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Diabetes: Symptoms, Diagnosis, and Complications01:15

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For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
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Methods for Quantitative Detection of Antibody-induced Complement Activation on Red Blood Cells
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Abrupt decrease in haemoglobin A1C as the first hint of autoimmune haemolytic anaemia.

Daniel Boctor1, Marina Heskel2, Andrew D Leavitt2

  • 1Medicine, UC San Francisco, San Francisco, California, USA Daniel.boctor@ucsf.edu.

BMJ Case Reports
|July 4, 2025
PubMed
Summary
This summary is machine-generated.

A patient with diabetes mellitus experienced a sudden drop in hemoglobin A1C (HbA1C) due to autoimmune hemolytic anemia, not improved diabetes control. This case highlights the impact of hemolysis on HbA1C levels.

Keywords:
DiabetesMalignant and Benign haematology

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Area of Science:

  • Internal Medicine
  • Hematology
  • Endocrinology

Background:

  • Glycated hemoglobin (HbA1C) reflects average blood glucose over 2-3 months.
  • Hemolysis, or red blood cell destruction, can falsely lower HbA1C levels.
  • Diabetes mellitus management relies on accurate glycemic monitoring.

Purpose of the Study:

  • To report a case of a diabetic patient with an unexpectedly low HbA1C.
  • To investigate the cause of the discrepancy between HbA1C and serum glucose.
  • To highlight the diagnostic challenge posed by hemolysis in diabetes management.

Main Methods:

  • Clinical case presentation.
  • Review of patient's laboratory results including HbA1C and fructosamine assays.
  • Diagnostic workup for anemia and underlying causes.

Main Results:

  • A patient with diabetes mellitus presented with a significant decrease in HbA1C.
  • Fructosamine assay indicated poor glycemic control, contradicting the low HbA1C.
  • Autoimmune hemolytic anemia was identified as the cause of the low HbA1C, with a concurrent diagnosis of B-cell lymphoma.

Conclusions:

  • Autoimmune hemolytic anemia can lead to falsely low HbA1C levels in diabetic patients.
  • Clinicians should consider hemolysis when HbA1C results do not align with clinical status or other glycemic markers.
  • Accurate interpretation of HbA1C requires awareness of potential confounding factors like hemolysis.