AC1 - PLease help!!!

Is Hemoglobin AC1 usually high in thalassemia patients or is it an indicator of diabetes in a patient?
Little A's fasting glucose was in the normal range - he didn't have a glucose tolerance test but his AC1 was 6.5  - the normal range is 4.3 to 6.1.

Thank you very kindly,

I am really nervous,

Sharmin

Hb A1C test is used to measure average of blood sugar in past 3 months, I believe. When I got diabetes, I too had it relatively high.

Sharmin, as for you, I don't believe little A is having any intolerance as of now, but yes, this maybe a sign of it. Because it is slightly higher for average, which we should not overlook.

I wish if I had got all those tests done first, then I'd be also alarmed, however, I was not a sweet lover.

I advise you to not let him consume any drinks such as coke and other similar drinks. A small bottle of coke has 6-7 teaspoons of sugar! which is even higher for a normal Joe.

Don't be too worried, just don't let him eat enough sweets, especially these drinks.

-P.

Hi Sharmin,

HbA1c tests can be affected in both directions by thalassemia, depending on which test is used. It is not really used as a diagnostic tool, but as a measure in diabetic patients, as one test in compared to the next to make sure the diabetes is under control. For those who are not diabetic, it is of limited value and for thals, it should not be used for diagnosis, and in fact isn't here either. The glucose tolerance test is a normal part of monitoring at his age. This starts at age 10 and should be done every two years through age 16. For this particular test, it is done simply as a precaution, because the HbA1C level is of little value in non-diabetic thals, and doesn't really tell us much. What's important is that diabetes in thals is directly related to iron load, and little A doesn't have one. Keeping iron low and the use of antioxidants makes it extremely unlikely that he could develop thal related diabetes. The SOC guidelines reveal that glucose intolerant patients must follow an intensive chelation schedule. This cannot be an issue with little A. His iron load is very low.

Patients diagnosed with glucose intolerance should have their chelation therapy reviewed and intensified.

I don't think there is anything to be concerned about here. The glucose test has real value during these years of growth, but more so for patients whose iron load is problematic.

Thank you very much for your responses.  Lil As ferritin is 400.

Andy, thank you so much for making me feel better.  After reading your response
I also read that A1C is a measure of how much glucose red blood cells
Have been exposed to in the past few months.  Lil a was transfused Friday and this
Was done wednesday - so the red blood cells were likely reflecting whatever the blood was stored
In... Does this make sense Andy? I'm not sure if I'm interpreting this
Information correctly.  I will email you all of his results tomorrow. 
Your advise has protected him from most problems that would otherwise be
A concern for kids his age.

Thanks again Andy

Yes Sharmin,

It may happen that a slighter high value may have been reflected due to recent blood transfusion. This is due to the blood glucose that is in the blood bottles, hence why certain times my sugar levels vary for a day after transfusion.

-P.

Pratik,

Thank you very kindly for your response.  I had read that the blood is stored in
A dextrose solution which exposes the hb to sugar in storage - so after transfusion
The A1C gives a reading which is indicative of the blood's exposure
To to the dextrose it was stored rather than the patient's body.  Considering
That A1C is a reading that the hemoglobin is telling about that last several weeks -
And the blood had only been in the patient for a few days perhaps his body
Is not the environment it gives information about.
I'm not sure if I'm understanding this information correctly or
If I'm overs implying it.

Thanks again for all your help,

Sharnin

Hi Sharmeen,
I am no expert but I understand Hb A1C is a measure of the amount of Hb that has formed a compound with glucose over last 8-12 weeks. I don't see how it could have any value in a transfused thalassemic  patient. Even if the blood wasn't stored in glucose like you found, it would be telling the blood sugar level of the blood donor at least as much as your sons. I hope I am making sense.
Zahra

Thank you Zahra,

You are right, AC1 is not a reliable value to measure risk of diabetes in transfusing thalassemia majors.  Oral glucose tolerance test is the most reliable test for thals.  

Every day is a learning experience

 
Sharmin

The two tests that I hate to hear mentioned, because they do cause unnecessary concern, are the platelet test and the HbA1c test. Platelets are often misread in thals and HbA1c is affected by certain beta globin variants and is also affected by the donor's blood and the storage procedures. Neither should be considered as diagnostic tests. Most high platelet readings will be corrected with the next test. It's mostly a matter of the expertise of the tech performing the test, as the pale small red blood cells are often mistaken as platelets. HbA1c is useful when a patient is diabetic, as this test will help to show if the diabetes is under control. It should not be used in a diagnostic manner.

Hemoglobin A1C test is NOT a valid test for thal major patients.
We found this out when the endocrinologist at our rural hospital ordered it. I called Boston frantically and they said this happens "all the time" to patients who are treated at non-thal centers.
They told me the correct test and the endocrinologist ran that with no issues (and made a note in his file for future draws)
nicole