Neutrophilia in T2 Diabetes Mellitus: Its hyperglycemia induced emergency myelopoiesis

Abstract Objectives- To study the correlation of Neutrophil-to–lymphocyte ratio (NLR) with glycosylated hemoglobin (HbA1c) in Type 2 Diabetes Mellitus (T2DM) patients and investigate for hyperglycemia induced “emergency myelopoiesis” derived immature neutrophils in peripheral blood. Methods- The study was carried out on 304 participants (both males and females), out of which 118 served as non- diabetic control group and 186 were T2DM patients (cases). 2 ml of peripheral blood was withdrawn in EDTA vial, HaA1c was measured using high performance liquid chromatography (HPLC) and NLR was calculated by dividing the absolute neutrophil count with the absolute lymphocyte count. Arneth count was performed on a peripheral smear considering the number of nuclear lobes in 100 Neutrophils. Statistical tests were performed using SPSS version 25.0. Results- Total leucocyte count (TLC), Absolute Neutrophil count (ANC), Platelet count (PC) and Absolute Monocyte count (AMC) were significantly higher in cases as compared to controls (p < 0.05). The Arneth curve showed a shift towards left with increasing HbA1c levels. Conclusion- NLR is a simple, cheap and reliable surrogate marker for HbA1c and any variations over time from static baseline with well controlled blood sugar levels must be documented for personalized patient care. Emergency myelopoiesis as indicated by a left shift of Arneth curve is a warning signal needing prompt therapeutic interventions.