Diagnostic Dilemma of HbA1c Detection in Presence of a Hemoglobinopathy: A Case Report |
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| Authors: | Vijay S Bhat Kalyan Kumar Dewan Patnam Rajagopalan Krishnaswamy |
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| Institution: | (1) Department of Biochemistry, Manipal Hospital Diagnostic Services, Manipal Hospital, Old Airport Road, Bangalore, 560017, India;(2) Cauvery Medical Center, 43/2 Sahakarnagar, Bellary Road, NH-7, Bangalore, 560092, India |
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| Abstract: | We report a case of a diabetic, heterozygote with near normal hematology, marginally low level of hemoglobin A2(HbA2) having an increased level of hemoglobin F(HbF) that was pancellularly distributed among the red cells. BioRad DiaSTAT measurements
gave a high glycated hemoglobin A1c(HbA1c) of 31.5% and the BioRad Variant analyzer recorded an HbA1c value which was very
low, in discordance with the detected blood glucose levels. Flow cytometry and polymerization chain reaction (PCR) based studies
were carried out which revealed the case to be that of the common hereditary persistence of fetal hemoglobin (HPFH)-3, an
Asian Indian mutation. Fructosamine estimation and HbA1c by Boronate affinity chromatography were able to resolve the discordant
value detected and was able to confirm the diabetes status. The case would have been a diagnostic dilemma, if reported without
correlation. |
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| Keywords: | Glycated hemoglobin A1c(HbA1c) Flow cytometry Fluorescein isothiocyanate (FITC) Gap polymerization chain reaction (Gap-PCR) Alkaline electrophoresis Hereditary persistence of fetal hemoglobin (HPFH) High performance liquid chromatography (HPLC) |
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