Misleading hemoglobin A1c levels in a patient with paroxysmal nocturnal hemoglobinuria.

Abstract:

OBJECTIVES:We report a case of a patient with diabetes mellitus and unexpectedly low hemoglobin A1c results associated with paroxysmal nocturnal hemoglobinuria (PNH). We review the impact of shortened RBC half-life on the interpretation of hemoglobin A1c levels. METHODS:Patient history and laboratory test results were obtained from electronic medical records and analyzed. RESULTS:The patient's hemoglobin A1c declined in parallel to worsening anemia after the diagnosis of PNH. However, elevated serum glucose (random), fructosamine, and glycated albumin suggest ongoing hyperglycemia. Together, these results argue that the decline in hemoglobin A1c was due to decreased RBC survival secondary to PNH. CONCLUSIONS:Hemoglobin A1c levels must be interpreted with caution in patients with hematologic diseases that change RBC survival. Serum fructosamine and glycated albumin measurements are alternative measures of time-averaged blood glucose control and may be useful in this subset of patients.

journal_name

Am J Clin Pathol

authors

Xia D,McShine R,Berg AH

doi

10.1309/AJCPTK1HPR2KULJU

subject

Has Abstract

pub_date

2014-08-01 00:00:00

pages

261-5

issue

2

eissn

0002-9173

issn

1943-7722

pii

142/2/261

journal_volume

142

pub_type

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