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Spuriously high HbA1c due to the presence of haemoglobin raleigh: a case report and review of the literature

(2010) ACTA CLINICA BELGICA. 65(5). p.336-340
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Organization
Abstract
Case summary The described case concerns a Caucasian obese female patient who presented with a spuriously high haemoglobin A1c value of 45.6% (ref. range 4.0-6.1%), as measured with one of the three cation-exchange chromatography methods used. Re-evaluation of serum haemoglobin A1c and glycohaemoglobin with immunoassay and affinity binding chromatography resulted in normal levels (4.14% (ref. range 4 0-6.0%) and 4.3% (ref range <6%), respectively). In addition, the patient's serum fructosamine value another indicator of plasma glucose concentration over time was low (184 mu mol/l (ref. range 205-285 mu mol/l)). Genetic testing lead to the identification of an uncommon and clinically silent haemoglobin variant, designated Raleigh, in which a mutation of the 13 chain results in the replacement of the N-terminal valine by acetylated alanine. Discussion Some Hb variants give rise to analytical errors in the HbA1c determination (e.g. co-elution of haemoglobin Raleigh with HbA1c in cation-exchange chromatography), whereas other Hb variants are associated with a shorter RBC turnover or a different glycation rate, which causes interpretation problems (e.g. no glycation of the acetylated alanine in haemoglobin Raleigh). Conclusion This article illustrates the difficulties in diabetes management in patients with a haemoglobin variant and it provides the clinician with a diagnostic flow chart for dealing with suspicious haemoglobin A1c values.
Keywords
ASSAYS, A(1C), DERIVATIVES, OBESITY, HBA(1C), GLYCOHEMOGLOBIN, FRUCTOSAMINE, VARIANTS, GLYCEMIC CONTROL, haemoglobin Raleigh, glycohaemoglobin, HbA1c, DIABETES-MELLITUS, fructosamine, haemoglobin variant

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Chicago
VANDEWIELE, ANNE, Kenneth Genbrugge, and Joris Delanghe. 2010. “Spuriously High HbA1c Due to the Presence of Haemoglobin Raleigh: a Case Report and Review of the Literature.” Acta Clinica Belgica 65 (5): 336–340.
APA
VANDEWIELE, A., Genbrugge, K., & Delanghe, J. (2010). Spuriously high HbA1c due to the presence of haemoglobin raleigh: a case report and review of the literature. ACTA CLINICA BELGICA, 65(5), 336–340.
Vancouver
1.
VANDEWIELE A, Genbrugge K, Delanghe J. Spuriously high HbA1c due to the presence of haemoglobin raleigh: a case report and review of the literature. ACTA CLINICA BELGICA. 2010;65(5):336–40.
MLA
VANDEWIELE, ANNE, Kenneth Genbrugge, and Joris Delanghe. “Spuriously High HbA1c Due to the Presence of Haemoglobin Raleigh: a Case Report and Review of the Literature.” ACTA CLINICA BELGICA 65.5 (2010): 336–340. Print.
@article{1181493,
  abstract     = {Case summary The described case concerns a Caucasian obese female patient who presented with a spuriously high haemoglobin A1c value of 45.6\% (ref. range 4.0-6.1\%), as measured with one of the three cation-exchange chromatography methods used. Re-evaluation of serum haemoglobin A1c and glycohaemoglobin with immunoassay and affinity binding chromatography resulted in normal levels (4.14\% (ref. range 4 0-6.0\%) and 4.3\% (ref range {\textlangle}6\%), respectively). In addition, the patient's serum fructosamine value another indicator of plasma glucose concentration over time was low (184 mu mol/l (ref. range 205-285 mu mol/l)). Genetic testing lead to the identification of an uncommon and clinically silent haemoglobin variant, designated Raleigh, in which a mutation of the 13 chain results in the replacement of the N-terminal valine by acetylated alanine.
Discussion Some Hb variants give rise to analytical errors in the HbA1c determination (e.g. co-elution of haemoglobin Raleigh with HbA1c in cation-exchange chromatography), whereas other Hb variants are associated with a shorter RBC turnover or a different glycation rate, which causes interpretation problems (e.g. no glycation of the acetylated alanine in haemoglobin Raleigh).
Conclusion This article illustrates the difficulties in diabetes management in patients with a haemoglobin variant and it provides the clinician with a diagnostic flow chart for dealing with suspicious haemoglobin A1c values.},
  author       = {VANDEWIELE, ANNE and Genbrugge, Kenneth and Delanghe, Joris},
  issn         = {0001-5512},
  journal      = {ACTA CLINICA BELGICA},
  keyword      = {ASSAYS,A(1C),DERIVATIVES,OBESITY,HBA(1C),GLYCOHEMOGLOBIN,FRUCTOSAMINE,VARIANTS,GLYCEMIC CONTROL,haemoglobin Raleigh,glycohaemoglobin,HbA1c,DIABETES-MELLITUS,fructosamine,haemoglobin variant},
  language     = {eng},
  number       = {5},
  pages        = {336--340},
  title        = {Spuriously high HbA1c due to the presence of haemoglobin raleigh: a case report and review of the literature},
  volume       = {65},
  year         = {2010},
}

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