We use Menarini HA8160s running in Beta Thalassemia mode.
We report the HbA1c result and use the following footnote for haemoglobin variants that do not appear to coincide with the HbA0 or A1c fractions:
'Haemoglobin variant detected. HbA1c result should be reliable but please interpret results with caution. Red cell lifespan may be reduced. If this patient has not been investigated for haemoglobinopathy previously, suggest sending EDTA specimen to haematology for Hb electrophoresis.
For further advice please contact the Duty Biochemist on xxxx xxxxxxx - Bleep xxx.'
Specimens where the haemoglobin variant obviously interferes with the HbA0 or A1c peaks are sent to the Menarini referral service for analysis (apparently they have a method that gives better separation). HbD is the most common interfering varient that we encounter.
Specimens containing homozygous varients are resulted as unsuitable with the following footnote:
'Haemoglobin varient detected - HbA1c result unreliable. If this patient has not been investigated for haemoglobinopathy previously, suggest sending EDTA specimen to haematology for Hb electrophoresis.
Fructosamine levels are recommended for assessment of diabetic control. A serum specimen (Brown top Sarstedt Monovette) is required for this assay.
For further advice please contact the Duty Biochemist on xxxx xxxxxxx - Bleep xxx.'
We used to automatically refer specimens to Haematology for Haemoglobin Electrophoresis but have recently stopped as some ethical issues have been raised.
Many thanks
Ben
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Akinlade Funmi (RF4) BHR Hospitals
Sent: 01 July 2013 11:57
To: [log in to unmask]
Subject: Re: Haemoglobin variants on HbA1c analysis
Hello Janice,
Where a variant is suggested by the chromatogram (and not previously confirmed) we do not report the result but ask for a repeat sample for HbA1c and Hb electrophoresis - with patient consent. Once the identity of the variant is confirmed we report as applicable for our method.
This website provides information on methods affected by HbA1c.
http://www.ngsp.org/interf.asp
NICE guideline on Type 2 DM (CG66) states:
When HbA1c monitoring is invalid (because of disturbed erythrocyte turnover or abnormal haemoglobin type), estimate trends in blood glucose control using one of the following:
1. fructosamine estimation
2. quality-controlled plasma glucose profiles 3. total glycated haemoglobin estimation (if abnormal haemoglobins).
Kind regards,
Funmi Akinlade MSc FRCPath
Queen's Hospital, Romford
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of janice reeve
Sent: 01 July 2013 11:23
To: [log in to unmask]
Subject: Haemoglobin variants on HbA1c analysis
Dear mailbase,
I wondered whether there were any guidelines, recommendations or thoughts on the topic of Hb variants identified, inadvertently, by HbA1c analysis.
How should variants and HbA1c results be reported in these patients?
What alternative tests should be recommended in these patients for monitoring of their diabetes? Is there any consensus on this?
What follow up testing, if any, should we be advising?
Your insight on this topic is much appreciated.
Best wishes,
Janice Reeve PhD. FRCPath
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