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Hemoglobin Wayne: A Rare Variant That Can Cause Falsely Elevated Hemoglobin A1c.

Xue Ao1, Nagapratap Ganta1, Suhrim Choe1

  • 1Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, USA.

Cureus
|August 8, 2022
PubMed
Summary

Hemoglobin A1c (HbA1c) testing can be inaccurate due to rare hemoglobin variants like Hemoglobin Wayne. This case highlights the importance of considering hemoglobinopathies to avoid misdiagnosing diabetes mellitus.

Keywords:
diabetes mellitus dmelevated hba1cglycated hemoglobin (hba1c)hemoglobin varianthemoglobin waynerare variant

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Area of Science:

  • Clinical Chemistry
  • Hematology
  • Endocrinology

Background:

  • Hemoglobin A1c (HbA1c) is a key biomarker for diagnosing and monitoring diabetes mellitus.
  • Certain conditions, including hemoglobinopathies, can lead to falsely elevated or lowered HbA1c levels, impacting clinical decisions.
  • Hemoglobin Wayne is a rare hemoglobin variant that can cause inaccurate HbA1c measurements.

Observation:

  • A female patient in her early 60s presented with persistently high HbA1c levels (10.3%-10.7%) over two years.
  • Fasting blood glucose levels and continuous glucose monitoring (CGM) data were consistently within the normal range (80-100 mg/dL).
  • The discrepancy between HbA1c and glucose readings suggested an interfering factor.

Findings:

  • Hemoglobin electrophoresis confirmed the presence of Hemoglobin Wayne, a rare Hgb variant.
  • Hemoglobin Wayne was identified as the cause of the falsely elevated HbA1c in this patient.
  • Metformin treatment was discontinued due to the confirmed false elevation of HbA1c.

Implications:

  • Clinicians must be aware of hemoglobinopathies, such as Hemoglobin Wayne, that can affect HbA1c accuracy.
  • Accurate diagnosis of diabetes mellitus requires considering potential interfering factors affecting HbA1c.
  • Awareness of rare hemoglobin variants prevents misdiagnosis and inappropriate treatment of diabetes mellitus.