Mechanism of megaloblastic anemia combined with hemolysis

Figures & data

Table 1. Characteristics of patients

		Total		Nonhaemolysis		Hemolysis		P value
		n	%	n	%	n	%
Sex
	Male	65	52.42	22	42.31	43	59.72	0.055
	Female	59	47.58	30	57.69	29	40.28
Age
	≤60	45	36.29	22	42.31	23	31.94	0.495
	>60	79	63.71	30	57.69	49	68.06
Bone marrow aspiration
	Yes	59	47.58	21	40.38	38	52.78	0.23
	No	65	52.42	31	59.62	34	47.22
Anemia
	Mild	20	16.13	17	32.69	3	4.17	0.001
	Moderate	74	59.68	28	53.85	46	63.89
	Severe	29	23.39	6	11.54	23	31.94
	Very Severe	1	0.81	1	1.92	0	0.00
MCV (fL)
	100–110	23	18.55	21	40.38	2	2.78	<0.001
	110.1–120	48	38.71	21	40.38	27	37.50
	120.1–130	41	33.06	8	15.38	33	45.83
	≥130	12	9.68	2	3.85	10	13.89

Mild anemia was defined as an Hb level >90 g/L, moderate anemia was defined as an Hb level <90 g/L and ≥ 60 g/L, severe anemia was defined as an Hb level <60 g/L and ≥ 30 g/L, and very severe anemia was defined as an Hb level <30 g/L.

Abbreviations: Hb, hemoglobin; MCV, mean corpuscular volume

Table 2. Related factors of patients with hemolysis in univariate logistic regression analysis

	χ2	P value	OR	95% CI for OR
Hb	9.669	0.002	0.964	0.941–0.986
MCV	25.072	<0.001	1.162	1.096–1.233
LDH	6.211	0.013	1.001	1.000–1.001
TBIL	30.704	<0.001	1.235	1.146–1.331
IBIL	23.022	<0.001	1.300	1.168–1.447

Abbreviations: Hb, hemoglobin; MCV, mean corpuscular volume; LDH, lactate dehydrogenase; TBIL, total bilirubin; IBIL, indirect bilirubin; CI, confidence interval

Table 3. Related factors of patients with hemolysis in multivariate logistic regression analysis

	χ2	p value	OR	95% CI for OR
MCV	7.055	0.008	0.828	0.721–0.952
IBIL	5.926	0.015	0.822	0.702–0.962

Abbreviations: MCV, Mean Corpuscular Volume; IBIL, indirect bilirubin;

Figure 1. ROC curve between MCV and hemolysis

Figure 2. Correlation between Hb and MCV in two groups. a: MA patients with hemolysis; b: MA patients with nonhaemolysis

Figure 3. Erythrocyte morphology. a and b are images of a single erythrocyte in healthy controls and patients, respectively; c and d are altitude profiles of a single erythrocyte in healthy controls and patients, respectively; e and f are 3D models of the single erythrocyte in panels a and b, respectively; g and h are images of the surface membrane of a single erythrocyte in healthy controls and patients, respectively; i and j are the ultrastructures of the membrane of the erythrocyte in panels a and b, respectively

Figure 4. Erythrocyte physical parameters. a: The length of the erythrocytes in the control group was 7.76 ± 0.67 µm, and in the MA patients, it was 8.15 ± 0.69 µm (P = 0.722). The width of the erythrocytes in the control group was 6.24 ± 0.62 µm, and in the MA patients, it was 6.38 ± 0.59 µm (P = 0.878). The length-width ratio of the erythrocytes in the control was 1.26 ± 0.03, and in the MA patients, it was 1.31 ± 0.04 (P = 0.466). b: The Rp-v of the erythrocytes in the control group was 2462 ± 89.99 nm, and that in the MA patients was 1964 ± 134.50 nm (P = 0.021). The Ra of the erythrocytes in the control group was 865.44 ± 38.09 nm, and in the MA patients, it was 658.28 ± 55.23 nm (P = 0.020). c: The surface area of the erythrocytes in the control group was 1082161.56 ± 14204.96 nm², and in the MA patients, it was 1036047.11 ± 1896.13 nm² (P < 0.001). L: length of erythrocyte; W: width of erythrocyte; both of which were the maximum cell diameter. Rp-v: peak-valley value, which is the difference between the maximum and minimum height of the Z-axis on the cell surface in the analysis area; Ra: erythrocyte surface roughness, which is the mean roughness in the analysis area, namely the relief on the surface of the erythrocytes; * P value <0.05, ** P value <0.01

Table 4. Characteristics of healthy control and MA patients with hemolysis

	Gender	Age	Hb	MCV	TBIL	IBIL	LDH
Healthy control	Man	58	137	86	12.1	8.0	201
Patient 1	Man	54	83	118	45.0	31.6	292
Patient 2	Man	73	75	121	56.1	47.5	320

Abbreviations: Hb, hemoglobin (g/L); MCV, mean corpuscular volume (80–100 fL); TBIL, total bilirubin, (3.4–17.1 µmol/L); IBIL, indirect bilirubin (1.7–10.2 µmol/L); LDH, lactate dehydrogenase (135–215 U/L)

Figure 5. The images of whole body 18F-FDG-PET/CT. a:(median, quartile), SUVmax of healthy people who underwent 18F-FDG-PET/CT examination at our hospital; In the whole-body 18F-FDG-PET/CT images, the higher that the tissue uptake rate of FDG is, the higher that the SUV value is, and the darker that the color in the image is. As the SUV value rises, the image color changes from blue to green, yellow, or even red. Abbreviations: SUVmax, maximum standardized uptake value; 18F-FDG-PET/CT, 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography and computed tomography (PET-CT)