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Elevated fructosamine = wrong A1Cs

Discussion in 'Parents of Children with Type 1' started by Anja821, Sep 28, 2012.

  1. Anja821

    Anja821 Approved members

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    Hi,
    It's been ages since I've posted on here but I knew after the conversation with our NP at the endo office, this forum would be here for me.

    Since dx, my son's A1Cs have been under 7%. Our former NP would routinely congratulated us on what a fine job we were doing keeping his BGs under such good control. Fast forward a couple of years, and we're now using a pediatric endo. The NP, who is also diabetic so I trust her instincts, routinely has been questioning the good A1Cs because the numbers weren't making sense. Two weeks ago, she ordered a fructosamine test and lo' and behold, the "true" A1C is in the 8 - 8.5 range.

    His RBC count is slightly elevated and his WBC count is slightly lower than normal. She is stumped and not quite knowing what to make of the test results, she is referring us to a hematologist.

    Needless to say, I'm stressed. She said not to worry because (a) she doesn't know that there really is anything to worry about; (b) if there was a true issue, the numbers would be off more than slightly, and (c) he is growing proportionately and well, so his body is working the way it should be (for a diabetic anyway).

    One POSSIBLE cause is spherocytosis, but I think if he had that, symptoms would have appeared at an earlier age.

    Has anyone else come across this issue with their diabetic kids?

    Forgive me if this issue has been addressed already. I did just a quick subject search and didn't see anything that quite fit, but maybe I missed something. Thank you :)
     
  2. C6H12O6

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    interesting - also if your hematocrit is high your a1c will be falsely high, and if it is low your a1c will be falsely low
     
  3. TheFormerLantusFiend

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    I read an article a while back on a diabetes center that decided to look for hemoglobin disorders in all diabetic patients whose A1cs didn't match their reported averages and found a whole bunch of carriers for hemoglobin disorders, people who do not have symptoms other than their funny A1cs. I looked for it and didn't find it.
    I did find this (much less readable) article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878696/
    And this interesting piece about a family with a rare asymptomatic different type of hemoglobin from normal that resulted in lowered A1cs (a 6.9 in a diabetic and 3.9-4.6 in the nondiabetic family members).
    http://www.ijpmonline.org/article.a...=55;issue=2;spage=270;epage=271;aulast=Sharma
     
  4. Anja821

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    waiting for an appointment

    Thanks, Jonah. I did find some information regarding hemoglobinopathy. Most of the symptom producing ones (such as sickle cell) occur in those of African, Asian, and Middle Eastern descent; none of which apply in our case. It was reassuring to read, though, that some of these Hb-pathies are just genetic mutations/flaws with no outward symptoms or problems related to it. I like to think of it has a birthmark, so to speak.

    Now, whether this is what Evan has remains to be seen. Waiting for the hematologist to call back and schedule an appointment with us.
     
  5. ashtensmom

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    Hi. I find this thread quite interesting and I don't know if I am way off track, but something my dd's doctor said to me before she was diagnosed with D is stuck in my head and I am wondering about it with this thread.... My dd has/had more "platelets" than usual with one of her blood tests... Are platelets related to hemoglobin? What I am asking is if increased hemocrits give increased a1c results, would increased platelets also give an elevated a1c, or is this not related what so ever? Like I said I may be way off topic, but I am wondering if anyone knows? Thanks.
     
  6. Anja821

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    We see the hematologist tomorrow so anything I find out I will pass along.
     
  7. C6H12O6

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    I could be wrong but I do not think her elevated platelet level would be related to elevated hemoglobin. Elevated platelets would be more likely related to some type of inflammatory process going on in her body at the time the blood was drawn. Her white blood count or ESR might have also been high at the time.

    They have probably retested her levels since then. Chronically high hemoglobin levels can have serious repercussions. Chronically high platelet levels would also warrant seeing a hematologist.
     
  8. Anja821

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    And the hematologist found.....nothing amiss

    :confused:
    The hematologist said the WBC and RBC counts were actually fine because all of the differentials were within the normal range. He's not even sure how the total count fell outside the norm.

    He can't answer why my son can't use an A1C test, though, so that will have to remain a mystery for now. We'll just continue doing a fructosamine test every 6 months, and any A1C we do will have to be corrected by 2% points.

    Bottom line, we need tighter control.
    :eek:
     

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