albumin (GA) ratio to estimate MRBC.Methods: This study included 238 subjects, including patients with hemolytic anemia and/or type 2 diabetes mellitus (T2DM).Results: In non‐diabetic individuals, both iA1c and iA1c/GA showed a strong positive correlation with EC‐MRBC (p < 0.0001). The equations to estimate iA1c‐MRBC and iA1c/GA‐MRBC derived from the regression equations between EC‐MRBC and iA1c, and EC‐MRBC and iA1c/GA in nondiabetic individuals were 1.45 × iA1c and 20.0 × iA1c/GA, respectively. iA1c‐MRBC and iA1c/GA‐MRBC in non‐diabetic individuals without hemolytic anemia were 57.6 ± 4.0 and 57.1 ± 6.4 days, respectively, and iA1c/GA‐MRBC in T2DM patients without hemolytic anemia was 56.0 ± 8.8 days.; no significant difference was seen in the comparisons.Conclusions: The MRBC can be estimated using iA1c or iA1c/GA in non‐diabetic individuals, and iA1c/GA in T2DM patients.

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