AI Article Synopsis
- The text discusses three cases of unexpected hemoglobin A1c (HbA1c) results caused by various forms of interference, specifically flagged as "suspected hemoglobin E (HbE)" by the testing instrument.
- Each case features a different cause: a rare variant (hemoglobin Hoshida), true heterozygous HbE, and an analytical artifact leading to abnormal peak splitting.
- The authors outline their laboratory's process for investigating these discrepancies, emphasizing the need for thorough evaluation due to the lack of standardized reporting methods for such interferences in HbA1c measurements.
Article Abstract
We present 3 cases of discordant results from screening hemoglobin A1c (HbA1c) measured by ion-exchange high-performance liquid chromatography (HPLC) all due to various forms of interference and flagged by the instrument as "suspected hemoglobin E (HbE)." The first case was due to a rare hemoglobin variant, later confirmed to be hemoglobin Hoshida, the second due to "true" heterozygous HbE, and the third a result of analytical artifact causing splitting of the HbA1c peak without an underlying variant hemoglobin. We examine the similarities in these cases along with the laboratory work-up to classify each cause of interference to demonstrate the wide array of potential causes for the suspected HbE flag and why it warrants proper work-up. Because there is no standardized method of reporting out hemoglobin variant interference in HbA1c measurement, we discuss our laboratory's process of investigating discordant HbA1c measurements and reporting results in cases with variant interference as 1 possible model to follow, along with discussing the associated laboratory, ethical, and clinical considerations. We also examine the structure of hemoglobin Hoshida, HbE, and conduct a brief literature review of previous reports.
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| http://dx.doi.org/10.1093/labmed/lmad113 | DOI Listing |
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