title: Markedly low hemoglobin A1c in a patient with an unusual presentation of beta-thalassemia minor.
abstract: OBJECTIVE
  To describe very low hemoglobin A1c levels in a patient with type 2 diabetes mellitus and an unusual presentation of beta-thalassemia minor.
  
  
  METHODS
  We present the clinical and laboratory findings of the study patient.
  
  
  RESULTS
  A 64-year-old African American man with type 2 diabetes mellitus was referred to the endocrinology clinic with a hemoglobin A1c level of 1.6% despite elevated blood glucose concentrations. A red blood cell survival study with chromium-51 revealed that he had a reduced erythrocyte life span less than 25% of normal. He also had a markedly elevated reticulocyte count ranging from 236 to 534 x 10(3)/microL (reference range, 25-75 x 10(3)/microL). The laboratory findings, which are not characteristic of beta-thalassemia minor, could be the cause of the markedly low hemoglobin A1c in this patient.
  
  
  CONCLUSIONS
  Although rare, when associated with marked erythrocyte turnover, beta-thalassemia minor can lead to a severe reduction in HbA1c levels. In this scenario, glycemic control is best assessed by measuring fructosamine.
authors.affiliation: Department of Internal Medicine, St. Joseph Mercy Oakland Hospital, Pontiac, Michigan, USA.
authors.forename: Liviu G
authors.initials: LG
authors.lastname: Danescu
authors.forename: Shiri
authors.initials: S
authors.lastname: Levy
authors.forename: Joseph
authors.initials: J
authors.lastname: Levy
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004912:Erythrocytes / Q000473:pathology; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017086:beta-Thalassemia / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology*
chemical_list: D006442:Glycated Hemoglobin