Fetal Hemoglobin in Starvation Ketosis of Young Women
Achim Peters,
Dagmar Rohloff,
Thomas Kohlmann,
Florian Renner,
Günther Jantschek,
Wolfgang Kerner, and
Horst Lorenz Fehm
From the Medical Clinic 1, the Institute for Social Medicine, the
Institut for Clinical Chemistry, and the Medical Clinic 2, Medical
University of Lübeck, Lübeck, Germany; and the Department
of Diabetes and Metabolic Disorders, Klinikum Karlsburg, Karlsburg,
Germany.
Ketones can reactivate the production of fetal hemoglobin (HbF) in
vitro and in vivo. A reactivation of HbF by ketones, which are
generated during starvation, remains largely speculative. Therefore, we
investigated HbF in 31 women with anorexia nervosa or bulimia, using
both of these as models of intermittent starvation ketosis. For comparison, we also studied 42 female control
subjects matched for age. 
-Hydroxybutyrate levels were
higher in patients than in controls (460 ± 90 v 110 ± 20 µmol/L; P < .0001). We correlated -hydroxybutyrate,
metabolic, and hematologic parameters with HbF. HbF was measured with
high pressure liquid chromatography. The data were analyzed with
logistic regression analysis. An elevated HbF fraction (>0.87%) was
observed four times as often in patients than in controls (29%
v 7%, P = .01). After adjustment for age, we found
HbF elevations associated with -hydroxybutyrate levels (P
= .005). No other correlations between the various
metabolic/hematologic parameters and HbF were significant. In
conclusion, -hydroxybutyrate generated in starvation is associated
with increased levels of HbF. Thus, unrestrained lipolysis can produce
-hydroxybutyrate in sufficient quantities to induce a clinically
measurable amount of HbF. These findings suggest that intermittent
ketosis might also explain some increases of HbF in type 1 diabetes and
pregnancy.
Blood, Vol. 91 No. 2 (January 15), 1998:
pp. 691-694
© 1998 by The American Society of Hematology.
