|
The Hemoglobin Wayne Variant and Association with Falsely Elevated HbA1c
|
Mohammad Ghahri   1, Mahmoud Shokrabadi |
|
|
|
Abstract: (55 Views) |
Hemoglobin A1c is routinely used to diagnose diabetes and monitor treatment. Therefore, it is important to identify factors that interfere with the accuracy of HbA1c measurement. Hemoglobin (Hb) Wayne is a frameshift alpha chain variant that produces two isoforms termed Hb Wayne I and II. Although clinically silent, this variant can interfere with HbA1c measurement with high performance liquid chromatography methods. Hb Wayne isoforms co-elute with HbF and HbA1c peaks, leading to a falsely elevated HbA1c. A few cases have been reported in the literature that inaccurate HbA1c measurement due to presence of Hb Wayne resulted in diabetes misdiagnosis (ie., HbA1c results > 6.5%) and treatment.
To describe the effect of hemoglobin Wayne variant on hemoglobin A1c (A1c) accuracy and to stress the importance of patient-physician communication and trust. We present the clinical history and laboratory findings of 5 patients, with a review of related literature.
Most heterogenous hemoglobinopathies are benign and clinically silent, and if not suspected as the cause of spuriously elevated A1c, can be easily missed, which may lead to misdiagnosis of DM. Some studies have suggested that the presence of hemoglobin variants should be considered as a differential when there are discrepancies in the A1c and blood glucose levels. The central lesson from these cases goes beyond the science of hemoglobin testing. In every cases, we were presented with a patient who insisted that they were following their diabetic treatment plan appropriately and yet experienced hypoglycemic episodes.
These cases not only present this rare and interesting hemoglobin variant but also remind providers that A1c testing is susceptible to misinterpretation due to multiple interfering factors. Use of additional laboratory tests, such as fasting glucose, in combination with A1c could help avoid diagnostic errors. With the proper awareness and improved patient-physician communication, providers may avoid the mismanagement of diabetic as well as nondiabetic patients and avoid the risk of hypoglycemia through unnecessary antihyperglycemic medications. |
|
| Keywords: Hemoglobin Wayne, Hemoglobin A1c, Diabetes Mellitus, Hemoglobinopathy, Hemoglobin Electrophoresis |
|
|
Full-Text [PDF 537 kb]
(42 Downloads)
|
Type of Study: Review |
Subject:
قارچ شناسی
Received: 2024/12/28 | Accepted: 2024/12/29 | Published: 2024/12/29
|
|
|
|
|
|
|
| Send email to the article author |
|
|
|
| Add your comments about this article |
|
|
|
