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Is the sample for blood glucose actually fasting? May need confirmation. The HbA1c level is low for any individual and considering issues around HbA1c assay, we need to consider what platform the HbA1c was assayed on. Look at the evidence(s) of decreased red cell life span - microcytic anaemia/microcytosis and evidence haemoglobin variant on chromatography. Suggest sending a blood sample to haematology for Hb electrophoresis. If all things been same, you might try analysing it on another platform- suggest boronate affinity method. Isaac From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Al-Bahrani Ali Sent: 11 September 2014 13:28 To: [log in to unmask] Subject: Disparate blood glucose vs. HBA1c/Frustosamine Dear Colleagues I would welcome your comments and advise on the interesting case below please. 60 years old gentleman refer to the diabetic clinic because of disparate fasting/random glucose vs. very normal HBA1c please. Chemistries below please. Apparently he is not glycating his proteins, possible evolving diabetes ..... Kind Regards ALi Dr Ali Al-bahrani MBCh.B MSc.Chem Path. EuClin.chem. CSci. FRCPath. Lead Pathologist RCPath Wessex Professionalism Lead Consultant Chemical Pathologist and HOD of Chemical Pathology St Mary's Hospital Newport Isle of Wight PO30 5TG United Kingdom Te: 01983 534859/534917 Collected 15.04.14 07:42 A.Diag ---------------------------------------------------------------------------- ......Fast.gluc.......... Fast.Gluc. + 9.7 ......Hb A1c............. HbA1c - 19 Specimen B,14.0700164.T Clin dets High Fasting glucose and low HBA1c Collected 01.04.14 08:11 A.Diag ---------------------------------------------------------------------------- ......GTT................ Time 1 0 mins Bl.Glucose 8.4 Time 2 120 mins Bl.Glucose 15.9 Collected 29.05.14 08:12 A.Diag ---------------------------------------------------------------------------- ......U&E................ |Free T4 10.8 | Urea 5.5 |......Hb A1c............. |......LFT................ Sodium 138 |HbA1c 20 |ALT 32 Potassium 4.1 HDL Chol........... |Bilirubin 17 Chloride 103 |HDL Chol. - 1.09 |Alk. Phos. 71 Anion Gap NA |Cholestrol 3.82 | Tot.Prot. 67 Creatinine 95 |Trig. 1.57 |Albumin 40 eGFR - 75 |T/HC ratio + 3.50 |Globulin 27 ......TFT................ | LDL(calc.) 2.01 |...... ....... Analyte Result Units Ref.Range | | MCH 31.3 pg (28.0-34.0) | | Reticulocytes 1.4 % (0.2-2.0) | | RETIC ABSOLUTE 62 x10^9/l (20-80) | | | | Thalassaemia/Haemoglobin variant screening | | Haemoglobin A2 2.5 % (2.0-3.3) | | Haemoglobin F <0.8 % (0.0-1.0) | | No atypical peaks seen | | MCH 31.3 pg (28.0-34.0) | | | | Blood film: Blood film review supports automated cell count. | | Thalassaemia Screen: No evidence of an abnormal Collected 10.06.14 07:50 A.Diag ---------------------------------------------------------------------------- ......U&E................ | |T/HC ratio + 4.37 Urea 4.7 |......Ferritin........... |LDL(calc.) 2.39 Sodium 137 |Ferritin 199 |......LFT................ Potassium 4.1 |......FRActasmine............... |ALT 26 Chloride 102 |FRUC 231.0 |Bilirubin 15 Anion Gap NA |Date ref. 11.06 |Alk. Phos. 64 Creatinine 88 |......HDL Chol........... |Tot.Prot. 65 eGFR - 82 |HDL Chol. - 0.93 |Albumin 39 ......Glucose............ |Cholestrol 4.06 |Globulin 26 Glucose 7.0 |Trig. 1.61 | ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ Disclaimer This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. 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