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Significantly High HbA1c in Diabetic Patient with Hb J: Case Report

Wan Nor Fazila Hafizan Wan Nik1, Noorazliyana Shafii1, Noor Azlin Azraini Che Soh1

  • 1Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.

Oman Medical Journal
|August 2, 2022
PubMed

Insights

Glycated hemoglobin (HbA1c) monitoring for diabetes can be inaccurate due to hemoglobin variants like Hb J. This case report highlights how Hb J can falsely elevate HbA1c readings, necessitating careful interpretation.

Area of Science:

  • Clinical Chemistry
  • Hematology
  • Genetics

Background:

  • Glycated hemoglobin (HbA1c) is a crucial biomarker for assessing long-term glycemic control in diabetes mellitus (DM).
  • Hemoglobin variants, such as Hb J, can interfere with standard HbA1c measurement methods, potentially leading to inaccurate results.
  • Accurate HbA1c monitoring is vital for effective diabetes management and preventing complications.

Observation:

  • Two cases of Malay patients with diabetes mellitus presented with persistently high HbA1c levels (>18.5%) using high-performance liquid chromatography (HPLC).
  • Despite optimal glycemic control, indicated by normal fasting blood sugar (FBS) levels, the elevated HbA1c persisted in both patients.
  • Hemoglobin analysis suggested the presence of the Hb J variant in both individuals.

Findings:

  • Repeated HbA1c measurements using capillary electrophoresis (CE) yielded accurate results (6.0% and 8.1%), confirming the interference from the Hb J variant.
  • The CE method successfully identified the Hb J variant peak, differentiating it from true glycated hemoglobin.
  • The HPLC method demonstrated a significant overestimation of HbA1c in the presence of the Hb J variant.

Implications:

  • HbA1c results in patients with known or suspected hemoglobin variants require cautious interpretation to avoid misdiagnosis.
  • Alternative or confirmatory testing methods, such as capillary electrophoresis, are essential for accurate glycemic assessment in individuals with hemoglobin variants.
  • Awareness of hemoglobin variants like Hb J is critical for healthcare providers to ensure appropriate diabetes management and patient care.

Keywords:
Chromatography, High Pressure LiquidDiabetes MellitusElectrophoresis, CapillaryGlycated Hemoglobin AHemoglobin J

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