Diagnostic confusion in diabetes with persistence of fetal haemoglobin.

Robertson, Debra; Tunbridge, F. K. E.; John, W. Garry; Home, Philip; Alberti, K. G. M. M.

doi:10.1136/bmj.305.6854.635

Cited by 10 publications

(5 citation statements)

References 21 publications

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“…It has been shown by Robertson et al 4 that hereditary persistence of HbF in non-pregnant non-diabetic adults can lead to the misdiagnosis of diabetes mellitus when HbAI measurements are made using electroendosmotic methods. In our study we found that three of75 (4%) of non-diabetic pregnant women had a significant transient elevation of HbF.…”

Section: Resultsmentioning

confidence: 99%

Clinically Significant Interference by Haemoglobin F during Pregnancy with the Measurement of HbA1 Using the Corning Agar Electroendosmotic Technique

Knapp

Manyonda²,

Attwell³

et al. 1996

Ann Clin Biochem

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The measurement of glycated haemoglobin (HbAI) is now well established as a marker of medium term glycaemic control in diabetic patients. Furthermore, it is widely accepted that optimal glycaemic control in women prior to conception and during pregnancy reduces fetal morbidity and mortality.' For HbAI measurements to be useful during pregnancy if is necessary to establish appropriate pregnancy specific reference ranges. Whilst obtaining HbAI values from non-diabetic pregnant women for reference range purposes we observed very high results in three patients which could not be attributed to impaired glucose tolerance. We therefore investigated the cause. METHODSBlood samples (5 mL) were collected into disodium EDTA from 25 pregnant women at sixteen, 26 and 34 weeks gestation. Ethical Committee approval was obtained for the collection of samples. All of the pregnant women had a fasting plasma glucose concentration of less than 5'5mmol/L by our laboratory glucose oxidase method. None of the women had either a family history of diabetes or previous gestational diabetes. Samples were stored at + 20°C and were analysed within 24 h of collection.HbAI was measured by agar gel electroendosmosis using the Ciba Corning glycosylated haemoglobin system." Between run imprecision (% CV) was 6·0% at an HbAI level of 13·2%. Haemoglobin F (HbF) was measured by Singer's alkali denaturation method.' The adult reference range for percentage HbF using this technique is less than 0·5%. RESULTSWith three exceptions all the HbAI results in the non-diabetic pregnant women fell within the adult non-pregnant reference range of 5·0 to 8·0% (Table I). Furthermore, there was no significant difference in HbAI values between the three gestational ages (Mann-Whitney Utest: P

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Section: Resultsmentioning

confidence: 99%

Clinically Significant Interference by Haemoglobin F during Pregnancy with the Measurement of HbA1 Using the Corning Agar Electroendosmotic Technique

Knapp

Manyonda²,

Attwell³

et al. 1996

Ann Clin Biochem

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“…There have been several reports of HbF interference in electroendophoreic HbA1 methods leading to the erroneous diagnosis of diabetes mellitus, 14 , 15 and this further case is cause for concern. The patient described by Connolly and Kesson 14 is similar to our patient in that the HbF was 6% while the GTT was not indicative of diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…Before the GTT their patient was treated by diet only. Robertson et al 15 reported two cases where patients were treated with oral hypoglycaemic agents, both of whom actually described having hypoglycaemic symptoms. Our patient appeared to be free of hypoglycaemic symptoms despite being given a high dose of gliclazide (160 mg b.d.).…”

Section: Discussionmentioning

confidence: 99%

Incorrect Diagnosis of Diabetes Mellitus in a Patient With Persistence of Fetal Haemoglobin

Leonard

Leong²,

Neithercut³

et al. 1998

Int J Clinical Practice

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A 65-year-old woman, referred to the endocrine clinic for investigation of tiredness and arthritis, was diagnosed as having diabetes on the basis of a positive family history and a raised glycated haemoglobin (HbA 1) measurement. Subsequently, she was shown not to have diabetes but to have a persistently raised haemoglobin F (HbF) level. Initial assessment of HbF level by electroendosmosis demonstrated a normal HbF level but high values were confirmed using HPLC. Thalassaemia was excluded following DNA analysis. This case illustrates the importance of a glucose tolerance test following WHO criteria for the diagnosis of diabetes and emphasises that HbA 1 is not a diagnostic test for diabetes. (/nt

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“…Hb Graz is the second hemoglobin variant detected in Austria and represents the fourth hemoglobin variant with a mutation in the second codon of the beta chain [8][9][10]. Elevated fetal hemoglobin is known to cause high HbAac values in some chromatographic procedures, leading possibly to misdiagnosis and subsequent management failures of diabetes mellitus [16]. In addition to the slightly unstable Hb Campertown, oz2/32104(G6)Arg~Ser [22], Hb Sherwood Forest is the second hemoglobin variant found with a mutation in position 104 of the /3-chain [10].…”

Section: Discussionmentioning

confidence: 99%

Hemoglobin variants recently detected in Austria

et al. 1995

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Measurement of glycated hemoglobin (HbAtc) is used for routine management of diabetic patients. Glucose linkage to HbAtc reflects mean blood glucose levels during the last 3 months before examination. Various methods for HbA1c determination show abnormal values with hemoglobin variants. In some diabetic patients excessively high HbA1c values with high-performance liquid chromatography (HPLC) led to the detection of Hb Graz. In addition to Hb Graz, other silent hemoglobin variants have been found in Austria. Here we review Hb Graz, Hb Sherwood Forest, and Hb Okayama detected while using HPLC for the measurement of HbA1c in diabetic patients.

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Diagnostic confusion in diabetes with persistence of fetal haemoglobin.

Cited by 10 publications

References 21 publications

Clinically Significant Interference by Haemoglobin F during Pregnancy with the Measurement of HbA1 Using the Corning Agar Electroendosmotic Technique

Clinically Significant Interference by Haemoglobin F during Pregnancy with the Measurement of HbA1 Using the Corning Agar Electroendosmotic Technique

Incorrect Diagnosis of Diabetes Mellitus in a Patient With Persistence of Fetal Haemoglobin

Hemoglobin variants recently detected in Austria

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