The impact of red blood cell lifespan on HbA1c measurement

In addition to monitoring whole blood glucose, it is recommended by the American Diabetes Association (ADA) to test diabetic patients for hemoglobin Ale (HbAlc) two to four times per year. [...]even modest variation in red cell survival-that would not be apparent in routine hematological studies-could have a significant impact on the HbAlc level.2 Therefore, the detection of some of the more common causes of decreased (or increased) RBC survival would be important in determining whether the HbAlc level was an accurate reflection of a patient's level of glycemic control. "3 The summary of the 2018 Standards of Medical Care in Diabetes by The American Diabetes Association stresses that the Ale test can give skewed results in people with certain genetic traits that alter the molecules in their red blood cells, such as hemoglobinopathies.3 Most methods are free from analytical interference from common hemoglobinopathies however, the clinical interference may not be known if the patient's results do not indicate the presence of a hemoglobinopathy or other disease state that can alter the RBC lifespan.4 The decision related to the method to be used for measurement of HbAlc would be easier if one knew that each patient being tested had a normal RBC lifespan.