Markedly low hemoglobin A1c in a patient with an unusual presentation of beta-thalassemia minor.
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.
Danescu
Liviu G
LG
Department of Internal Medicine, St. Joseph Mercy Oakland Hospital, Pontiac, Michigan, USA.
Levy
Shiri
S
Levy
Joseph
J
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*
D006442:Glycated Hemoglobin