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HbA1c Below the Reportable Range.

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  • 1Department of Clinical Biochemistry, Samyak Diagnostic Pvt Ltd., Jawalakhel, Kathmandu, Nepal.

Laboratory Medicine
|October 6, 2021
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Summary
This summary is machine-generated.

A patient with systemic lupus erythematosus experienced falsely low hemoglobin A1c (HbA1c) levels due to cold agglutinin-induced hemolysis. Alternative glycemic control tests like fructosamine may be necessary when HbA1c assays are unreliable.

Keywords:
cold agglutinincomplete blood countfalse low HbA1cfructosaminehigh-performance liquid chromatographysystemic lupus erythematosus

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Area of Science:

  • Clinical Medicine
  • Hematology
  • Endocrinology

Background:

  • Glycosylated hemoglobin (HbA1c) is a standard measure for long-term glycemic control.
  • Certain medical conditions and medications can interfere with HbA1c assay accuracy.
  • Systemic lupus erythematosus (SLE) is an autoimmune disease with varied clinical presentations.

Observation:

  • A 71-year-old female on hydroxychloroquine for SLE presented with high fasting blood glucose but low HbA1c.
  • Initial labs showed decreased erythrocytes and elevated red blood cell indices, suggesting hemolysis.
  • Further investigation revealed the presence of cold agglutinins.

Findings:

  • Cold agglutinins interfered with the HbA1c assay, leading to falsely low results.
  • Reanalysis after warming the samples did not correct the HbA1c value.
  • Hemolysis was confirmed as the cause of the assay interference.

Implications:

  • This case highlights the potential for cold agglutinins to artifactually lower HbA1c measurements.
  • Clinicians should consider alternative glycemic markers, such as fructosamine, in patients with suspected assay interference.
  • Accurate glycemic monitoring is crucial for managing diabetes, especially in patients with autoimmune conditions.