Unmeasurable Hemoglobin A1c due to Extreme Hyperglycemia in High-performance Liquid Chromatography Method: A Case Report

Hiroki Doi; Midori Saito; Ayane Ozaki; Yuya Ishihara; Takashi Fujita; Hidehiko Akiyama; Hiroyasu Ito

doi:10.3889/oamjms.2023.11728

Authors

Hiroki Doi Department of Cellular and Molecular Biology, School of Medical Sciences, Fujita Health University, Toyoake, Japan https://orcid.org/0000-0002-3595-6235
Midori Saito Department of Clinical Laboratory, Fujita Health University Hospital, Toyoake, Japan
Ayane Ozaki Department of Clinical Laboratory, Fujita Health University Hospital, Toyoake, Japan
Yuya Ishihara Department of Clinical Laboratory, Fujita Health University Hospital, Toyoake, Japan https://orcid.org/0000-0002-8066-7344
Takashi Fujita Department of Biomedical Sciences, College of Life and Health Sciences, Chubu University, Kasugai, Japan
Hidehiko Akiyama Department of Cellular and Molecular Biology, School of Medical Sciences, Fujita Health University, Toyoake, Japan
Hiroyasu Ito Department of Clinical Laboratory, Fujita Health University Hospital, Toyoake, Japan; Joint Research Laboratory of Clinical Medicine, School of Medicine, Fujita Health University, Toyoake, Japan https://orcid.org/0000-0002-4836-4001

DOI:

https://doi.org/10.3889/oamjms.2023.11728

Keywords:

Hemoglobin A1c, Glucose, Hyperglycemia, Labile HbA1c, High-Performance Liquid Chromatography (HPLC)

Abstract

BACKGROUND: Hemoglobin A1c (HbA1c), which is one of the important parameters considered when judging the degree of glucose concentrations during the preceding 8–12 weeks, is used as the standard assessment of glycemic control in patients with diabetes. However, some measurement principles may cause errors in HbA1c measurement.

CASE REPORT: A 49-year-old male patient with hyperglycemic hyperosmotic syndrome had an extreme high blood glucose level of 2,161 mg/dL and an HbA1c level that was not measurable due to a large amount of labile HbA1c. Many institutions measure HbA1c by high-performance liquid chromatography (HPLC). We measure HbA1c using ARKRAY HA-8190V (ion-exchange HPLC) and report National Glycohemoglobin Standardization Program (NGSP) (%). HbA1c was not measurable in this case, so we requested glycated albumin measurement as a substitute which revealed an extreme abnormal value of 64.5%. HPLC analysis revealed a large #C peak, which appeared to be labile HbA1c, before the HbA1c peak. The patient was treated with insulin therapy, and the HbA1c was measurable and was 14.1% a day after the glucose level was controlled.

CONCLUSION: The report emphasiz of HbA1c measurements in situations of extreme hyperglycemia.

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