J Hematol

Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc

Journal website http://www.thejh.org

Original Article

Volume 7, Number 4, December 2018, pages 140-148

Morphology and Chromic Status of Red Blood Cells Are Significantly Influenced by Gestational Diabetes

Figure 2. The mean percentages of cells found in different patient groups to be (a) microcytic hypochromic, (b) macrocytic and (c) anisocytic among the total of their own cell types in the groups. Comparisons of their standard deviations and P-values are illustrated.

Figure 3. Observed microscopic pictures showing (a) anisocytosis with microcytosis and hypochromia in a GDM case, (b) anisocytosis with microcytosis, hypochromia and target cells in a DM case.

**Table 1.** Reference Guide for Grading Red Blood Cell Morphology (RBC-M) /hpf (100 × oil) [19]
RBCs description	Normal	Occasional/rare	Mild/slight +1	Moderate +2	Marked +3
MCV: mean corpuscular volume; MCH: mean corpuscular hemoglobin, fL: femtoliter; pg: pictogram.
Microcyte	MCV 80 - 99 fL		MCV 70 - 79 fL (25% smaller than nucleus of small lymphocyte)	MCV 60 - 69 fL (26-49% smaller than nucleus of small lymphocyte)	MCV < 60 fL (≥ 50% smaller than nucleus of small lymphocyte)
Macrocyte			MCV 100 - 110 fL (25% larger than nucleus of small lymphocyte)	MCV 111 - 125 fL (26-49% larger than nucleus of small lymphocyte)	MCV > 125 fL (≥ 50% larger than nucleus of small lymphocyte)
Hypochromasia	MCH 27 - 34 pg	< 5% but present	5-15% (MCH 2 - 26 pg)	16-40% (MCH 18 - 21 pg)	> 40% (MCH < 18 pg)
Polychromasia		< 3% but present	3-5%	6-20%	> 20%
Target cells		< 5% but present	5-10%	11-25%	> 25%
Oval macrocytes		< 5% but present	6-20%	21-50%	> 50%
Anisocytosis		< 15%	15-25%	26-49%	50-89%
Poikilocytosis		< 1%	1-5%	6-10%	> 10%

Table 1. Reference Guide for Grading Red Blood Cell Morphology (RBC-M) /hpf (100 × oil) [19]

RBCs description

Normal

Occasional/rare

Mild/slight +1

Moderate +2

Marked +3

MCV: mean corpuscular volume; MCH: mean corpuscular hemoglobin, fL: femtoliter; pg: pictogram.

Microcyte

MCV 80 - 99 fL

MCV 70 - 79 fL (25% smaller than nucleus of small lymphocyte)

MCV 60 - 69 fL (26-49% smaller than nucleus of small lymphocyte)

MCV < 60 fL (≥ 50% smaller than nucleus of small lymphocyte)

Macrocyte

MCV 100 - 110 fL (25% larger than nucleus of small lymphocyte)

MCV 111 - 125 fL (26-49% larger than nucleus of small lymphocyte)

MCV > 125 fL (≥ 50% larger than nucleus of small lymphocyte)

Hypochromasia

MCH 27 - 34 pg

< 5% but present

5-15% (MCH 2 - 26 pg)

16-40% (MCH 18 - 21 pg)

> 40% (MCH < 18 pg)

Polychromasia

< 3% but present

3-5%

6-20%

> 20%

Target cells

< 5% but present

5-10%

11-25%

> 25%

Oval macrocytes

< 5% but present

6-20%

21-50%

> 50%

Anisocytosis

< 15%

15-25%

26-49%

50-89%

Poikilocytosis

< 1%

1-5%

6-10%

> 10%

**Table 2.** Demographics and Laboratory Properties of the GDM, DM and Control Groups Shown as Mean ± Standard Deviation
Variables	GDM	DM	Control
BMI: body mass index; FBG: fasting blood glucose; RBCs: red blood cells; Hb: hemoglobin; MCV: mean corpuscular volume; HCT: hematocrit; MPV: mean platelet volume; RDW: red cells distribution width.
Age (years)	33.33 ± 4.8	34 ± 5.1	32.13 ± 2.8
Parity (number)	2.73 ± 1.8	2.17 ± 1.4	1.47 ± 1.3
Gestational age (weeks)	34.8 ± 2.9	35.5 ± 2	34.7 ± 4.6
BMI (kg/m²)	35.024 ± 3.1	35.02 ± 5.3	34.744 ± 4.4
FBS (mg/dL)	148.62 ± 42.5	164.99 ± 34.5	76.4 ± 10.2
RBCs (10⁶/uL)	4.217 ± 0.5	4.207 ± 0.45	4.181 ± 0.4
Hb (g/dL)	11.15 ± 1.1	10.89 ± 1.3	11.543 ± 1.2
MCV (fL)	80.3 ± 4.6	78.2 ± 33.3	83 ± 34.6
HCT (%)	32.9 ± 5.6	33.3 ± 4.1	34.6 ± 3.4
RDW (%)	15.65 ± 2.2	16.19 ± 2.8	15.25 ± 3

Table 2. Demographics and Laboratory Properties of the GDM, DM and Control Groups Shown as Mean ± Standard Deviation

Variables

GDM

Control

BMI: body mass index; FBG: fasting blood glucose; RBCs: red blood cells; Hb: hemoglobin; MCV: mean corpuscular volume; HCT: hematocrit; MPV: mean platelet volume; RDW: red cells distribution width.

Age (years)

33.33 ± 4.8

34 ± 5.1

32.13 ± 2.8

Parity (number)

2.73 ± 1.8

2.17 ± 1.4

1.47 ± 1.3

Gestational age (weeks)

34.8 ± 2.9

35.5 ± 2

34.7 ± 4.6

BMI (kg/m²)

35.024 ± 3.1

35.02 ± 5.3

34.744 ± 4.4

FBS (mg/dL)

148.62 ± 42.5

164.99 ± 34.5

76.4 ± 10.2

RBCs (10⁶/uL)

4.217 ± 0.5

4.207 ± 0.45

4.181 ± 0.4

Hb (g/dL)

11.15 ± 1.1

10.89 ± 1.3

11.543 ± 1.2

MCV (fL)

80.3 ± 4.6

78.2 ± 33.3

83 ± 34.6

HCT (%)

32.9 ± 5.6

33.3 ± 4.1

34.6 ± 3.4

RDW (%)

15.65 ± 2.2

16.19 ± 2.8

15.25 ± 3

**Table 3.** The Comparison of Variables’ Means
	P-value (GDM vs. control)	P-value (GDM vs. DM)
BMI: body mass index; FBG: fasting blood glucose; RBCs: red blood cells; Hb: hemoglobin; MCV: mean corpuscular volume; HCT: hematocrit; MPV: mean platelet volume; RDW: red cells distribution width. *P-values denoting statistical significance.
Age	0.232	0.572
Parity	0.002*	0.153
Gestational age	0.1	0.268
BMI	0.757	0.997
FBS	0.001*	0.08
RBCs	0.739	0.92
Hb	0.53	0.739
MCV	0.034*	0.308
HCT	0.152	0.742
RDW	0.523	0.366

Table 3. The Comparison of Variables’ Means

P-value (GDM vs. control)

P-value (GDM vs. DM)

BMI: body mass index; FBG: fasting blood glucose; RBCs: red blood cells; Hb: hemoglobin; MCV: mean corpuscular volume; HCT: hematocrit; MPV: mean platelet volume; RDW: red cells distribution width. *P-values denoting statistical significance.

Age

0.232

0.572

Parity

0.002*

0.153

Gestational age

0.1

0.268

BMI

0.757

0.997

FBS

0.001*

0.08

RBCs

0.739

0.92

0.53

0.739

MCV

0.034*

0.308

HCT

0.152

0.742

RDW

0.523

0.366

**Table 4.** The Counts and Percentages of the Different RBCs Morphological Variables Among the Studying Groups: GDM, DM and Control
RBCs morphology	GDM	DM	Control	Total count
Normocytic normochromic
Yes	23	57.50%	9	30%	25	83.30%	57
No	17	42.50%	21	70%	5	16.70%	43
Microcytic hypochromic
Few	16	40%	16	35.30%	4	13.30%	36
No	24	60%	14	46.70%	26	86.70%	64
Anisocytosis
Mild	17	42.50%	28	93.30%	3	10%	48
No	23	57.50%	2	6.70%	27	90%	52
Poikilocytosis
Mild	3	7.50%	12	40%	0	0	16
No	37	92.50%	18	60%	30	100%	86
Target cells
Occasional	5	12.50%	12	40%	0	0	17
No	35	87.50%	18	60%	30	100%	83
Macrocytes
Occasional	4	10%	14	46.70%	1	3.30%	19
No	36	90%	16	53.30%	29	96.70%	81

Table 4. The Counts and Percentages of the Different RBCs Morphological Variables Among the Studying Groups: GDM, DM and Control

RBCs morphology

GDM

Control

Total count

Count

Percentage

Count

Percentage

Count

Percentage

Normocytic normochromic

Yes

57.50%

30%

83.30%

42.50%

70%

16.70%

Microcytic hypochromic

Few

40%

35.30%

13.30%

60%

46.70%

86.70%

Anisocytosis

Mild

42.50%

93.30%

10%

57.50%

6.70%

90%

Poikilocytosis

Mild

7.50%

40%

92.50%

60%

100%

Target cells

Occasional

12.50%

40%

87.50%

60%

100%

Macrocytes

Occasional

10%

46.70%

3.30%

90%

53.30%

96.70%

**Table 5.** Chi-Square and the Resulting P-Values of the Different Observed Variables Among the Studied Groups
	Normocytic normochromic	Microcytic hypochromic	Anisocytosis	Poikilocytosis	Target cells	Macrocytes
*P-values denoting statistical significance.
GDM vs. control	Chi-square	5.309	5.973	8.873	2.351	4.038	1.149
	P-value	0.021*	0.015*	0.003*	0.125	0.255	0.383
GDM vs. DM	Chi-square	5.224	1.228	19.294	10.755	7.05	12.066
	P-value	0.022*	0.268	0.000011*	0.001*	0.008*	0.001*
DM vs. Control	Chi-square	17.376	10.8	41.713	15	15	15.022
	P-value	0.000031*	0.001*	0.000000*	0.000108*	0.000108*	0.000106*

Table 5. Chi-Square and the Resulting P-Values of the Different Observed Variables Among the Studied Groups

Normocytic normochromic

Microcytic hypochromic

Anisocytosis

Poikilocytosis

Target cells

Macrocytes

*P-values denoting statistical significance.

GDM vs. control

Chi-square

5.309

5.973

8.873

2.351

4.038

1.149

P-value

0.021*

0.015*

0.003*

0.125

0.255

0.383

GDM vs. DM

Chi-square

5.224

1.228

19.294

10.755

7.05

12.066

P-value

0.022*

0.268

0.000011*

0.001*

0.008*

0.001*

DM vs. Control

Chi-square

17.376

10.8

41.713

15.022

P-value

0.000031*

0.001*

0.000000*

0.000108*

0.000106*