Unknown Peaks and Spuriously Low Values of Glycated Haemoglobin by High Performance Liquid Chromatography: A Cross-sectional Survey
Introduction: Glycated haemoglobin (HbA1c) has humongous role both in diagnosis as well as in guiding the clinicians in making therapeutic decision in diabetic patients. There are various methods of laboratory estimation of glycated haemoglobin depending on charge and affinity. However, the meth...
Main Author: | |
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Format: | Article |
Language: | English |
Published: |
JCDR Research and Publications Pvt. Ltd.
2022-01-01
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Series: | National Journal of Laboratory Medicine |
Subjects: | |
Online Access: | https://www.njlm.net/articles/PDF/2584/52355_CE[Ra1]_F(SHU)_PF1(SG_SHU)_PFA(SHU)_PB(SG_SHU)_PN(SHU).pdf |
Summary: | Introduction: Glycated haemoglobin (HbA1c) has humongous
role both in diagnosis as well as in guiding the clinicians in making
therapeutic decision in diabetic patients. There are various
methods of laboratory estimation of glycated haemoglobin
depending on charge and affinity. However, the methods are
affected by a number of factors like haemoglobin variants, drugs
and erythrocyte survival.
Aim: To identify and evaluate abnormal peaks in chromatogram
of High Performance Liquid Chromatography (HPLC) and
compare it with boronate affinity chromatography and it also
assessed the interference of elution of silent haemoglobin
variants or drugs in exactness of HbA1c estimation by HPLC.
Materials and Methods: A cross-sectional survey was conducted
in the laboratory of Purwanchal Nagarik Samity, Kolkata, West
Bengal, India, from November 2020 to August 2021, where
2500 samples were evaluated for HbA1c estimation. Abnormal
variant window, unknown peaks or spuriously low HbA1c were
identified in eight samples, where estimation was done by HPLC.
These were processed further to investigate for the haemoglobin
variants. The glycated haemoglobin in those samples was further
estimated by Boronate affinity chromatography.
Results: Out of the eight samples, three patients were Haemoglobin
E trait, two were Haemoglobin E homozygous and one had sickel
cell trait. However, two samples showed a normal chromatogram
in HbA2/HbF mode. The glycated haemoglobin was affected by
Haemoglobin E, sickel cell traits as well as other interferences that
may cause inappropriate lowering of glycated haemoglobin.
Conclusion: The results of this study and literature review suggests
the progression of various micro/macrovascular complications in
diabetic individuals can be arrested by maintaining normal HbA1c
levels. Therefore, the laboratory consultant should meticulously
take into consideration factors like plasma glucose concentration,
drug history, biological variation or abnormal haemoglobinopathies.
Thus, every laboratory catering to the huge burden of diabetic
patients, where the prevalence of haemoglobinopathy is high,
should individualise the method of HbA1c estimation. |
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ISSN: | 2277-8551 2455-6882 |