Abstract
Laboratory and patient-related factors can result in false glycated haemoglobin (HbA1c) measurements. Haemoglobin (Hb) variants that interfere with laboratory readings is an important cause. We report a case of hereditary persistence of Fetal Haemoglobin manifesting as a falsely high HbA1c in a 35-year old patient with type 2 diabetes mellitus, whose high HbA1c values persisted despite intensive anti-diabetic treatment. His fasting and postprandial blood glucose values as well as serum fructosamine level was incongruously low compared to HbA1c values. The presence of fetal haemoglobin was confirmed by haemoglobin electrophoresis. This case highlights the importance of being aware of the factors that can influence laboratory HbA1c measurements. DOI: http://dx.doi.org/10.4038/sjdem.v1i1.4192 Sri Lanka Journal of Diabetes Endocrinology and Metabolism 2011; 1 : 45-47
Highlights
Glycated haemoglobin (HbA1c) is a widely used measure of glycaemic control
We present a case of an Hb variant causing aberrantly high HbA1c values in a patient with diabetes, and review some of the factors that affect HbA1c measurements
Glucose binds to haemogloin in a two step process, and as one is irreversible, once bound
Summary
Glycated haemoglobin (HbA1c) is a widely used measure of glycaemic control. Haemoglobin (Hb) variants can affect laboratory interpretations of HbA1c, resulting in discordantly high or low values. A 35-year old welder was referred to the endocrinologist by a general practitioner for the management and follow up of very poorly controlled diabetes mellitus He had presented one month ago with a fainting episode elevated capillary blood glucose. Since Hb variants are known to cause aberrantly high HbA1c values during laboratory testing, we considered a Hb variant to be a strong possibility in our patient who had hepatosplenomegaly. His Hb count was 15.2 g/dl and the blood picture showed hypochromic microcytic red cells, numerous target cells, irregularly contracted cells and irregularly haemoglobinized cells suggesting a thalassaemia trait. He was a product of a consanguineous marriage a similar illness had not been diagnosed in any of his family members previously
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