Related Experiment Video
Updated: Sep 1, 2025
A Precision Medicine Tool for Measurement and Monitoring of Hemoglobin S in Sickle Cell Disease Patients Receiving Transfusion Therapy
Influence of RBC Indices on HbA1c Measurement by Capillary Electrophoresis and HPLC Methods
Insights
Anemia significantly impacts hemoglobin A1c (HbA1c) test results, especially with low hemoglobin or high red blood cell distribution width. Simultaneous hemoglobin testing is recommended for anemia patients undergoing HbA1c analysis.
Area of Science:
- Clinical Chemistry
- Hematology
- Diabetology
Background:
- Hemoglobin A1c (HbA1c) is crucial for monitoring long-term glycemic control in diabetes.
- Anemia is a known confounder for HbA1c accuracy, but the specific impact of red blood cell (RBC) indices remains unclear.
- Understanding these influences is vital for accurate diabetes management in anemic populations.
Purpose of the Study:
- To compare ion-exchange high-performance liquid chromatography (HPLC) and capillary electrophoresis (CE) for HbA1c measurement.
- To evaluate the influence of RBC parameters on HbA1c values in patients with anemia.
Main Methods:
- Collected erythrocyte parameters from 307 randomly selected specimens.
- Measured HbA1c using both Tosoh G8 (HPLC) and Capillarys 2 Flex Piercing (CE) on the same day.
- Analyzed the correlation and differences between the two methods concerning RBC indices.
Main Results:
- High concordance was observed between CE and HPLC methods (R² = 0.953, p < 0.001).
- Significant differences in HbA1c values were found between the two methods in patients with abnormal RBC indices (p < 0.001).
- Low hemoglobin (≤ 8 g/dL) and high Red Cell Distribution Width-CV (RDW-CV ≥ 13.7%) showed significant HbA1c variations.
Conclusions:
- HbA1c results are significantly affected by low hemoglobin and high RDW-CV in anemic patients.
- Simultaneous hemoglobin level testing is recommended when analyzing HbA1c in anemic individuals.
- Consideration should be given to developing new HbA1c reference values for patients with severe anemia.
Background:
HbA1c is the gold standard of diabetic surveys to monitor the long-term glycemic control. Anemia is cited as a major confounder to HbA1c analysis; however, the effect of RBC indices influences on HbA1c analysis is not known. The aim of this study is to compare ion-exchange high-performance liquid chromatography, and capillary electrophoresis to evaluate the influence of RBC parameters on HbA1c values in anemia patients.
Methods:
Erythrocyte parameters were collected from the 307 randomly selected specimens from the Hematology division. HbA1c was measured on the same specimen using Tosoh G8 and Capillarys 2 Flex Piercing on the same day.
Results:
There is acceptable concordance between the results of capillary electrophoresis and HPLC methods (R2 = 0.953, p < 0.001). However, significant differences in HbA1c value between the two assay methods were obtained in the patients with abnormal RBC indices (p < 0.001).
Conclusions:
Our results demonstrated HbA1c differences were significantly different in the patients with low Hb (≤ 8 g/dL) and high RDW-CV (≥ 13.7%). It is suggested that in the analysis of HbA1c level in anemia patients, simultaneous testing for hemoglobin level is needed. In addition, development of a new reference value of HBA1c for patients with severe anemia should be considered.
Related Concept Videos
01:20Electrophoresis: Overview
There...
01:20Capillary Electrophoresis: Instrumentation
01:30Capillary Electrophoresis: Applications
Capillary zone electrophoresis (CZE) separates ionic components based on their electrophoretic mobility. It has been used to separate proteins, amino acids,...