HbA1C Misleading in Diabetic Patient with PNH
the MPR take:
A case report in the American Journal of Clinical Pathology highlights the need to evaluate hemoglobin A1c levels carefully in patients with hematologic diseases that impact red blood cell survival. A patient with diabetes mellitus experienced a decline in hemoglobin A1c linked to paroxysmal nocturnal hemoglobinuria (PNH). After laboratory testing, the patient was shown to have elevated serum glucose (random), fructosamine, and glycated albumin that suggested ongoing hyperglycemia. The combined results led to the diagnosis that the hemoglobin A1c decline was caused by decreased red blood cell survival, secondary to PNH. For similar patients with diabetes plus hematological disease, serum fructosamine and glycated albumin measurements may be used as an alternative.
Objectives: We report a case of a patient with diabetes mellitus and unexpectedly low hemoglobin A1c results associated with paroxysmal nocturnal hemoglobinuria (PNH). We review the impact of shortened RBC half-life on the interpretation of hemoglobin A1c levels. However, elevated serum glucose (random), fructosamine, and glycated albumin suggest ongoing hyperglycemia.
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