Hba1c inappropriately elevated - normal blood sugar

[jackyhorner]

Hi
I have a 67 yr old female patient with an persistantly elevated Hba1c of 8.3  . 8.2 % over past 4 years
prior to this her Hba1c was +- 5 %
Her plood sugars fasting and postprandial  and after a 75 gram oral glucose intake has been normal
She is otherwise healthy
all haemoglobin indeces have been normal !
Any suggestions investigative \diagnostic will be appreciated
 IJH

[Admin]

HbA1c is also known as glycated hemoglobin. It is a measurement of percntage of hemoglobin in the red cells being linked to sugar. Another alternative of this test is to measure the serum fructosamine level. Fructosamine is a sugar-linked albumin (a type of human protein). However, for fructosamine test to be acurate, he must have a normal serum albumin level, not too low or too high.

Do the test and let us know the result!

[jackyhorner]

Hi Admin
Ive had a Fructosamine done a few days ago
Ill let you know result as soon as I get it
Her brother has the same phenomenon
viz elevated HbA1c and  normal blood glucose values.
both have normal haemoglobins and RBC indices.
Thanks for your interest
Jacky Horner

[jackyhorner]

Her fructosamine blood level came back within normal limits
Electrophresis of Haemoglobin  showed  a suggestion of Hb H
possibly indicating Thalassemia Hb  trait.
Even if this does explain her erroneous  Hba1c level ,what would explain the abnormal
and gradual rise of her Hba1c over the past few years from completely normal values.?
I appreciate your thoughts.
Jacky Horner

[Admin]

normal fructosamine show good sugar control.

Just want to share another case of falsely elevated HbA1C: http://www.ncbi.nlm.nih.gov/pubmed/16178917

[Admin]

One more common reason for a falsely elevated HbA1 is iron-deficiency anemia. People with iron-deficiency anemia has higher level of hemoglobin A1C molecules. Read following quote:

a 2004 "Acta Haematologica" journal article noted that people with iron-deficiency anemia had an average HbA1C level of 7.4 percent +/- 0.8 versus a healthy group with an average of 5.9 percent +/- 0.5. Upon supplementation with iron, the levels were reduced to 6.2 percent +/- 0.6.

Read more: http://www.livestrong.com/article/153932-reasons-for-elevated-a1cs-without-diabetes/

[jackyhorner]

Hi Admin
Just want to report on 2 more patients in my practice- 2 sisters of the 1st male patient
Both have elevated Hba1c, normal fasting blood sugars, normal fructosamine
and an abnormal Haemoglobin Electrophoresis (Hb H ) . I spoke to the Laboratory
Head .Apparently a change in in the Hba1c assay method was introduced about
5 years ago It does not differientiate between the Hba1c and Hb H. Measuring
them together as Hba1c.It seems this explains the marked rise in Hba1c values
occuring since that time .
 Thanks for your help
Sincerely Jacky Horner

[Admin]

Oh, that's a very great information! So next time if we encounter similar senario, a Hb electrophoresis can be a consideration.

Many thanks!

[jackyhorner]

Hi Admin
Well You,ll be suprised
We are actually going to present this family at a Diabetic conference
Ill let you know if anything extra came forth.
It also puts  the absolute reliability on Hba1c for Diabetes doubtfull
This seems to depend on the particular assay used for the  Hba1c.
Now it seems that when a suspicious abnormal  elevated Hba1c arrise
one should do  the following   -  repeat Hba1c, Fructosamine , HB electrophresis,
Serum Iron Tibc Ferritin .
Once again thanks a lot for your help
Hope this  adds to knowledge of the forum members (especially coming in part from a 72 yearold GP)
Happy Passover
Dr Jacky Horner

[Admin]

Wow! Thats great! When and where is the conference? 

[jackyhorner]

Let you know when I have information JH