What Clinical Laboratorians Should Do in Response to Extremely Low Hemoglobin A1c Results.
Extremely low hemoglobin A1c (HbA1c) results below reference range are rare, and the causes and clinical implications associated with low HbA1c results are not well understood among clinical laboratorians. A case of extremely low HbA1c results was reported, in which liver cirrhosis, subacute hemorrhage and recent transfusion all contributed to the low result. This case illustrates when HbA1c should not be used as a clinically relevant diabetes marker. However, low or extremely low HbA1c (<5.0% or <4.0%) may occur in apparently healthy individuals. When this occurs, it is an independent risk factor associated with liver diseases, hospitalization, and all-cause mortality. From the clinical laboratory perspective, the clinical cause of extremely low HbA1c should be determined, and suggestions of different test utilization or increased health surveillance should be given to care providers.
Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston TX, and Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York City, NY pwang@houstonmethodist.org.|Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston TX, and Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York City, NY.
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D003920:Diabetes Mellitus / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000378:metabolism; D008103:Liver Cirrhosis / Q000378:metabolism; D017056:Medical Laboratory Personnel; D008875:Middle Aged; D024382:Professional Role; D012016:Reference Values
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
diabetes; hemoglobin A1c; liver disease; mortality