Localized and multicentric Castleman disease are different clinical disorders with overlapping histologic features. Localized disease can be cured with surgery, but complete remissions in patients with multicentric disease have been achieved only with chemotherapy or prednisone given at the time of diagnosis.

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We confirmed the existence of the reported paradoxical PSA decrease in patients with androgen-independent carcinoma of the prostate, and that the delivery of simultaneous initial flutamide with castration predicts for PSA decrease. Individual patients appear to benefit from flutamide withdrawal although the overall impact was slight. The differences in frequency compared to those reported by others may be accounted for by patient selection and the number of patients receiving sequential castration therapy followed by flutamide.

We confirmed the existence of the reported paradoxical PSA decrease in patients with androgen-independent carcinoma of the prostate, and that the delivery of simultaneous initial flutamide with castration predicts for PSA decrease. Individual patients appear to benefit from flutamide withdrawal although the overall impact was slight. The differences in frequency compared to those reported by others may be accounted for by patient selection and the number of patients receiving sequential castration therapy followed by flutamide.

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IntroductionMeasurement of glycated hemoglobin (HbA1c) is widely used in the management of patients with diabetes mellitus (DM). We report on three patients with a history of type 2 DM and consistent elevation of fasting blood glucose values, but with falsely low HbA1c values.Fasting blood glucose measurements were made using the hexokinase method in a Cobas 6000 (Roche Diagnostics, Rotkreuz, Switzerland). Determinations of HbA1c were performed on ethylenediaminetetraacetic acid-anticoagulated blood sample by two methods: high-performance liquid chromatography (HPLC) (HA-8160 in diabetic mode, A. Menarini Diagnostics, Florence, Italy), which detected no abnormal hemoglobin (Hb); and immune-turbidimetric method (Tina-quant Hemoglobin A1c Gen3 in a Cobas 6000), which was used for two patients. Both methods were calibrated according to the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Reference Measurement Procedure. Results are shown in Table 1.All three patients had evidence of hemolytic anemia, and their average Hb levels were as follows: patient A: 9.41 g/dl, patient B: 10.9 g/dl, patient C: 8.6 g/dl. Abnormally low HbA1c concentrations are usually encountered in patients with high turnover rates of hemoglobin.1 Further investigations revealed that the patients belonged to the same family, and all three had a history of heterozygosity trait for Hb Louisville.2 Hemoglobin Louisville is an unstable Hb that differs from HbA by the substitution of a phenylalanine residue for a leucine residue in position 42 of the β globin chain, resulting in instability in the Hb molecule, with increased erythrocyte destruction, and clinically manifested as hemolytic anemia 2 . The Hb Louisville heterozygotes suffer from mild anemia, jaundice, and hemolytic crisis.Upon testing our patients, the abnormal Hb could not be separated from normal HbA by electrophoresis method, 3 but interference in the HbA2 zone was noted using the HLPC Bio-Rad D-10 TM Dual Program, extended program. As hemolytic anemia causes decreased exposure time of Hb to glucose, the result is a decreased percentage of Hb undergoing glycation. 4 Fructosamine is neither affected by disorders of red blood cells nor influenced by Hb variants; We therefore determined fructosamine levels with a colorimetric test using nitriblue tetrazolium in alkaline solution, with the following results: patient A (patient deceased); patient B: 420 µmol/liter (in a previous test 391 µmol/dl); and patient C: 295 µmol/liter (reference range >285 µmol/liter). LETTER TO EDITORPhysicians need to be aware of the factors that can influence laboratory HbA1c levels, as therapeutic decisions are often based on these measurements. In diabetes patients who are Hb Louisville carriers, glycemic control should be monitored with serial glucose determinations or by fructosamine level.Acknowledgments:

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