Two Patients with Low HbA1c Levels Due to Subclinical Hemolysis

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  • 不顕性溶血のためにHbA1cが低値を示した2例
  • 症例報告 不顕性溶血のためにHbA1cが低値を示した2例
  • ショウレイ ホウコク フケンセイ ヨウケツ ノ タメニ HbA1c ガ テイチ オ シメシタ 2レイ

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Abstract

We experienced two patients with low HbA1c levels due to subclinical hemolysis. One patient did not present with diabetes mellitus, whereas the other patient exhibited diabetes mellitus; in both cases, the glycated albumin to HbA1c ratio was extremely high. Since the HbA1c levels measured using the HPLC method and an immunoassay were identical in both patients, the possibility of variant hemoglobin was excluded. Although neither subject was anemic, the levels of haptoglobin and reticulocytes were low and high, respectively. A morphological examination of the erythrocytes revealed elliptocytes in one patient and spherocytes in the other patient according to smears of the peripheral blood and scanning electron microscopy. These findings indicated that the cause of the low HbA1c levels was subclinical hemolysis resulting from elliptocytosis and spherocytosis, respectively. Subclinical hemolysis should thus be considered in patients with apparently low HbA1c levels.

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