Immeasurable glycosylated haemoglobin: a marker for severe haemolysis

Aggarwal, Nidhi; Kumar, Anand; Kupfer, Yizhak; Tessler, Sidney

doi:10.1136/bcr-2013-200307

Cited by 9 publications

(8 citation statements)

References 3 publications

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“…The hemolysis in these individuals occurred between 2 to 7 days after normalisation of hyperglycaemia in newly diagnosed diabetes, which is consistent with that previously reported between 1 to 14 days [ 24 ]. Furthermore, severe hemolysis had been reported after the patient discharged [ 29 ]. Hence, for T1D with G6PD deficiency patients, we recommend careful clinical surveillance in these patients even correction of the hyperglycemia.…”

Section: Discussionmentioning

confidence: 99%

Glucose-6-Phosphate dehydrogenase deficiency associated hemolysis in a cohort of new onset type 1 diabetes children in Guangdong province, China

Jiang

Zhang

et al. 2022

Diabetol Metab Syndr

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Background Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the most common human genetic abnormalities, with a high prevalence in Guangdong, China. The purpose of this study was to explore the characteristics of newly diagnosed type 1 diabetes (T1D) patients with G6PD deficiency in a cohort of Chinese children and to investigate the relationship between the diabetic ketoacidosis (DKA) and hemolysis due to G6PD deficiency in these patients. Methods A total of 503 newly diagnosed T1D children aged 6 months–18 years were collected and their G6PD enzyme activity were measured. Fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), and G6PD gene were analysed. The pH, HCO3, and plasma osmotic pressure between DKA patients with and without hemolysis at the presentation were compared. Results In the present study, G6PD deficiency accounted for 5.3% of newly diagnosed T1D children. There were no significant differences in FPG/HbA1c and HbA1c levels between T1D children alone and T1D children with G6PD deficiency. Hemolysis appeared in five of the twenty-two DKA patients with G6PD deficiency. Two patients had fever at onset and were given ibuprofen and cefazolin. The other three patients did not have infection or ingestion of hemolytic drugs. There were no significant difference in pH, HCO3, and osmotic pressure between the children with DKA with and without hemolysis at the presentation. The hemolysis occurred between 2 and 7 days after admission and the hyperglycaemia had been corrected by the time hemolysis occurs. Four G6PD gene mutations were found in the diabetes with G6PD deficiency patients: c.1376G > T, c.1388G > A, c.95A > G, and c.871G > A, all of which were genes with high frequency of G6PD deficiency in Guangdong Province. No correlation between genotype and hemolysis was found. Conclusion In the present study, we found the frequency of G6PD deficiency among newly diagnosed T1D children was similar to that of the general population. However, DKA children with G6PD deficiency are prone to occur hemolytic anemia, and these hemolysis usually occurs when DKA is corrected and blood glucose is in homeostatic state, which is easy to be ignored. To reduce the risk of this complication, especially in areas with high incidence of G6PD deficiency, screening for G6PD activity in people with newly diagnosed diabetes should be considered.

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Section: Discussionmentioning

confidence: 99%

Glucose-6-Phosphate dehydrogenase deficiency associated hemolysis in a cohort of new onset type 1 diabetes children in Guangdong province, China

Jiang

Zhang

et al. 2022

Diabetol Metab Syndr

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“…Glycosylated hemoglobin (HbA1c) is an important determinant of diabetes control and reflects the mean glycemic level over the preceding 120 days, which is the average lifespan of a red blood cell. The HbA1c level at any point in time is contributed to by all the circulating erythrocytes, from the oldest (120 days old) to the youngest [15]. Falsely low HbA1c has been reported in glucose-6-phosphate dehydrogenase deficiency due to increased red cell turn over [15] and reduced exposure time of hemoglobin to glucose [16].…”

Section: Discussionmentioning

confidence: 99%

Manifestation of glucose-6-phosphate dehydrogenase deficiency in the wake of new-onset type 1 diabetes mellitus: a case report

Govindarajan

Zamir

Bagewadi³

et al. 2022

J Med Case Reports

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Background Diabetes mellitus is the most common metabolic disease globally, while glucose-6-phosphate dehydrogenase deficiency, an X-linked inherited disorder, is the most common erythrocyte enzyme defect. The association between the two in children has been infrequently reported. Case presentation We report the case of a 10-year-old boy of Iraqi descent who presented to our emergency department with new-onset type 1 diabetes mellitus without Diabetic Keto Acidosis. He was treated with subcutaneous insulin and discharged. Eleven days after hospitalization, he was found to be jaundiced during his home visit. Hence, he was referred to the pediatric unit, and his hemoglobin had declined from 130 g/L at the previous admission to 81 g/L. Blood tests revealed low haptoglobin, and his peripheral blood film showed anisocytosis, polychromasia, and occasional red cell fragments suggestive of acute hemolysis. His glucose-6-phosphate dehydrogenase activity was very low, and his subsequent genetic tests confirmed Mediterranean-type glucose-6-phosphate dehydrogenase deficiency. Conclusion Glucose-6-phosphate dehydrogenase deficiency in people with diabetes mellitus has been underreported in the literature so far, and screening of glucose-6-phosphate dehydrogenase deficiency should be considered on diagnosis of diabetes mellitus, especially in boys of African, Mediterranean, or Asian descent.

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“…Conditions that reduce red cell survival, such as hemolytic anemia, splenomegaly, chronic renal failure, and acute blood loss, are associated with lower HbA1c levels. Additionally, it has been suggested by others that decreased levels of HbA1c may be an indicator of hemolysis, chronic and acutely severe (15,16).…”

Section: Discussionmentioning

confidence: 99%

Glycemic Assessment in a Patient with HB Leiden and Type 2 Diabetes

Arakaki¹,

Changcharoen²

2016

AACE Clinical Case Reports

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Objective: To evaluate the discordance between blood glucose and hemoglobin A1c (HbA1c) levels in a patient with hemoglobin (Hb) Leiden and type 2 diabetes.Methods: Case report. Results: Measurement of HbA1c levels by immunoturbidimetric assay and boronate affinity high-performance liquid chromatography revealed values of 4.6 (26.8 mmol/ mol) and 4.8% (29.0 mmol/mol), respectively, while his fasting plasma glucose was 170 mg/dL and fructosamine was 345 mmol/L. Hb Leiden accounted for 27% of total hemoglobin, and the patient had splenomegaly and elevated hemolytic indices.Conclusion: The discrepancy between normal HbA1c and high blood sugar levels is attributed to chronic hemolysis. Treatment and monitoring options for this patient's diabetes and diabetes-related comorbid conditions will require careful management. (AACE Clinical Case Rep. 2016;2:e307-e310) Abbreviations: FPG = fasting plasma glucose; Hb = hemoglobin; HbA1c = hemoglobin A1c; RBC = red blood cell; SMBG = self-monitoring of blood glucose e308 Hb Leiden and Glycemic Assessment, AACE Clinical Case Rep. 2016;2(No. 4)

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Immeasurable glycosylated haemoglobin: a marker for severe haemolysis

Cited by 9 publications

References 3 publications

Glucose-6-Phosphate dehydrogenase deficiency associated hemolysis in a cohort of new onset type 1 diabetes children in Guangdong province, China

Glucose-6-Phosphate dehydrogenase deficiency associated hemolysis in a cohort of new onset type 1 diabetes children in Guangdong province, China

Manifestation of glucose-6-phosphate dehydrogenase deficiency in the wake of new-onset type 1 diabetes mellitus: a case report

Glycemic Assessment in a Patient with HB Leiden and Type 2 Diabetes

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