Lack of precision in HbA1c values on variant II in cases of hemoglobin Q India

Nigam, Pramod; Sharma, Smriti; Sareen, R; Paul, Vergis; Lal, Avtar

doi:10.1007/bf02912916

Cited by 5 publications

(2 citation statements)

References 21 publications

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“…Nigam et al conducted a study to examine the precision of HbA1c values on Bio-Rad Variant II in cases of Q India, a rare hemoglobin variant. They concluded that the results of HbA1c on Variant II cannot be reported and needs to be assessed by a different method and glycemic control be monitored by an alternative test such as serum fructosamine (23). Choudhary et al highlighted the potential that oral glucose tolerance test results can be erroneous in patients with beta-thalassemia, and continuous glucose monitoring may be accurate for patients to define their glycemic control (24).…”

Section: Discussionmentioning

confidence: 99%

Unexpected Detection of Abnormal Hemoglobin Variants During Routine HbA1c Analysis by HPLC Technique: Challenges and Opportunities in HbA1c Testing

Sreedevi

Kumar

Chendar

et al. 2021

Avicenna J Med Biochem

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Background: Glycated Hemoglobin A1c (HbA1c) assay is most widely used in diabetic patients for assessing long-term control of glycemia. The presence of hemoglobin variants may be an incidental finding and can interfere with HbA1c measurements. The aim of the present study is to investigate the prevalence and impact of interference of different abnormal hemoglobin variants on HbA1c measurements during routine HbA1c testing. Methods: A total of 12,092 HbA1c samples were collected from January to August 2018. HbA1c quantification was carried out on a Variant II Bio-Rad’s HPLC analyzer. Abnormal chromatograms were further analyzed using the extended-run high-pressure liquid chromatography (HPLC) analysis in the A2/F mode. Results: The samples were examined for presence of abnormal variants. Samples producing abnormal chromatograms were further analyzed in A2/F mode to characterize hemoglobin variants. Abnormal variants were identified in 126 (1%) samples, and 74 (0.59%) sickle cell traits (SCT) were the most common variant in our findings. Moreover, 30 (0.24%) cases were eluted in the variant window in A1c mode, which on further analysis were found to be Hb E & Hb D traits. Furthermore, 3 (0.02%) cases were eluted at a RT <1 min as (unknown) and identified as Hb H. Also,19 (0.15%) samples were eluted in the P3 window at different retention times. Conclusion: Observing each chromatograph after the analysis can help us in identifying silent hemoglobin variants in routine HbA1c testing. Knowledge and awareness of common hemoglobin variants affecting measurement of HbA1c is imperative to avoid reporting of falsely low HbA1c values in diabetic population.

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Section: Discussionmentioning

confidence: 99%

Unexpected Detection of Abnormal Hemoglobin Variants During Routine HbA1c Analysis by HPLC Technique: Challenges and Opportunities in HbA1c Testing

Sreedevi

Kumar

Chendar

et al. 2021

Avicenna J Med Biochem

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“…Because an HbA1c deviation of 1 % reflects a change of 1.4 to 1.9 mmol/L in average blood glucose concentration, a falsely high or low HbA1c value caused by the presence of a clinical hemoglobin variant may lead to over-or undertreatment of diabetic patients. Cationexchange high-performance liquid chromatography (HPLC) is one of the methods vulnerable to the effect of hemoglobin variants on HgbA1c measurements, as has been previously reported [11][12][13]. Hemoglobin variants that produce changes in the charge or structure of the hemoglobin molecule may affect the accuracy of HbA1c measurement.…”

Section: Introductionmentioning

confidence: 99%

Effects of hemoglobin S variants on the measurement of glycosylated hemoglobin A1c by four analytical methods

Tamimi

Aljasser

Kanan

et al. 2015

Int J Diabetes Dev Ctries

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Identification of hemoglobin Q India (α 1–64 Asp–His) through ARMS-PCR. First report from Pakistan

et al. 2008

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Various hemoglobinopathies have been reported from Pakistan excepting the rare ones like hemoglobin Q India. Our purpose of study was to identify the mutation (alpha 1 64 aspartate to histidine) through amplification restriction mutation system-polymerase chain reaction (ARMS-PCR) in patients where hemoglobin Q has been detected via high performance liquid chromatography (HPLC) and also to evaluate the cost effectiveness of the two technologies. All patients irrespective of age and gender who underwent HPLC for identification of their hemoglobin variant during January 1, 2006 to January 30, 2007 were studied. The blood samples with unknown peak at a retention time of 4.7 min were evaluated at the molecular level. Analysis of HPLC tracings of 11,008 subjects over a thirteen-month period identified ten individuals with hemoglobin Q. Male to female ratio was 1:1.5 and their age was variable ranging from 1 to 49 (mean 22.8) years. The mean hemoglobin level was 11.3 g/dl while MCV (fl) and MCH (pg) were 73.0 and 20.8 respectively. HPLC showed an unknown peak of 17.7% which was detected as Hb Q. ARMS based PCR showed Hb Q specific product of 370 bp and also an amplified product of 766 bp as the control fragment in these samples. This is the first ever report that documents the presence of Hb Q India (alpha 64 Asp to His) in Pakistani population. We recommend that HPLC be used as a useful screening tool especially in developing countries where PCR facilities may not be accessible.

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Lack of precision in HbA1c values on variant II in cases of hemoglobin Q India

Abstract: ABSTRACT

Cited by 5 publications

References 21 publications

Unexpected Detection of Abnormal Hemoglobin Variants During Routine HbA1c Analysis by HPLC Technique: Challenges and Opportunities in HbA1c Testing

Unexpected Detection of Abnormal Hemoglobin Variants During Routine HbA1c Analysis by HPLC Technique: Challenges and Opportunities in HbA1c Testing

Effects of hemoglobin S variants on the measurement of glycosylated hemoglobin A1c by four analytical methods

Identification of hemoglobin Q India (α 1–64 Asp–His) through ARMS-PCR. First report from Pakistan

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