In-House Algorithm for Reporting Discrepant HbA1c Result and Troubleshooting a Case of False Low HbA1c

• Published in: EJIFCC Vol. 32; no. 3; pp. 377 - 384
• Main Authors: Pant, Vivek, Shrestha, Abha, Pyakurel, Devish, Gautam, Keyoor, Pradhan, Santosh
• Format: Journal Article
• Language: English
• Published: The Communications and Publications Division (CPD) of the IFCC 18.10.2021
• ISSN: 1650-3414; 1650-3414

We report an unusual case of a patient having low glycosylated hemoglobin (HbA1c) below the reportable range, despite having borderline fasting blood glucose. The patient had decreased erythrocytes count and elevated reticulocyte count, with no evidence of hemoglobinopathy. He reported taking multidrug therapy for borderline lepromatous leprosy. Dapsone induced hemolysis was identified as the cause for the discordant HbA1c. Thus, it is important to be aware of medications and conditions that may lead to a falsely low HbA1c level so that incorrect treatment decisions are not made. In such situations, alternative measure of glycemic control, such as fructosamine is recommended. Further it is also recommended that clinical laboratories have standard protocol to troubleshoot any discrepant HbA1c result.We report an unusual case of a patient having low glycosylated hemoglobin (HbA1c) below the reportable range, despite having borderline fasting blood glucose. The patient had decreased erythrocytes count and elevated reticulocyte count, with no evidence of hemoglobinopathy. He reported taking multidrug therapy for borderline lepromatous leprosy. Dapsone induced hemolysis was identified as the cause for the discordant HbA1c. Thus, it is important to be aware of medications and conditions that may lead to a falsely low HbA1c level so that incorrect treatment decisions are not made. In such situations, alternative measure of glycemic control, such as fructosamine is recommended. Further it is also recommended that clinical laboratories have standard protocol to troubleshoot any discrepant HbA1c result.