Elevation of the Glycated Albumin to Hemoglobin A1c Ratio Is an Index of Ineffective Erythropoiesis in Myelodysplastic Syndromes

Background: The index for estimating ineffective erythropoiesis in bone marrow failure syndromes has not been standardized. Thus, this study aimed to investigate the glycated albumin to hemoglobin A1c ratio (GA/HbA1c) as a useful index for evaluating ineffective erythropoiesis status in bone marrow failure syndromes. Methods: This study included patients who were diagnosed with either myelodysplastic syndromes, aplastic anemia, myeloproliferative diseases, anemia of chronic diseases, or autoimmune hemolytic anemia. The index of GA/HbA1c was determined, and haptoglobin was measured in each patient. Laboratory data, including bone marrow aspiration, were collected from electronic medical records. Results: A total of 53 cases were studied. GA/HbA1c was significantly elevated in myelodysplastic syndromes, aplastic anemia, and autoimmune hemolytic anemia compared to that in controls. Haptoglobin depletion was observed in 9 of 18 cases of myelodysplastic syndromes and in none of 9 cases of aplastic anemia. GA/HbA1c was significantly elevated in myelodysplastic syndromes with haptoglobin depletion, suggesting enhanced ineffective erythropoiesis in this group. Conclusions: Determining GA/HbA1c, as well as the haptoglobin level, is a useful surrogate index for detecting ineffective erythropoiesis in bone marrow failure syndromes.