Falsely low glycosylated haemoglobin levels probably secondary to hypersplenism in a patient with diabetes mellitus

A man in his 70s presented with a history of low glycated haemoglobin (HbA1c) values despite a diagnosis of type 2 diabetes. His blood glucose readings ranged between 8 and 15 mmol/L, but his HbA1c values were below 27 mmol/mol. Initial investigations demonstrated evidence of reduced red blood cell...

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Published inBMJ case reports Vol. 17; no. 4; p. e260249
Main Authors Hayakawa, Guy, Leibowitz, Maya M, Nagumantry, Sateesh Kumar, Oyibo, Samson Oghenetsovwe
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group LTD 04.04.2024
Subjects
Anemia
Blood Glucose - metabolism
Blood Glucose Self-Monitoring
Bone marrow
Case reports
Chronic illnesses
Congenital diseases
Dehydrogenases
Diabetes
Diabetes Mellitus, Type 2 - complications
Glucose monitoring
Glycated Hemoglobin
Hemoglobin
Humans
Hyperplasia
Hypersplenism - etiology
Kinases
Liver cirrhosis
Liver diseases
Male
Spleen
Urine
Haematology (incl blood transfusion)
Diabetes
Alcoholic liver disease
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Summary:A man in his 70s presented with a history of low glycated haemoglobin (HbA1c) values despite a diagnosis of type 2 diabetes. His blood glucose readings ranged between 8 and 15 mmol/L, but his HbA1c values were below 27 mmol/mol. Initial investigations demonstrated evidence of reduced red blood cell lifespan as a cause of misleadingly low HbA1c values. Further investigation revealed chronic liver disease and splenomegaly, with hypersplenism being the probable cause of increased red blood cell turnover. HbA1c estimation was no longer reliable, so ongoing diabetic care was guided by home capillary blood glucose monitoring. Healthcare providers and clinical laboratorians need to be aware of the possible clinical implications of very low HbA1c values in patients with type 2 diabetes.
Bibliography:ObjectType-Case Study-2
SourceType-Scholarly Journals-1
ObjectType-Feature-4
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ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2024-260249