Introduction and Objective: Glycated hemoglobin (A1C) is widely used in the screening and follow-up of patients with diabetes mellitus (DM), making its accuracy critical for patient care. However, A1C results can be influenced by various factors, including alterations in blood cell counts. This study aimed to evaluate the correlation between hematological abnormalities and inaccuracies in A1C measurement.Methods: Cross-sectional study was conducted using data from a laboratory database in Northeast Brazil, involving patients who underwent A1C by High-Performance Liquid Chromatography (HPLC) from 2019 to 2024. Out of 767,514 samples, A1C results for 194 (0.02%) patients were not released. Seven cases were excluded due to missing fasting blood glucose (FBG) and complete blood count (CBC) data, leaving 187 samples for analysis. High red cell distribution width (RDW >16%) and severe anemia (Hb <8 g/dL) were considered as hematological abnormalities.Results: Of the 187 patients, 96% were adults (mean age 59.2 ± 21.5 years; 74.3% women). Mean hemoglobin (Hb) level was 11.16 ± 2.21 g/dL, and mean FBG level, 95.5 ± 16 mg/dL. Red blood cell morphological abnormalities were found in 83.9% (157/187) of CBCs. High RDW was present in 38.5% (72/187) of tests. Severe anemia (mean Hb 6.9 ± 1.3 g/dL) occurred in 7.5% (14/187) of patients, most of whom had macrocytic red blood cells (12/14). Sickle cell anemia was found in 4 patients. Children made up 4.3% (8/187) of the cohort, with mean age of 10 ± 3.5 years. All were female, with mean Hb of 10 ± 1.7 g/dL and mean FBG of 81 ± 7 mg/dL. High RDW was found in 25% (2/8), and severe anemia in 1 child. Hemolytic characteristics were found in 3 children, with sickle cell anemia in 2.Conclusion: Although A1C by HPLC is a reliable method for DM diagnosis and monitoring, this study shows that unreleased A1C results may occur due to hematological abnormalities, such as red blood cell morphological changes, high RDW and severe anemia. These findings underscore the need for alternative methods to assess mean blood glucose levels in affected patients.
M.R. Hasbun: None. R.A. Magalhaes: None. D.B. Macedo: None. C.M. Figueirêdo: None. R. Petrola: None. M.G. Teles: None.
Emilio Ribas Medicina Diagnostica
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