The Curious Clinicians 90 - Less Sugar, More Blood
May 29, 2024
Exploring how SGLT2 inhibitors impact hemoglobin and hematocrit levels in heart failure patients, revealing surprising effects on red blood cell mass and EPO levels. Delving into the complex interplay of SGLT2 inhibitors, iron, and hemoglobin, and the significance of point of care cytosolic iron testing.
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Avi Cooper's Erythrocytosis Case
- Avi Cooper shared a recent patient case where hemoglobin rose above normal after SGLT2 inhibitor use.
- This observation sparked his interest to learn about the mechanism and frequency of this erythrocytosis.
SGLT2 Inhibitors Raise Hematocrit
- SGLT2 inhibitors cause a dose-dependent increase in hematocrit noted since their first trial in 2010.
- Early assumption was this was due to glucose-induced osmotic diuresis, but newer evidence challenges this.
More Than Diuresis Explains Rise
- The increase in hemoglobin from SGLT2 inhibitors often exceeds a simple diuretic effect.
- Unlike diuretics like furosemide, SGLT2 inhibitors lead to persistent hemoglobin increases by another mechanism.