Page 34 - Delaware Medical Journal - July/August 2019
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not correlate with clinical setting, more specifically looking at self-monitored blood glucose in a setting where hypoglycemia would be very likely. An important learning point from this case is to recognize the various causes of falsely low or high A1c (Table 2).
Conditions that result in alteration of red blood cell (RBC) turnover rate
can affect the A1c measurements. In circumstances where there is rapid turnover of RBCs and decreased survival of RBCs, the A1c can be falsely low because a greater proportion of RBCs are younger.1 Examples of such conditions include blood loss anemia (which was the case in our patient), hemolysis, or treatment
with erythropoietin. In cases where
Abbreviations: A1c = hemoglobin A1c; B12 = Vitamin B12; CKD = chronic kidney disease
Table 2: Factors that Affect A1c Measurements
Falsely Low A1c
Falsely High A1c
Blood loss anemia
Iron deficiency anemia
Hemolysis
B12 and Folate deficiency anemia
Erythropoietin treatment
Uremia in CKD
Hemodialysis
Alcohol abuse
Abnormal hemoglobin
Abnormal hemoglobin
Recent blood transfusion
Splenectomy
Hypertriglyceridemia
RBC turnover is decreased, A1c can
be falsely high because a greater proportion of RBCs are older, and thus a higher level of glycated hemoglobin is detected.1 Examples of such conditions
thalassemia. In our case, the patient had
anemia because he most likely had a component of blood loss anemia from his colon cancer. Abnormal hemoglobin,
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Del Med J | July/August 2019 | Vol. 91 | No. 4
