LBODP031 Evaluation Of Artifactual Hypoglycemia: A Case-based Review

Abstract

Background Artifactual Hypoglycemia (AH), is defined as a discrepancy between the measured and actual blood glucose level. The absence of classical symptoms of hypoglycemia in patients with low measured glucose levels should raise the suspicion of AH. Here we describe a case of AH in a patient with chronic myeloid leukemia (CML). Clinical Case A 47-year-old woman was hospitalized for the evaluation of a four-month history of headache, anorexia, and weight loss. After further workup, she was diagnosed with CML; and upon evaluation, she was found to have a very low serum glucose level of 22 mg/dL. She reported no symptoms of hypoglycemia at the time and no personal or family history of diabetes. She was not using any glucose-lowering medication. Physical examination findings, including vital signs, were unremarkable. Laboratory studies revealed a serum glucose of 22 mg/dL with a simultaneous point-of-care (POC) capillary glucose level of 81 mg/dL. This discrepancy in glucose levels raised the suspicion of artifactual hypoglycemia. To further explore this, we drew three simultaneous venous blood samples and processed them differently to examine the impact of sample processing on serum glucose level in this patient. Two samples were drawn in tubes with no antiglycolytic agent (one sample was centrifuged immediately after the blood draw, and the second one was processed 5 hours after the blood draw). Whereas, the third sample was drawn in a tube containing sodium fluoride, an inhibitor of aerobic glycolysis, and was processed after one hour of the blood draw. Glucose concentrations in the three samples were as follows: 79 mg/dl, 41.4 mg/dl, and 77.4 mg/dl, respectively. The diagnosis of artifactual hypoglycemia due to excessive glucose consumption by leukocytes was established based on the findings of normal capillary blood glucose and normal plasma glucose levels when a tube prefilled with a glycolysis inhibitor is used. Conclusion Artifactual hypoglycemia should be considered in patients with asymptomatic hypoglycemia, especially when there is a discrepancy between the capillary and venous glucose levels. Patients with marked leukocytosis can have artifactually low serum glucose, an erroneous finding that can be mitigated by a) rapid processing of the blood sample or b) utilization of tubes pre-filled with a glycolysis inhibitor. Presentation: No date and time listed