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Causes of Low HbA1c in Malaysian University Hospital
P Sthaneshwar1, S R Vethakkan2, C W Wong3
1University of Malaya, Faculty of Medicine, Department of Pathology, 50603, Kuala Lumpur, Malaysia. pavai@ummc.edu.my.
Insights
Low hemoglobin A1c (HbA1c) results can be influenced by various conditions beyond diabetes. This study identified hemoglobinopathies, chronic diseases, and pregnancy as factors affecting HbA1c measurements.
Area of Science:
- Clinical Chemistry
- Hematology
Background:
- Glycohemoglobin (HbA1c) is a key indicator of long-term glycemic control in diabetes, with target values typically below 7% to prevent complications.
- Numerous factors, including genetic hemoglobin variants and other medical conditions, can impact HbA1c measurement accuracy.
Purpose of the Study:
- To investigate and identify conditions associated with unexpectedly low hemoglobin A1c (HbA1c) results.
- To raise awareness among healthcare professionals about factors influencing HbA1c interpretation.
Main Methods:
- Retrospective analysis of 58,437 HbA1c measurements performed using a Biorad Variant II turbo 2.0 system.
- Review of medical records to identify patient conditions linked to low HbA1c values (< 4.0%).
- The laboratory method is certified by the National Glycohemoglobin Standardization Programme (NGSP).
Main Results:
- Fifty-three patients (0.09%) exhibited HbA1c levels below 4.0%.
- Fourteen patients had diagnosed hemoglobinopathies.
- Thirty-four patients without hemoglobin variants presented with conditions including chronic liver disease, chronic kidney disease, hemolytic anemia, pregnancy, and anemia of chronic disease.
Conclusions:
- Healthcare providers and laboratories must recognize factors that can falsely lower HbA1c readings.
- Hematological status is crucial for accurate interpretation of HbA1c results in clinical practice.
Introduction:
Glycohemoglobin (HbA1c) most accurately reflects the previous two to three months of glycaemic control. HbA1c should be measured regularly in all patients with diabetes, and values should be maintained below 7% to prevent the risk of chronic complications. Apart from the genetic variants of haemoglobins many other conditions also known to affect HbA1c measurements. In this study we evaluated the conditions that cause low HbA1c results.
Methods And Materials:
The data was collected retrospectively HbA1c was measured in our laboratory by Biorad Variant II turbo 2.0. The method is based on chromatographic separation of HbA1c on a cation exchange cartridge. This method has been certified by National Glycohemoglobin Standardization Programme (NGSP). 58437 requests were received in a period of one year (January to December 2011). Medical records were reviewed to identify the conditions that might be associated with these low values.
Results:
Among 58437 samples analysed, 53 patients had HbA1c levels < 4.0%. Fourteen patients had haemoglobinopathy. In 34 patients without Hb variants had conditions such as chronic liver disease, chronic kidney disease, haemolytic anaemia, pregnancy, and anaemia of chronic disease. Five non-pregnant individuals who were screened for diabetes mellitus had HbA1c levels < 4%.
Conclusion:
Our study underscores the importance of that both laboratories and the physicians should be aware of the factors that can influence the HbA1c results. The haematological status should be taken into consideration for proper interpretation of HbA1c results.