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*類別：
* 姓名： 曾致豪
投稿種類： 壁報
*中文投稿標題： HbA1c– marker of overall glycemic control and hemolytic anemia indicator- Case Report
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*中文服務單位：
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* 投稿摘要： ntroduction：Glycated hemoglobin A1c reflects a mean glucose over the previous period, approximately 3 months (erythrocyte life span). According to the ACE/AACE guidelines on A1c, target HbA1c should be set under 6.5%, in diabetes management, to reduce the risk of chronic complications. However, there are different situatinos that lead to a shortened lifespan of erythrocytes, resulting in falsely low HbA1c value. Case presented involves a 49-year-old patient with history of diabetes and possibe autoimmune hemolytic anemia (AIHA). Thus, HbA1c may be a screening test for hemolysis in non-diabetic patients with hemolytic anemia, but in diabetic population with hemolytic disease it is considered to be a very poor marker for both glycemia and haemolysis. Case report：A 49-year-old female has history of type 2 diabetes, Hepatitis C, and Myasthenia Gravis, was transferred to our ER due to poor glycemic control and weakness. Laboratory findings were as follows：RBC 1.37 M/Ul、Hb 6.81 g/dl、Hct 15.3％、MCV 111.0 fl、MCH 50.8 pg、MCHC 44.6％, apparently CBC was interferenced, reticular count=9.2%、DAT(+) , IAT(-) spherocytosis was found in PB smears, Total bilirubin 1.2 mg/dl、Direct bilirubin 0.3 mg/dl、Haptoglobin < 7.19 mg/dl、LDH 1566 U/L、C3、C4 were 47.0 mg/dl、5.4 mg/dl、Glucose 238 mg/dl，HbA1c 3.8 %, ANA homogenous 160X(+)、Anti-DNA 235.500 units、IgG 2380 mg/dl. Besides, when operating forward and reverse blood typing, ABO blood type discrepancy was found in this patient. We consequently took saline replacement technique to correct both blood type discrepancy and CBC (RBC、Hct、MCV、MCH、MCHC were corrected to 2.79 M/uL、28.2 %、101 fl、33.7 pg、33.4% repectively). All laboratory findings confirming the diagnosis of AIHA in this patient according to Merck Manual on AIHA. Till this year HbA1c values were kept persistently monitored, all A1c results predented falsely low datas about 2.9-3.6%. Discussion：Any condition maked by a shortening of erythrocyte life-span including hemolytic anemia, hemoglobinopathies, or an acute or chronic hemorrhage can lead to falsely low HbA1c values in patients with diabetes. On the other hand, HbA1c may be a screening test for hemolysis in non-diabetic patients with hemolytic anemia with warm or cold antibodies or with herediatary spherocytosis, as demonstrated by Panzer et al. in 1982. Conclusion：Hemolytic anemia caused a significant fall in A1c values without a change to fasting plasma glucose levels in diabetic patient. Falsely low A1c values may lead the clinicians to relax glycemic control inappropriately. Therefore, HbA1c, overall glycermic marker, but should not be used to guide diabetes therapy with the hemolytic anemia patients.
*關鍵字1 ： HbA1c
*關鍵字2 ： Hemoglobn A1c
*關鍵字3 ： hemolytic anemia
*關鍵字4 ： AIHA
*關鍵字5 ： Diabetes mellitus
* 服務機關：
* 第一作者： 曾致豪
* 身分字號： *****61828
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審查委員意見： 此案例報告非罕見病例，已有相關之病例報告，無新診斷方法或新檢驗項目之呈現
主任委員意見： 無意見
 
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