A Diabetic Case with Hemoglobin J-Meerut and Low HbA1C Levels.

Abstract

A diabetic patient with hemoglobin (Hb) J-Meerut and low HbAlc levels is reported. An automatic glycohemoglobinanalyzer used for the determination of HbAlcrevealed an abnormal peak of the peripheral blood obtained from a Japanese female with diabetes. She showed a lower HbAlc level (3.7 % ) than expected from her fasting plasma glucose (172 mg/dl). High performance liquid chromatography and isoelectric focusing indicated that her abnormal hemoglobin was Hb J-Meerut [od20(H3)Ala^Glu] and it accounted for 28.3% of the total hemoglobin. Abnormal hemoglobinemiashould be considered whena major discrepancy between the levels ofHbAlcand fasting plasma glucose is observed.

Two Cases in which an Abnormal Hemoglobin (Hb Kamakura) was Identified on the Basis of an Abnormally Low Glycohemoglobin Levels

“…The major peak of the abnormal Hb might even overlap with HbAic giving rise to an erroneously high HbAic level, thereby causing determination errors. Thus, both abnormally low HbAic levels, as in our cases (7)(8)(9), and abnormally high HbAic levels (10) have been reported in the past. In such cases of abnormal hemoglobin levels, the true levels can be obtained by immuneturbidimetry, except for variants with N-terminal substitution of the P globin chain.…”

Hb Ube-2 in a Diabetic Case with an Abnormally Low HbA1C Value.

“…Out of these 3 parameters, HbA,c is notably advantageous for evaluating the plasma glucose level of the previous month, hence HbAlc is indispensable for the management of diabetes, particularly in outpatient clinics. With the increased frequency of HbAlc tests performed due to the increasing numberof diabetic patients in Japan, cases with abnormal Hb have accumulated recently (1)(2)(3)(4)(5)(6).…”

Hemoglobin J—As a Cause of Congenital Hemolytic Anemia

“…The isopropanol test is more convenient than heat stability test which is somewhat difficult to interpret. Hb J variants have been implicated to cause falsely low Hb A1c (glycated Hb) values and thus interfering in the assessment of glycemic control in diabetics [8]. Abnormal Hb should be considered when a major discrepancy is seen between levels of Hb A1c and fasting blood sugar values.…”