Haemoglobin A1C Levels Constantly Below Lower Reference Limit in a Diabetic Patient With Microcytic Anaemia
KeywordsHaemoglobin A1C, haemoglobin H disease, microcytic anaemia, thalassaemia
Introduction: Haemoglobin A1C (A1C), as a parameter of long-term glycaemic control, has been adopted to guide diabetic therapy all over the world. However, falsely high or low A1C could be troublesome in daily practice.
Case description: A 75-year-old male diabetic patient affected by a reasonably inferred life-long history of microcytic anaemia was found to have abnormally low A1C values in the previous 5 months. Subsequent laboratory assessment with brilliant cresyl blue staining and haemoglobin electrophoresis detected haemoglobin H disease as the underlying cause of both the microcytic anaemia and the disturbed A1C measurement.
Discussion: Enhanced erythrocyte destruction such as in haemoglobin H disease could explain a falsely decreased A1C level very well. Upon facing a questionable A1C value, physicians dealing with diabetes should consider the possibility of undiscovered underlying causes rather than too tightly glycaemic control.
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