Glucose-induced hemolysis of spheric red blood cells in hereditary spherocytosis: new aspects of the autohemolysis test.

Increased autohemolysis with a partial protecting effect of added glucose is a common finding in hereditary spherocytosis (HS). For unknown reasons, in some rare cases, glucose fails to prevent the increased autohemolysis (Type II autohemolysis). The authors investigated the autohemolysis of such a patient and found that glucose actually induced the hemolysis prior to energy depletion. Old erythrocytes proved to be more fragile in the presence of D-glucose than did young ones. Other D-hexoses reacted similarly to D-glucose, while L-glucose did not. After being splenectomized, the patient's red blood cells' specific sensitivity to D-hexoses disappeared unless a 24-hour preincubation of his whole blood was performed. Other HS blood samples also became fragile in the presence of D-glucose if a 24-hour preincubation at 37 degrees C was made. Normal blood samples preheated to 50 degrees C or normal washed red blood cells in hypotonic conditions also showed a glucose-induced hemolysis. The authors assume that during the routine autohemolysis test, the accumulation of the hexose is followed by volume expansion and results in hemolysis of those cells with extremely low surface area-to-volume ratio.