Fragmentation Haemolysis in Patients with Severe Diabetic Angiopathy

Haemolytic anaemia associated with prominent red cell fragmentation is described in seven patients with long‐standing diabetes mellitus. A common feature in the patients was severe microangiopathy as detected by retinal examination and microscopic examination of the kidneys. Renal or pancreatic islet malfunction per se is not involved in the haemolytic syndrome, since red cell abnormalities persisted in one patient for over a year following successful renal and pancreatic transplantation—this, despite the maintenance of normal renal and carbohydrate homeostasis. The kinetics of fragmentation was studied by transfusing normal type O cells into this type A patient. With reisolation of these cells by the Ashby‐technique, rapid and progressive red cell fragmentation was demonstrated by: (a) membrane lipid loss; (b) osmotic fragility increase; and (c) increase in mean cell haemoglobin concentration. These studies indicate that a red‐cell‐fragmentation haemolytic anaemia may occur in long‐standing diabetes mellitus, related to the angiopathy of this disease and not to insulin deficiency or renal malfunction.