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Adekanmbi J, Higgins T, Rodriguez-Capote K, Thomas D, Winterstein J, Dixon T, Gifford JL, Krause R, Venner AA, Clarke G, Estey MP. Erroneous HbA1c results in a patient with elevated HbC and HbF. Clin Chim Acta 2016; 462:153-157. [PMID: 27664335 DOI: 10.1016/j.cca.2016.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND HbA1c is used in the diagnosis and monitoring of diabetes mellitus (DM). Interference from hemoglobin variants is a well-described phenomenon, particularly with HPLC-based methods. While immunoassays may generate more reliable HbA1c results in the presence of some variants, these methods are susceptible to negative interference from high concentrations of HbF. We report a case where an accurate HbA1c result could not be obtained by any available method due to the presence of a compound hemoglobinopathy. METHODS HbA1c was measured by HPLC, immunoassay, and capillary electrophoresis. Hemoglobinopathy investigation consisted of a CBC, hemoglobin fractionation by HPLC and electrophoresis, and molecular analysis. RESULTS HbA1c analysis by HPLC and capillary electrophoresis gave no result. Analysis by immunoassay yielded HbA1c results of 5.9% (Siemens DCA 2000+) and 5.1% (Roche Integra), which were inconsistent with other markers of glycemic control. Hemoglobinopathy investigation showed HbC with the hereditary persistence of fetal hemoglobin-2 Ghana deletion. CONCLUSION Reliable HbA1c results may be unobtainable in the presence of some hemoglobinopathies. HPLC and capillary electrophoresis alerted the laboratory to the presence of an unusual hemoglobinopathy. Immunoassays generated falsely low results without warning, which could lead to missed diagnoses and under treatment of patients with DM.
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Affiliation(s)
- Joy Adekanmbi
- Department of Laboratory Medicine and Pathology, University of Alberta, Canada
| | - Trefor Higgins
- Department of Laboratory Medicine and Pathology, University of Alberta, Canada; DynaLIFE(Dx), Edmonton, Canada
| | - Karina Rodriguez-Capote
- Department of Laboratory Medicine and Pathology, University of Alberta, Canada; DynaLIFE(Dx), Edmonton, Canada
| | - Dylan Thomas
- Department of Laboratory Medicine and Pathology, University of Alberta, Canada; DynaLIFE(Dx), Edmonton, Canada
| | | | - Tara Dixon
- Department of Laboratory Medicine and Pathology, University of Alberta, Canada
| | | | | | - Allison A Venner
- Department of Laboratory Medicine and Pathology, University of Alberta, Canada; Alberta Health Services, Red Deer, Canada
| | - Gwen Clarke
- Department of Laboratory Medicine and Pathology, University of Alberta, Canada
| | - Mathew P Estey
- Department of Laboratory Medicine and Pathology, University of Alberta, Canada; DynaLIFE(Dx), Edmonton, Canada.
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Takeda Y, Kawanami D, Utsunomiya K. Detection of hemoglobin variant HbS on the basis of discrepant HbA1c values in different measurement methods. Diabetol Int 2016; 7:199-203. [DOI: 10.1007/s13340-015-0237-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 09/09/2015] [Indexed: 11/24/2022]
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van den Berg SAA, de Groot MJM, Salden LPW, Draad PJGJ, Dijkstra IM, Lunshof S, van Thiel SW, Boonen KJM, Thelen MHM. Pregnancy diabetes: A comparison of diagnostic protocols based on point-of-care, routine and optimized laboratory conditions. Sci Rep 2015; 5:16302. [PMID: 26542612 PMCID: PMC4635356 DOI: 10.1038/srep16302] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 10/09/2015] [Indexed: 12/16/2022] Open
Abstract
In vitro glycolysis poses a problem during diabetes screening, especially in remote laboratories. Point-of-care analysis (POC) may provide an alternative. We compared POC, routine and STAT analysis and a feasible protocol during glucose tolerance test (GTT) for pregnancy diabetes (GDM) screening. In the routine protocol, heparin tubes were used and turn-around-time (TAT) was unsupervised. In the STAT protocol, tubes were processed immediately. The feasible protocol comprised of citrated tubes with a TAT of 1 hour. Outcome was defined as glucose concentration and clinical diagnosis. Glucose measured by POC was higher compared to routine analysis at t = 0 (0.25 mM) and t = 120 (1.17 mM) resulting in 17% more GDM diagnoses. Compared to STAT analysis, POC glucose was also higher, although less pronounced (0.06 and 0.9 mM at t = 0 and t = 120 minutes, respectively) and misclassification was only 2%. Glucose levels and clinical diagnosis were similar using the feasible protocol and STAT analysis (0.03 mM and −0.07 mM at t = 0 and t = 120, 100% identical diagnoses). POC is an viable alternative for STAT glucose analysis in GDM screening (sensitivity: 100%, specificity: 98%). A feasible protocol (citrated phlebotomy tubes with a TAT of 60 minutes) resulted in 100% identical outcome and provides the best alternative.
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Affiliation(s)
| | | | - Lorenzo P W Salden
- Dept. of Clinical Chemistry and Hematology, Amphia Hospital, Breda, The Netherlands
| | - Patrick J G J Draad
- Dept. of Clinical Chemistry and Hematology, Amphia Hospital, Breda, The Netherlands
| | - Ineke M Dijkstra
- Dept. of Clinical Chemistry, Sint Anthonius Hospital, Nieuwegein, The Netherlands
| | - Simone Lunshof
- Dept. of Gynaecology, Amphia Hospital, Breda, The Netherlands
| | | | - Kristel J M Boonen
- Dept. of Clinical Chemistry and Hematology, Amphia Hospital, Breda, The Netherlands
| | - Marc H M Thelen
- Dept. of Clinical Chemistry and Hematology, Amphia Hospital, Breda, The Netherlands
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Identification of Hb Wayne and its effects on HbA1c measurement by 5 methods. Clin Biochem 2015; 48:1144-50. [DOI: 10.1016/j.clinbiochem.2015.07.100] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 07/26/2015] [Accepted: 07/31/2015] [Indexed: 11/23/2022]
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Chakraborty S, Chanda D, Gain M, Krishnan P. Interference of the Hope Hemoglobin With Hemoglobin A1c Results. Lab Med 2015. [PMID: 26199262 DOI: 10.1309/lme82xny6syvwdyq] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Hemoglobin A1c (HbA1c) is now considered to be the marker of choice in diagnosis and management of diabetes mellitus, based on the results of certain landmark clinical trials. Herein, we report the case of a 52-year-old ethnic Southeast Asian Indian man with impaired glucose tolerance whose glycated hemoglobin (ie, HbA1c) levels, as measured via Bio-Rad D10 high-performance liquid chromatography (HPLC) and Roche Tina-quant immunoassay were 47.8% and 44.0%, respectively. No variant hemoglobin (Hb) peak was observed via the D10 chromatogram. We assayed the patient specimen on the Sebia MINICAP capillary electrophoresis platform; the HbA1c level was 6.8%, with a large variant Hb peak of 42.0%. This finding suggested the possible presence of the heterozygous Hb Hope, which can result in spuriously elevated HbA1c results on HPLC and turbidimetric immunoassays. Although the capillary electrophoresis system was able to identify the variant, the A1c results should not be considered accurate due to overlapping of the variant and adult Hb peaks on the electrophoretogram reading. Hb Hope is usually clinically silent but can present such analytical challenges. Through this case study, we critically discuss the limitations of various HbA1c assay methods, highlighting the fact that laboratory professionals need to be aware of occurrences of Hb Hope, to help ensure patient safety.
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Affiliation(s)
- Sutirtha Chakraborty
- Department of Biochemistry, Peerless Hospital and B. K. Roy Research Centre, Kolkata, India
| | - Dalia Chanda
- B. P. Poddar Hospital and Medical Research Limited, Kolkata, India
| | - Mithun Gain
- Department of Biochemistry, Peerless Hospital and B. K. Roy Research Centre, Kolkata, India
| | - Prasad Krishnan
- Department of Neurosurgery, National Neurosciences Center, Kolkata, India
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de la Fuente-Gonzalo F, Nieto JM, Ricard P, Anguita J, Martínez R, Cervera A, Villegas A, González FA, Ropero P. Hb Cervantes, Hb Marañón, Hb La Mancha and Hb Goya: Description of 4 new haemoglobinopathies. Clin Biochem 2015; 48:662-7. [DOI: 10.1016/j.clinbiochem.2015.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 04/23/2015] [Accepted: 04/24/2015] [Indexed: 11/29/2022]
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Barbaro M, Ku-Chulim C, Johnston F, Cochrane R, Rota F, Passerini G, Guerra E, Ceriotti F, Carobene A. Evaluation of the performance of an immunoturbidimetric HbA1c reagent applied to the Siemens ADVIA 2400 automatic analyzer. Clin Biochem 2015; 48:177-80. [DOI: 10.1016/j.clinbiochem.2014.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/17/2014] [Accepted: 11/03/2014] [Indexed: 12/19/2022]
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Greene DN, Vaughn CP, Crews BO, Agarwal AM. Advances in detection of hemoglobinopathies. Clin Chim Acta 2014; 439:50-7. [PMID: 25314938 DOI: 10.1016/j.cca.2014.10.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 10/04/2014] [Accepted: 10/04/2014] [Indexed: 01/19/2023]
Abstract
Hemoglobin disorders are recognized as one of the most common inherited diseases worldwide. Detecting and characterizing variant hemoglobins and thalassemias depends primarily on clinical laboratory methods. Multiple biophysical, biochemical, and genetic assays are available to provide phenotypic or genotypic evidence of pathology. For many years conventional slab-gel electrophoresis and HPLC were the most commonly utilized laboratory methods. However, the field has rapidly expanded to regularly include capillary zone electrophoresis, molecular assays, and, more recently, mass spectrometric assays. Interpretation of these techniques is, in general, complicated because of the involvement of multiple polymorphic genes. Proper characterization of hemoglobin variants is necessary for diagnosis, primary prevention and genetic counseling for underlying disorders. This review provides an overview of the current hemoglobin analysis techniques, and also discusses technologies that have potential to translate into widespread clinical settings.
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Affiliation(s)
- Dina N Greene
- TPMG, Northern California Kaiser Permanente Regional Laboratories, Berkeley, CA, United States.
| | - Cecily P Vaughn
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, United States
| | - Bridgit O Crews
- TPMG, Northern California Kaiser Permanente Regional Laboratories, Berkeley, CA, United States
| | - Archana M Agarwal
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, United States; Department of Pathology, University of Utah Health Sciences, Salt Lake City, UT, United States
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Affiliation(s)
- Mark E. Williams
- Joslin Diabetes Center; Harvard Medical School; Boston Massachusetts
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Vikram NK, Jialal I. Use of HbA1c in the diagnosis of diabetes and prediabetes: sensitivity versus specificity. Metab Syndr Relat Disord 2014; 12:255-7. [PMID: 24716577 DOI: 10.1089/met.2014.1501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Naval K Vikram
- 1 Department of Medicine, All India Institute of Medical Sciences , New Delhi, India
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