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Rupesh Vijay Agrawal, Justin Tan Kok Soon, Wei Xin, Peter Agustinus Wong, Sangho Kim; Altered Red blood cell deformability – A novel hypothesis for retinal microangiopathy in diabetic retinopathy. Invest. Ophthalmol. Vis. Sci. 2020;61(7):805.
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© ARVO (1962-2015); The Authors (2016-present)
Impaired red blood cell (RBC) deformability impedes tissue perfusion. This study aims to investigate RBC deformability in type 2 diabetes mellitus (DM) patients with different grades of diabetic retinopathy (DR), and to correlate RBC deformability with hematological and serum biochemical markers.
This cross-sectional prospective study included 86 DM patients (31 with no DR, 31 with non-proliferative DR [NPDR] and 24 with proliferative DR [PDR]) and 32 control subjects. RBC deformability was measured by elongation index (EI) with a cross-slot microfluidics device that stretched RBC uni-axially under extensional flow. EI was calculated as the ratio of the stretched lateral width to the initial lateral width of the RBC. Venous blood sample was taken for assessment of hematological and serum biochemical markers.
RBC deformability as measured by EI showed significant reduction in diabetic patients, being lowest in PDR group (2.43 ± 0.41), followed by NPDR (2.62 ± 0.29) and DM with no DR (2.64 ± 0.38) groups, and highest in control group (2.77 ± 0.27) (p=0.018). In the regression analysis controlling for DM status, serum urea concentration was negatively associated with EI (p=0.006). EI was not affected by age, gender and other hematological and serum biochemical markers.
Impaired RBC deformability as measured by cross slot microfluidics in DM patients with different grades of DR underscores the contribution of RBC rheological properties to the pathogenesis and progression of DM related microangiopathy. This might shine light on novel diagnostic and therapeutic interventions in the management of DR based on RBC hemorheology.
This is a 2020 ARVO Annual Meeting abstract.
Overview of the hypothesized scenario by which RBC rheological changes in diabetes lead to retinopathy.
Comparative graphs for deformability index of red blood cell across the severity of diabetic retinopathy
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