Danescu LG, Levy S, Levy J. Markedly low hemoglobin A1c in a patient with an unusual presentation of beta-thalassemia minor.
Endocr Pract 2010;
16:89-92. [PMID:
19703808 DOI:
10.4158/ep09160.cr]
[Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE
To describe very low hemoglobin A1c levels in a patient with type 2 diabetes mellitus and an unusual presentation of beta-thalassemia minor.
METHODS
We present the clinical and laboratory findings of the study patient.
RESULTS
A 64-year-old African American man with type 2 diabetes mellitus was referred to the endocrinology clinic with a hemoglobin A1c level of 1.6% despite elevated blood glucose concentrations. A red blood cell survival study with chromium-51 revealed that he had a reduced erythrocyte life span less than 25% of normal. He also had a markedly elevated reticulocyte count ranging from 236 to 534 x 10(3)/microL (reference range, 25-75 x 10(3)/microL). The laboratory findings, which are not characteristic of beta-thalassemia minor, could be the cause of the markedly low hemoglobin A1c in this patient.
CONCLUSIONS
Although rare, when associated with marked erythrocyte turnover, beta-thalassemia minor can lead to a severe reduction in HbA1c levels. In this scenario, glycemic control is best assessed by measuring fructosamine.
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