Hemoglobin E: a potential interferent in measurement of glycated hemoglobin

Authors

  • Shobhit Goel Department of Laboratory Medicine, Command Hospital Airforce, Bangalore, Karnataka, India
  • Preeti Tripathi Department of Laboratory Medicine, Command Hospital Airforce, Bangalore, Karnataka, India
  • Arijit Sen Department of Laboratory Medicine, Command Hospital Airforce, Bangalore, Karnataka, India
  • Sangeetha Sampath Department of Laboratory Medicine, Command Hospital Airforce, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20203609

Keywords:

Glycosylated hemoglobin, Hemoglobin E variant, High performance liquid chromatography, Interference

Abstract

Glycosylated hemoglobin (HbA1C) is a routinely measured parameter to monitor long term glycemic control in patients with diabetes mellitus. There are many potential interferents which can affect measurement of HbA1C by high performance liquid chromatography (HPLC). Variant hemoglobins, especially, are a common source of confusion and errors in HbA1C measurement. Authors present an interesting case of Hb E variant (undiagnosed hitherto) which came to attention when the machine repeatedly failed to give Hb A1C levels. Hb E is the commonest Hb variant in North East India. In the presence of Hb E, HbA1C may not be detected by ion exchange chromatography as both hemoglobin’s co- elute together, thereby causing errors. In such cases, the clinician may resort to subcutaneous sugar monitoring as an alternate or if required, Hb A1C measurement may be done by other techniques like immunoassay technique or boronated affinity chromatography. The laboratory staff and clinicians, both, should be aware of this limitation of HbA1C estimation in patients with HbE and other Hb variants.

Metrics

Metrics Loading ...

References

Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, et al. Diabetes control and complications trial research group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin dependent diabetes mellitus. New Engl J Med. 1993;329:977-86.

Turner Robert C, Holman Rury R, Cull Carole A, Stratton Irene M, Matthews David R, Valeria F, et al. Intensive blood-glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Endocrinol. 1999;9(2):149.

Grant Richard W, Donner Thomas W, Fradkin, Judith E, Hayes, Charlotte, Herrman William H, Hsu WC, et al. Standards of medical care in diabetes-2015: summary of revisions. Diabetes Care. 2015;38:S4.

Yedla N, Kuchay MS, Mithal A. Hemoglobin E disease and glycosylated hemoglobin. Indian J Endocrinol Metab. 2015;19(5):683-5.

Nathan DM, Balkau B, Bonora E, Borch-Johnsen K, Buse JB, Colagiuri S, et al. International expert committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32(7):1327-34.

Kohne E. Hemoglobinopathies: clinical appearances, diagnostic and therapeutic indications. Dtsch Arztebl. 2011;108(31-32):532-40.

Little RR, Roberts LW. A review of variant hemoglobins interfering with hemoglobin A1c measurement. J Diabetes Sci Technol. 2009;3(3):446-51.

Vichinsky E. Hemoglobin e-syndromes. Hematol Am Soc Hematol Educ Program. 2007;79-83.

Musalmah M, Normah J, Mohamad WB, Salwah ON, Fatah HA, Zahari NA. Effect of hemoglobin E on glycosylated hemoglobin determinations using different commercial kits. Med J Malaysia. 2000;55(3):352-6.

Paisooksantivatana K, Kongsomgan A, Banyatsuppasin W, Khupulsup K. Influence of hemoglobin E on measurement of hemoglobin A1c by immunoassays. Diabetes Res Clin Pract. 2009;83(3):84-5.

Downloads

Published

2020-08-25

Issue

Section

Case Reports