High peak of carbamylated hemoglobina discordant with urea level: a case report
Main Author: | |
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Publication Date: | 2021 |
Other Authors: | , , |
Format: | Report |
Language: | eng |
Source: | Jornal Brasileiro de Patologia e Medicina Laboratorial (Online) |
Download full: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1676-24442021000100706 |
Summary: | ABSTRACT Hemoglobin A1c (HbA1c) measurement is commonly performed in diabetes mellitus patients to monitor glycemic control over the last three to four months. Carbamylated hemoglobin, which is the hemoglobin that binds to isocyanic acid derived from urea, is one of the possible analytical interference in the uremic patient. When measured by ion-exchange high-performance liquid chromatography (HPLC), carbamylated hemoglobin forms a peak that overlaps the peak of HbA1c, causing a falsely elevated HbA1c result. We report a case of a 60-years-old man who had a spurious increase in HbA1c, with a high carbamylated hemoglobin peak disproportionate to the urea value. Subsequent hemoglobin analysis using hemoglobin electrophoresis and HPLC hemoglobin testing system suggested hemoglobin J (Hb J) variant. Our case highlighted the possibility of misleading HbA1c interpretation in the presence of a high carbamylated hemoglobin peak, but not proportionate to urea value. In this study, Hb J was detected. A method free from hemoglobin variant interference should be used ideally, and monitoring glycemic control should be performed using alternative methods, such as serum fructosamine or continuous glucose monitoring. |
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High peak of carbamylated hemoglobina discordant with urea level: a case reportglycated hemoglobin Achromatography high-pressure liquidcarbamylated hemoglobinureaABSTRACT Hemoglobin A1c (HbA1c) measurement is commonly performed in diabetes mellitus patients to monitor glycemic control over the last three to four months. Carbamylated hemoglobin, which is the hemoglobin that binds to isocyanic acid derived from urea, is one of the possible analytical interference in the uremic patient. When measured by ion-exchange high-performance liquid chromatography (HPLC), carbamylated hemoglobin forms a peak that overlaps the peak of HbA1c, causing a falsely elevated HbA1c result. We report a case of a 60-years-old man who had a spurious increase in HbA1c, with a high carbamylated hemoglobin peak disproportionate to the urea value. Subsequent hemoglobin analysis using hemoglobin electrophoresis and HPLC hemoglobin testing system suggested hemoglobin J (Hb J) variant. Our case highlighted the possibility of misleading HbA1c interpretation in the presence of a high carbamylated hemoglobin peak, but not proportionate to urea value. In this study, Hb J was detected. A method free from hemoglobin variant interference should be used ideally, and monitoring glycemic control should be performed using alternative methods, such as serum fructosamine or continuous glucose monitoring.Sociedade Brasileira de Patologia Clínica2021-01-01info:eu-repo/semantics/reportinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S1676-24442021000100706Jornal Brasileiro de Patologia e Medicina Laboratorial v.57 2021reponame:Jornal Brasileiro de Patologia e Medicina Laboratorial (Online)instname:Sociedade Brasileira de Patologia (SBP)instacron:SBP10.5935/1676-2444.20210029info:eu-repo/semantics/openAccessAb-Rahim,Siti N.Tuan-Ismail,Tuan S.Ibrahim,Hanim A.Hassan,Mohd N.eng2021-07-06T00:00:00Zoai:scielo:S1676-24442021000100706Revistahttp://www.scielo.br/jbpmlhttps://old.scielo.br/oai/scielo-oai.php||jbpml@sbpc.org.br1678-47741676-2444opendoar:2021-07-06T00:00Jornal Brasileiro de Patologia e Medicina Laboratorial (Online) - Sociedade Brasileira de Patologia (SBP)false |
dc.title.none.fl_str_mv |
High peak of carbamylated hemoglobina discordant with urea level: a case report |
title |
High peak of carbamylated hemoglobina discordant with urea level: a case report |
spellingShingle |
High peak of carbamylated hemoglobina discordant with urea level: a case report Ab-Rahim,Siti N. glycated hemoglobin A chromatography high-pressure liquid carbamylated hemoglobin urea |
title_short |
High peak of carbamylated hemoglobina discordant with urea level: a case report |
title_full |
High peak of carbamylated hemoglobina discordant with urea level: a case report |
title_fullStr |
High peak of carbamylated hemoglobina discordant with urea level: a case report |
title_full_unstemmed |
High peak of carbamylated hemoglobina discordant with urea level: a case report |
title_sort |
High peak of carbamylated hemoglobina discordant with urea level: a case report |
author |
Ab-Rahim,Siti N. |
author_facet |
Ab-Rahim,Siti N. Tuan-Ismail,Tuan S. Ibrahim,Hanim A. Hassan,Mohd N. |
author_role |
author |
author2 |
Tuan-Ismail,Tuan S. Ibrahim,Hanim A. Hassan,Mohd N. |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Ab-Rahim,Siti N. Tuan-Ismail,Tuan S. Ibrahim,Hanim A. Hassan,Mohd N. |
dc.subject.por.fl_str_mv |
glycated hemoglobin A chromatography high-pressure liquid carbamylated hemoglobin urea |
topic |
glycated hemoglobin A chromatography high-pressure liquid carbamylated hemoglobin urea |
description |
ABSTRACT Hemoglobin A1c (HbA1c) measurement is commonly performed in diabetes mellitus patients to monitor glycemic control over the last three to four months. Carbamylated hemoglobin, which is the hemoglobin that binds to isocyanic acid derived from urea, is one of the possible analytical interference in the uremic patient. When measured by ion-exchange high-performance liquid chromatography (HPLC), carbamylated hemoglobin forms a peak that overlaps the peak of HbA1c, causing a falsely elevated HbA1c result. We report a case of a 60-years-old man who had a spurious increase in HbA1c, with a high carbamylated hemoglobin peak disproportionate to the urea value. Subsequent hemoglobin analysis using hemoglobin electrophoresis and HPLC hemoglobin testing system suggested hemoglobin J (Hb J) variant. Our case highlighted the possibility of misleading HbA1c interpretation in the presence of a high carbamylated hemoglobin peak, but not proportionate to urea value. In this study, Hb J was detected. A method free from hemoglobin variant interference should be used ideally, and monitoring glycemic control should be performed using alternative methods, such as serum fructosamine or continuous glucose monitoring. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-01-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/report |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
report |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1676-24442021000100706 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1676-24442021000100706 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.5935/1676-2444.20210029 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira de Patologia Clínica |
publisher.none.fl_str_mv |
Sociedade Brasileira de Patologia Clínica |
dc.source.none.fl_str_mv |
Jornal Brasileiro de Patologia e Medicina Laboratorial v.57 2021 reponame:Jornal Brasileiro de Patologia e Medicina Laboratorial (Online) instname:Sociedade Brasileira de Patologia (SBP) instacron:SBP |
instname_str |
Sociedade Brasileira de Patologia (SBP) |
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SBP |
institution |
SBP |
reponame_str |
Jornal Brasileiro de Patologia e Medicina Laboratorial (Online) |
collection |
Jornal Brasileiro de Patologia e Medicina Laboratorial (Online) |
repository.name.fl_str_mv |
Jornal Brasileiro de Patologia e Medicina Laboratorial (Online) - Sociedade Brasileira de Patologia (SBP) |
repository.mail.fl_str_mv |
||jbpml@sbpc.org.br |
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1752122297881198592 |