Haemoglobin A1C Levels Constantly Below Lower Reference Limit in a Diabetic Patient With Microcytic Anaemia

  • Frank Sheng Fan Section of Haematology and Oncology, Ministry of Health and Welfare Taitung Hospital, Taitung County, Taiwan
  • Chih-Hao Chen Section of Cardiology, Department of Medicine, Ministry of Health and Welfare Taitung Hospital, Taitung County, Taiwan
  • Hui-Chun Yang Department of Laboratory Medicine, Ministry of Health and Welfare Taitung Hospital, Taitung County, Taiwan

Keywords

Haemoglobin A1C, haemoglobin H disease, microcytic anaemia, thalassaemia

Abstract

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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  • Published: 2019-11-29

    Issue: LATEST ONLINE (view)

    Section: Articles

    How to cite:
    Fan, F., Chen, C.-H., & Yang, H.-C. (2019). Haemoglobin A1C Levels Constantly Below Lower Reference Limit in a Diabetic Patient With Microcytic Anaemia. European Journal of Case Reports in Internal Medicine, 2. https://doi.org/https://doi.org/10.12890/2019_001338