Hemoglobinopathies May Distort HbA1C

Natasha Patel, PharmD Candidate, LECOM College of Pharmacy

Measuring glycated hemoglobin (HbA1c) gives us a patient’s long term average blood glucose levels.1

Since HbA1c measures the percentage of patients’ glycosolated hemoglobin, patients who possess variants of hemoglobin can exhibit false readings. Such variants, called hemoglobinopathies, can include inherited hemoglobin variants, elevated fetal hemoglobin, and hemoglobin S and E which are prevalent in people of Southeast Asia, Mediterranean, and African descent. 2 One variant of particular concern is the sickle cell trait. People with this trait have inherited biological differences affecting the formation of their hemoglobin and erythrocytes, which in turn affects their levels of glycated hemoglobin. 5

People who have the sickle cell trait have both normal hemoglobin A and hemoglobin S. In the U.S., African Americans are at a higher risk of having the sickle cell trait, and approximately 18.7 percent of African Americans who are 20 years and older have diabetes. 2 In people who have both the sickle cell trait and diabetes, about 1 million people in the U.S., using HbA1c to measure blood glucose levels can be prone to anomalies. People with these hemoglobin variants can have falsely low or high levels which can lead to improper treatment including: HbA1c readings that are different than expected; HbA1c levels that are extremely different from previous HbA1c readings; or low correlations between HbA1c and self-monitored glucose levels. 2

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