Abrupt decrease in haemoglobin A1C as the first hint of autoimmune haemolytic anaemia

Haemolysis shortens erythrocyte life span, thereby reducing the normal accumulation of glycated haemoglobin. We present a case of a patient with diabetes mellitus who, on routine follow-up to the primary care clinic, was found to have a notable decrease in haemoglobin A1C (HbA1C) without changes in medications, diet or exercise habits. A fructosamine assay indicated that the patient's serum glucose was not well-controlled despite the abnormally low HbA1C. Further laboratory evaluation revealed a new normocytic anaemia, secondary to autoimmune haemolytic anaemia, that explained his unexpected low HbA1C. He was diagnosed with B-cell lymphoma.