Patient with Elevated HbA1c But No Symptoms of Diabetes

Patient with Elevated HbA1c But No Symptoms of Diabetes

Appearing in the Journal of Medical Cases, a case study outlines what is only the fourth reported case worldwide of a rare hemoglobin (Hb) variant, Hb South Florida (Hb-SF) that can cause falsely elevated HbA1c results during standard laboratory testing in the range of poorly controlled diabetes mellitus.
During routine lab work using the ion-exchange high performance liquid chromatography (HPLC) method, a 42-year-old female patient with a history of sclerosing bone dysplasia (treated with acetaminophen/codeine) was found to have an elevated HbA1c of 13.8%. The patient denied any family history of diabetes but repeat testing showed HbA1c of 12.8% with fasting blood sugar of 98mg/dL. Over the course of several months, her HbA1c was persistently elevated at 12–14% with mildly elevated blood sugar readings. Finally, Hb electrophoresis was performed at an endocrinology clinic and the results indicated that the patients was heterozygous for Hb-SF that leads to falsely elevated HbA1c levels. When evaluated by affinity column HPLC, her HbA1c levels were in the normoglycemic range.
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