Bio-Rad D10 Research Articles

Prevalence of hemoglobinopathies detected by high performance liquid chromatography in tertiary care centre, Kota, Rajasthan

Background: Hemoglobinopathies are the most common heterogeneous group of monogenetic disorder in the world. Their prevalence varies with geographical regions. India is developing country and many studies have shown a significant burden of hemoglobinopathies in India. Our aim is to estimate prevalence of various hemoglobinopathies in our region. Methods: The present study was conducted at the department of pathology, Government Medical College, Kota on patients referred for antenatal or voluntary premarital checkup, patients with clinical history and complete blood count (CBC) suggestive of hemolytic anemia, and family members of known cases of hemoglobinopathies. Transfusion-dependent patients were also included. However, patients with history of blood transfusion within the last 1 month were excluded. EDTA samples were used for CBC using 6-part differential cell counter and high-performance liquid chromatography (HPLC) using BIORAD D10 analyzer. The results were tabulated and analyzed. Results: Of the 226 cases studied, 139 (61.5%) were females and 87 (38.5%) were males. Most common age group was 21 to 30 years. The number of thalassemia traits were 26 (11.5%), sickle cell traits were 7 (3.1%), sickle cell homozygous was 1 (0.4%), compound heterozygous for sickle cell and thalassemia were 2 (0.9%), while the remaining 190 patients (84.07%) were found to have normal HPLC, with presence or absence of nutritional deficiency. Conclusions: In our study, we found a high prevalence of hemoglobinopathies among patients. The most common disorder detected was beta thalassemia trait. Most of the hemoglobinopathies found in our study could be accurately quantified by HPLC which is a rapid, sensitive, and reproducible method for the detection of different hemoglobinopathies.

A Case of Compound Heterozygous HbS and HbD Disease in Premarital Screening

Introduction: Among the inherited disorders of blood, haemoglobinopathy and thalassaemia constitute a major bulk of non-communicable genetic diseases in India. They cause a high degree of morbidity in affected individuals. Moderate to severe haemolytic anaemia among vulnerable segments of the society like infants and children, adolescent girls, pregnant women, etc. may result in many deaths in India. Hemoglobinopathies are a vast group of inherited disorders of hemoglobin production and function. Compound heterozygous HbSD-Punjab is an uncommon hemoglobinopathy encountered in Indians. In premarital screening, molecular testing is mostly inconvenient and diagnosis often relies on the abnormal hemoglobin analysis, family studies and epidemiological facts. We present the clinical and laboratory characteristics of hemoglobin D-Punjab with sickle cell disease found on premarital screening. Case Report: Blood sample of a 22 year old patient for high-performance liquid chromatography was received. A complete blood count (CBC) showed mild anemia with Hb of 8.3 g/dl with mild microcytic hypochromic red cell indices.The HPLC showed HbD and S-window on BIO RAD D10 machine. The high-performance liquid chromatography showed normal hemoglobin Hb F and Hb A2, which indicates presence of a Compound heterozygous for HbSD-Punjab. Conclusion: Compound heterozygous state for HbD-Punjab with S-window is a rare disorder. HbSD-Punjab has a heterogeneous clinical presentation. Anemia and sickle crises are quite common. The data obtained from the clinical findings, blood picture and electrophoresis or HPLC will help in diagnosis. Genetic counseling is advisable in patients with presence of a Compound heterozygous HbSD-Punjab.

Comparison of NGSP Certified Methods and their Cost Analysis for Estimation of HbA1c- A Cross-sectional Study

Introduction: Diabetes Mellitus (DM) is a major non communicable disease that adversely impacts the health of the global community, contributing significantly to mortality. Estimation of glycated haemoglobin (HbA1c) is an integral component of diagnosis, treatment and follow-up of cases of DM as the various protocols have included it for therapy. In order to regularise the estimation of HbA1c, it is mandated by American Diabetes Association (ADA) to perform the test on NGSP certified methods only. Aim: To compare the results of HbA1c analysis by SIEMENS DIMENSION EXL 200 and BIORAD D-10 (NGSP certified methods). Materials and Methods: This was a cross-sectional observational study done in Department of Biochemistry, Armed Forces Medical College, Pune, Maharashtra, a tertiary care center. One hundred and twenty blood samples in EDTA tubes for haemoglobin variant analysis, received from patients with unexplained anaemia or screening for antenatal care were included in the study. The tests for HbA1c were performed by HPLC based BIORAD D10 and enzymatic based method, SIEMENS DIMENSION EXL 200 analyser. Cost analysis of both the methods was also performed. Students paired t-test was done to look for any significant statistical difference. Kappa coefficient was also calculated to analyse for agreement between values. Results: HbA1c estimation by SIEMENS DIMENSION EXL200 and BIORAD D-10 (both NGSP certified) showed marginally different results, but it was not significant enough to make a clinical difference (5.308% on BIORAD D10 and 5.211% on SIEMENS DIMENSION EXL 200). On performing the cost analysis, there was a significant difference observed with a figure of Rs 476.05/- per test on the SIEMENS DIMENSION EXL200, while it was significantly cheaper at Rs 266/- per test on the BIORAD D10. Conclusion: Estimation of HbA1c on SIEMENS DIMENSION EXL200 and BIORAD D10 was not clinically significant. As per cost analysis, BIORAD D10 is a cheaper alternative and suitable for tertiary care or large volume centres.

Variation of HbA1c with Hemoglobin level: A comparative study between High Performance Liquid Chromatography and Immunochromatography Analyzer

Introduction: The measurement of glycated hemoglobin (HbA1c) is an established procedure in evaluating long-term glycemic control in diabetic patients. There are many factors like temperature, pH, lifespan of protein, substrate concentrations and hemoglobin levels that influence HbA1c estimation by any methods. The aim of the study is to estimate HbA1c by High Performance Liquid Chromatography (HPLC) and immunochromatography analyzer and find the influence of hemoglobin in HbA1c by both the methods. Methods: This was a descriptive, cross-sectional study carried out in the department of Biochemistry of Shree Birendra Hospital, Chhauni, Kathmandu over a period of two months from May 2021 to June 2021. We selected patients with type 2 diabetes mellitus. HbA1c was measured in EDTA blood samples by Bio-Rad D10 (HPLC method) and Nycocard (Immunochromatography method) whereas hemoglobin was estimated using Horiba Penta XLR fully automated hematology analyzer. Results: In our study of 100 known cases with type 2 diabetes mellitus, the mean hemoglobin level was 14 ± 2.09 g/dL. The mean HbA1c value obtained by Nycocard and HPLC analyzer were 7 ± 1.95 % and 7.39 ± 2.21% respectively. We found that there was a strong correlation of HbA1c values with hemoglobin levels in HPLC method p = 0.001, r = 0.6. However, we found no such correlation by Nycocard method p = 0.6, r = 0.08. Conclusion: There was a positive correlation of hemoglobin with HbA1c values obtained by HPLC method however no such variation was seen with immunochromatography method. This suggests that estimating HbA1c by HPLC methods may show decreased HbA1c with decreased hemoglobin levels and increased HbA1c with increased hemoglobin levels.

Assessment of Hepatobiliary Status and Cardiometabolic Risk Markers among Type 2 Diabetes Mellitus Patients. A Cross-Sectional Study

Objective: Previous studies have shown a higher prevalence of non-alcoholic fatty liver disease (NAFLD) among patients with type 2 diabetes mellitus (T2DM), and NAFLD itself is a risk factor for cardiovascular diseases (CVD). With both NAFLD and T2DM, there is a vicious circle of disease worsening, with one disease aggravating the development and progression of the other, thereby predisposing to early CVD events. Hence, we aimed to study the association between hepatobiliary status and cardiometabolic risk among T2DM patients. Material and methods: Eighty two patients with T2DM without any established liver and cardiac disease were recruited for the study. Routine biochemical parameters were measured by an autoanalyzer. Parameters such as triglyceride glucose index (TyG index), lipid pentad index, fatty liver disease index (FLDI) etc. were calculated using the established formulas. HbA1c was estimated using Biorad D10 autoanalyzer. Apolipoprotein B (Apo-B), Apo-A, lipoprotein (a) [Lp(a)], insulin, C-peptide were analyzed using ELISA. Results: Significant positive correlation was seen between cardiometabolic risk biomarkers and hepatobiliary biomarkers and significant negative correlation with total bilirubin and De-Ritis ratio. Through stepwise regression, FLDI was found to be a significant factor in the prediction of lipid pentad index (LPI). LPI, TyG index, FLDI were able to differentiate patients with T2DM based on the gold standard HbA1c values for T2DM diagnosis. Conclusions: Increase in hepatobiliary dysfunction contributes to increased CVD risk in T2DM patients. This study highlights the need for collaborative actions of diabetologists and hepatologists in identifying the people with NAFLD among T2DM patients, who should be targeted with intensive therapy to decrease their risk of future CVD events.

A Rare Case of Haemoglobin J-Toronto in a Child

Introduction: India is an ethnically diverse country with marked regional variation. This diversity is often reflected in the presence of different Hemoglobin variants. Hb variants arise due to mutations in the genes encoding for the α-chain and β-chain. Hb J is an infrequently found α-globin variant. It is a Fast moving hemoglobin. Haemoglobin J (Hb-J) was first described by Thorup et al. in an African-American patient (1956) and since then more than 50 variants of Hb-J are identified. Hb J-Toronto [alpha5(A3) Ala>Asp] is one of the rare variants identified. Case report: Blood sample of one year old child for high-performance liquid chromatography was received. The HPLC showed an abnormally high peak in P3 window on BIO RAD D10 machine. The high-performance liquid chromatography showed normal hemoglobin Hb F and Hb A2, but showed elevated levels of P3 (31.7%) which indicates presence of a Hb J variant. Conclusion: Hb J-Toronto is a rare variant of abnormal hemoglobin. It has little clinical significance in heterozygous state but when combined with other variants, they may give rise to severe disease.Prenatal analysis, especially by HPLC, is a key screening method to avoid hemoglobinopathies in off springs. One important clinical condition which may lead to a wrong diagnosis of FMH’s is uncontrolled diabetes mellitus.

Multiple chemiluminescence immunoassay detection of the concentration ratio of glycosylated hemoglobin A1c to total hemoglobin in whole blood samples

The concentration ratio of glycosylated hemoglobin A1c (HbA1c) to total hemoglobin (Hb) has long been used to accurately determine stagewise diabetes because this parameter represents a reliable and accurate biomarker of mean 90-day blood glucose values. In this paper, we report a time-resolved chemiluminescence assay that can detect both Hb and HbA1c. For the determination of Hb, the interaction of heme in Hb with H2O2 in NaOH solution was performed to generate a chemiluminescence peak. HbA1c was detected using a sandwich immunoassay based on an acridine ester-labeling method using the same Hb chemiluminescence trigger system. The results showed that the repeatability %CV of the proposed method for multiple detections of HbA1c and Hb ranged from 1.22 to 2.21%, with a median value of 1.73%, while the within-site reproducibility %CV ranged from 2.13 to 3.27%, with a median value of 2.81%. Compared with the conventional HPLC method (BIO-RAD D10 system), the correlation coefficient was 0.9959. In conclusion, a time-resolved multiple chemiluminescence immunoassay biosensor for HbA1c/Hb detection was established, and the method has excellent reproducibility and accuracy, thus demonstrating great potential for clinical application.

INTERFERENCES OF HbA1c ANALYSIS IN HOSPITAL UNIVERSITI SAINS MALAYSIA – 3 YEARS STUDY

Haemoglobin A1c (HbA1c) is used to monitor glycaemic control and predict diabetic complications. Measurement of HbA1c can be interfered by haemoglobin (Hb) variant and other Hb derivatives include carbamylated Hb and elevated labile A1c. This study is to determine the percentages and type of interferences during HbA1c analysis and the percentages of non- reportable HbA1c results. This is a cross-sectional study using retrospective data of HbA1c. The HbA1c is measured on Biorad D10 using the ion-exchange high-performance liquid chromatography method. The data were analyzed using descriptive statistics. A total of 26,560 patients were included. The result showed the presence of interferences of 2269 (8.56%). The most common causes of the interferences were the Hb variant (8.48%) followed by carbamylated Hb and labile A1c (0.03% each). The non-reportable HbA1c results were 0.46% with the Hb variant contributed most of the causes. By knowing the presence of interferences particularly the Hb variant, the HbA1c results hopefully are interpreted with caution and correct management can be given to the patients.

Estimation of Fluoride and Sirtuin1 in Patients with Diabetic Nephropathy in Kolar District of Karnataka, India.

Objective Prevalence of type-2 diabetes mellitus (DM) and diabetic nephropathy is growing rapidly in Asian countries, affecting low- and middle-income groups. One of the epidemiological issues of Kolar district is fluorosis; advanced glycation end product, carboxymethyl lysine (CML), and a molecule of interest Sirtuin1 are employed in the present study. In the correlation of fluoride with sirtuin1and CML with sirtuin1 of cases lies the important rationale of the study to assess the extent of kidney damage. Materials and Methods This is a comparative cross-sectional study with three groups, each with 70 patients, as follows: G1, control; G2, diabetes with diabetic nephropathy; and G3, type-2 DM without any complications. Informed written consent was obtained from all study patients. All the routine investigations were performed by fully automated Vitro 5, 1 Fs, Vitros. Fasting insulin was analyzed by Vitro eCI and glycated hemoglobin was estimated by BioRad D10. Sirtuin1, CML, and fructosamine were estimated by double antibody sandwich technique. Statistical Analysis The statistical analysis was performed by SPSS 20 (IBM) software. Means of normally distributed data were compared using analysis of variance (ANOVA), and not normally distributed data were compared by Kruskal–Wallis test. A p -value of less than 0.05 was considered statistically significant. Results A decrease in sirtuin1, serum, and urine fluoride of group 2 (34.74 [25.08–53.2], 0.24 [0.2–0.5], and 0.24 [0.16–0.41]) was observed compared with other groups. Increased CML and fluoride act as prooxidant, restricting the effect of sirtuin1 on cellular damage, causing further complications such as increased insulin resistance and decreased insulin sensitivity. Conclusion The alterations in serum sirtuin1 levels indicate the severity of damage due to stress during hyperglycemia and fluoride toxicity; hence, sirtuin1 can be considered as biomarker of aging. Subsequently, the correlation of CML, estimated glomerular filtration rate (eGFR), and fluoride with sirtuin1 indicates that increasing sirtuin1 may defend the forthcoming damage and could be considered in therapeutics.

Estimation of glycemic control in patients with type 2 diabetes mellites with various forms of tuberculosis with dots

Since ancient times people are aware of the association between tuberculosis and diabetes mellitus. Patients with tuberculosis and diabetes experience worse clinical manifestations, increased risk of treatment failure, recurrence, and death. The present study was conducted to evaluate glycosylated hemoglobin (HbA1c) and blood glucose levels, in patients with Type - 2 diabetes mellitus with various forms of tuberculosis who are on RNTCP DOTS and antidiabetic regimens. The study subjects included Type-2 diabetes mellitus with tuberculosis who are registered under RNTCP DOTS, in Dept of Pulmonology, PESIMSR, Kuppam, Chittoor district. Study groups comprises, 20 cases of type 2 DM WITH TB who are on oral hypo glycemic agents (OHA), 20 cases of Type 2DM WITH TB who are on oral hypoglycemic agents (OHA) with insulin, 20 cases of Type 2 DM WITH TB who are on insulin. HbAc is measured by fully automatic Bio-Rad D10 - HbA1c Analyzer. Blood glucose levels are estimated by auto analyser VITROS 250 in PESIMSR, Kuppam. The mean HbA1c levels showed good control in those patients kept on insulin alone compared to OHA and OHA with insulin groups (P <0.001). The mean HbAC levels were high in OHA alone group compared to other groups (P<0.001). The study revealed that increased levels of Glycosylated haemoglobin (HbA1C) are observed in those patients kept on OHA alone with DOTS as compared with other two groups. There is strong interaction between anti tubercular drugs and OHA which in turn leads to poor glycemic control. Poor glycemic state in diabetic patients is having strong impact on TB treatment outcome.

Incidental Detection of Hemoglobin Variants During Evaluation of HbA1c.

HemoglobinA1c (HbA1c) is used to diagnose Diabetes mellitus and monitor glycemic control over the previous eight to twelve weeks in diabetic patients. Detection of HbA1c by cation exchange-high performance liquid chromatography (CE-HPLC) gives a chromatogram by which abnormal hemoglobin variants are also picked up. Some of these may interfere with HbA1c values affecting clinical management. Due to increased inter-state migration as well as medical tourism, there is a high possibility of finding various hemoglobin variants in any part of India. We did a prospective analysis over 1.5years, of the hemoglobin variants detected during all the HbA1c runs. The HbA1c was tested on Bio-Rad D10 dual HbA2/F/A1c platform, which uses the CE-HPLC method. Every chromatogram was carefully studied to look for unknown peaks. The samples showing unknown peaks >6% were re-run in extended HbA2/F mode to categorize the hemoglobin variants. We had 9595 HbA1c samples, of which 70 cases showed a variant window. There were 40 males and 30 females, age ranging from 28 to 76years. The different hemoglobin variants detected were HbD, HbE and HbS in heterozygous state, high HbF (with a differential diagnosis of HPFH heterozygous and delta-beta thalassemia heterozygous), HbE homozygous, HbQ heterozygous and HbJ heterozygous. We conclude that in the process of monitoring glycemic control using HbA1c, we can also pick-up hemoglobin variants. Hence, it is essential to review HbA1c graphs, so that the diagnosis of hemoglobin variants is not missed and the HbA1c reported is reliable.

Biochemical evaluation of vitamin D levels in pre diabetes, type 2 diabetes mellitus and its correlation with glycated hemoglobin

Introduction: Globally, 1 billion people are suffering with deficiency or insufficiency of vitamin D. Vitamin D deficiency is also associated with metabolic disorders. This study evaluates Vitamin D levels in prediabetes, T2DM patients and its correlation with HbA1c. Materials and Methods: This study was done in Department of Physiology in association with Department of Endocrinology, JNU Institute of Medical Sciences & Research Center, Jaipur. A total of 155 subjected were enrolled into the study. They were divided into three groups, 65 age and gender matched healthy subjects were taken as group I (controls) (HbA1c: 5.5 to 6.5 %), 45 prediabetic subjects were taken as group II (HbA1c: 6.5 to 7.5 %) and 45 T2DM subjects were taken as group III (HbA1c: >7.5%). Age of the study subjects was 45 to 65 years. Serum sample was used for the estimation of random sugar (GOD-POD method) by using ERBA chemistry analyzer, vitamin D by ELISA method, using mini VIDAS and EDTA sample for HbA1c by using BIORAD D10. Results: In this study, random blood sugar and HbA1c levels were significantly elevated in pre diabetic (group II), T2DM (group III) subjects compared with controls (group I). Significant reduction was observed in prediabetic, T2DM subjects compared to controls in respect to vitamin D levels. Negative correlation was observed between HbA1c and vitamin D. Conclusion: In conclusion, the results of this study showed, significant reduction and negative correlation between serum vitamin D levels and HbA1c in prediabetic and T2DM patients. This study results indicates that there may be need to screen pre diabetic and T2DM patients with poor glycemic control for Vitamin D status. Keywords: Glycated hemoglobin, Glycemic control, T2DM, Vitamin D deficiency.

Impact of Iron deficiency on diagnosis of Beta Thalassemia Trait.

Objectives: We aimed to evaluate the effect of low serum ferritin levels on HbA2 values in BTT patients. Study Design: Cross-sectional study. Setting: Pathology department of University Medical & Dental College Faisalabad. Period: August, 2018 to July, 2019. Materials & Methods: One hundred and thirty seven subjects were included in the study after written informed consent. Those with serum ferritin < 10µg/L were taken as iron deficient. Based on serum ferritin levels, we divided our study participants into two groups (Group A Vs Group B). As ferritin is considered an acute-phase protein, 25/137 participants with leukocytosis were excluded from statistical analysis. We measured serum Ferritin on Cobas 6000 e611 and we assessed the red cell parameters on Sysmex (seven part differential XN 1000). Hb variants were analysed through High performance liquid chromatography (HPLC) based technique of BioRad D10. Results: After excluding 25 subjects with high Total leukocyte count (TLC), we are left with 112 subjects. We observed 26 participants in group A with Iron deficiency and 38 in group B with no Iron deficiency. Mean±SD serum ferritin in iron deficient group was 7.25±1.95 as compared to non-iron deficient group (87.63±7.35). Mean HbA2 value in group A was 4.56±0.04 and in group B it was 5.80±1.06 with significant statistical difference of P=0.0188. We also observed significant difference in the mean values of other Red cell indices (MCV, HCT MCHC, MCH) except for RBC count and RDW. Conclusion: This study shows that ID may reduce HbA2 levels. Overall, it does not essentially preclude the identification of BTT. It is recommended that Iron deficiency should be considered before measuring HbA2 levels in BTT.

Diagnosis of patients with hemoglobinopathies including α-thalassemia in a laboratory with limited resources

BACKGROUND: Diagnosis of α-thalassemia can be challenging as it is clinically insignificant in the majority of patients who are presented with one or two α-gene deletion, it cannot be always suspected from the red cell indices, and the confirmatory tests of α-thalassemia are not readily available, applied, and/or provide conclusive results. The importance of diagnosis of α-thalassemia is mainly to identify the patients with α0-thalassemia, hemoglobin (Hb) H disease, Hb Bart's hydrops fetalis, and to identify the ameliorating effect that the coinheritance of α-thalassemia may have on the clinical phenotype of patients with HbS and other structural β-globin chain variants and/or patients with beta-thalassemia. The aim of this study is to evaluate the presentation and diagnosis of patients with α-thalassemia in a cohort of Iraqi patients with hemoglobinopathies.PATIENTS, MATERIALS, AND METHODS: This is a prospective cohort study that included 216 patients diagnosed with different types of hemoglobinopathies from June 2016 to October 2019. For each patient after reviewing the cause of presentation and family history of thalassemia, blood samples were sent for complete blood count, including calculated absolute reticulocyte count, peripheral blood smear, Hb H preparation, serum iron and total iron-binding capacity, sickling test, and if indicated Hb high-performance liquid chromatography (HPLC) (using BioRad D10). Family study was requested for several patients.RESULTS: Male:female for patients with α-thalassemia is 1:1.25. Consanguinity and family history of α-thalassemia are present in 85.2% and 51.9%, respectively. Out of 216 patients with different types of hemoglobinopathies, 25% are diagnosed with isolated or copresence of α-thalassemia. Low/lower normal HbA2% is the most sensitive parameter for the diagnosis of α-thalassemia.CONCLUSIONS: The most sensitive parameter for the diagnosis of α-thalassemia in this study is the low/lower normal HbA2% in patient with normal iron study. Other parameters such as the presence of golf-ball red cells in Hb H preparation and/or presence of HbH wave in Hb HPLC can be helpful but are only seen in smaller fraction of patients.

Relevant aspects of identification and interpretation of the glycated hemoglobin research findings.

The article contains the literature review on laboratory criteria of detection and monitoring of the progression of the disease in patients with the diagnosis of diabetes mellitus. It also covers the issues of methodical approaches to the identification of glycated hemoglobin (HbA1c). The findings of author's researches of glycated hemoglobin in 149 patients have been given within the framework of comparison of two methodical approaches and comparison of the results with the subsequent classification of the received data. A random laboratory finding of qualitative hemoglobinopathy has been demonstrated, and the results recognized as unqualifiable and the approach to classification of such values have been discussed.Comparison of the results of glycated hemoglobin identification performed by different methods. 149 patients underwent a one-stage identification of glycated hemoglobin from plasma stabilized with K2-EDTA on Bio-Rad D10 and Sebia Capillarys Flex Piercing 2. Comparative study of the results of glycated hemoglobin identification has shown a difference in absolute values. However, a statistically reliable (p < 0.05) correlation between the values of glycated hemoglobin, expressed as a percentage obtained by different methods, has been revealed. In this case, the choice of a method for identifying glycated hemoglobin is not a matter of principal but it is important to adhere to the same method in treatment and long-term monitoring.

Hemoglobin Phenotypes in Nigeria: Data From a National Reference Laboratory

Abstract On a global scale, 5% to 7% of the population carries an abnormal hemoglobin. With a sickle hemoglobin (HbS) carrier prevalence of 25% to 40%, Nigeria bears the greatest burden of sickle cell disorder worldwide. Until recent times, detection of other clinically significant hemoglobin variants associated with HbS has been unavailable, resulting in missed/wrong diagnosis, weak national data, and suboptimal control of hemoglobin disorders. This study aimed to review hemoglobin assays over a 2-year period at a national reference laboratory in Nigeria, in order to describe the prevalent hemoglobin phenotypes for health planning. The study was a retrospective, laboratory data-based survey. Sociodemographics and hemoglobin assay results of 6,851 specimens between January 2016 and December 2017 were analyzed. Study protocol was approved by the Institutional Review Board. Participants aged less than 1 year and who had recent transfusions and a history of hydroxyurea therapy were excluded. At the hemoglobin laboratory, specimens were analyzed using cation exchange high-performance liquid chromatography (CE-HPLC) (Bio Rad D10, California). When indicated, further analysis of suspected abnormal hemoglobins was confirmed using a second method, capillary electrophoresis (SEBIA Capiflex II, France). The distribution of the identified hemoglobin phenotypes was determined as a proportion of the total number of participants. The mean (SD) age of the participants was 31.8 (14.9) years. The most frequent hemoglobin phenotypes were AA (59.4%), AS (23.3%), and SS (13.3%). Hemoglobin phenotypes AC (2.1%), SC (0.9%), AGPhiladelphia (0.2%), and CC (0.2%) were less frequent. Least occurring phenotypes were ADIbadan, AE, AGPhiladelphia, AOArab, DD, and hereditary persistence of fetal hemoglobin (HPFH). In the Nigerian context, accurate diagnosis of hemoglobin variants using quantitative, high-resolution hemoglobin assays, compared to zone (cellulose acetate) electrophoresis at alkaline pH will provide data for health planning, better access to genetic counseling, informed reproductive health choices, and secondary prevention of hemoglobinopathies.

DISTRIBUSI DAN FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KADAR HEMOGLOBIN A1C (HbA1c) PADA SUBJEK DEWASA INDONESIA

HbA1c is a parameter that may be used in predicting and diagnosing diabetes. Since diabetes is predicted to increase in Indonesia, it is necessary to understand the distribution and associated factors of HbA1c in the general Indonesian population. However, those data are still limited. This study aims to determine the distribution of HbA1c and its associated factors in Indonesian adults. We conducted a cross-sectional study analyzing data from Indonesia Family Life Survey (IFLS) 2014-2015. HbA1c was analyzed using dried blood spot (DBS) specimen with Bio-Rad D10 HPLC. We performed Student’s t test and ANOVA to show the results of the bivariate analyses and multiple linear regression to determine the association between variables. The study included 4.101 subjects (20-59 years) without diabetes and provided an overview of the distribution of HbA1c levels based on socio-demographic factors and smoking behavior described in percentiles. The mean of HbA1c was 5.35% with a standard error of 0.01. The threshold value of HbA1c for prediabetes (5.7%) corresponded approximately to the 75th percentile. Although there were differences in HbA1c distribution, socio-demographic factors such as education levels, employment, and settlement region as well as smoking were not independently associated with HbA1c levels in Indonesian adults. Furthermore, age and sex were associated with HbA1c.

Associations of Dietary Diversity Score, Obesity, and High-sensitivity C-reactive Protein with HbA1c

Background: Associations of dietary diversity score (DDS), obesity and high-sensitivity C-reactive protein (hs-CRP) with glucose metabolism have been reported. Furthermore, DDS may not be associated with healthy weight. However, studies on these topics are limited in general Indonesia population. Methods: A total of 3,825 Indonesia Family Life Survey 2014/2015 participants aged 20-59 years old were included in this study. DDS was measured qualitatively in five food groups: carbohydrates, proteins, dairy products, vegetables, and fruits. Obesity was defined by Body Mass Index (BMI) classification for Indonesians. Blood analyses were performed in dried blood spot specimens. hs-CRP were analyzed using enzyme-linked immunosorbent assay and HbA1c was analyzed using Bio-Rad D10. Results: High DDS group had higher HbA1c than low DDS group (p = 0.030). Furthermore, medium and high DDS group had higher BMI than low DDS group (p = 0.003 and < 0.001). Obese group had higher HbA1c than nonobese group (p < 0.001). hs-CRP was correlated with HbA1c (r = 0.1194; p < 0.001). Multivariate analysis showed that DDS, obesity and hs-CRP were associated with HbA1c (p = 0.030, p < 0.001 and < 0.001). Conclusions: Present study confirmed that obesity and hs-CRP are associated with HbA1c. DDS is positively associated with HbA1c and BMI. Promoting dietary diversity requires careful consideration. Moreover, further studies are warranted.

Hypertriglyceridemia and Its Association with HbA1c Test: A Prospective In Vivo Controlled Study.

Background Hypertriglyceridemia and hyperglycemia coexist in 30-60% of patients with diabetes. The impact of hypertriglyceridemia regarding HbA1c assay reliability remains uncertain. Therefore, we conducted a prospective in vivo controlled study with the aim of defining the association between triglyceride levels and HbA1c. Methods A total of 44 patients with an index-hospital admission diagnosis of diabetic ketoacidosis or hypertriglyceridemia-induced pancreatitis, as a model for acute elevation of triglycerides, were recruited. Blood samples were drawn for the measurement of HbA1c, triglycerides, glucose, and hemoglobin at baseline and subsequently 24 and 48 hours after admission. HbA1c analysis was performed with high-performance liquid chromatography Bio-Rad D10 (NGSP approved). Results All patients completed the study protocol. A difference between mean triglycerides from day 0 (baseline) to day 2 of 1567.2 mg/dL was observed. We found a difference between mean serum HbA1c from days 0 to 2 of 0.09% [1 mmol/mol] (p = 0.004). Moreover, a weak correlation between the mean difference of HbA1c and triglycerides from baseline to day 2 was found to be statistically significant (r = 0.256, p = 0.015). None of these findings, however, are clinically significant. Conclusion Triglycerides do not impair the interpretation of HbA1c assay. Patients and clinicians can now be confident that hypertriglyceridemia is not an important factor when interpreting HbA1c results.

Elevated HbF Labelled as LA1C/cHb1 on BioRad D10 HPLC: Missed Diagnosis of Homozygous Beta Thalassemia.

Elevated HbF Labelled as LA1C/cHb1 on BioRad D10 HPLC: Missed Diagnosis of Homozygous Beta Thalassemia.