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    Includes Expert Content
    Anemia and A1C
    brunosbud posted:

    "...Clinicians should also appreciate the differences in assay methods for A1C, which have relevance to the possibility of interference. In the case of reduced total hemoglobin or increased turnover of red blood cells (RBCs), the level of A1C will be reduced even in the presence of high ambient plasma glucose, thereby falsely lowering the A1C and limiting its usefulness as a measure of glycemia. In situations where the A1C is low, contrary to high day-to-day glucose levels, attention should be paid to the hemoglobin concentration, the blood smear, and possibly hemolytic parameters to rule out the presence of anemia or hemolysis..."

    Had a discussion, today, with a diabetes specialist regarding the symptom of fatigue.

    He said that many women and seniors, too, suffer from chronic anemia which can often times explain a condition like chronic fatigue and daytime drowsiness.

    He also added that patients that suffer anemia may test at normal A1C levels but when they actually test at home, their numbers are much higher and not reflective of their lab results.

    nwsmom responded:
    Brunosbud: Most (if not all) lab A1c methods have an algorithm to adjust for deviations from the normal range of hgb and/or red cell count. If the patient has severe anemia or polycythemia, the algorithm will not normalize it, and the A1c result will be adversely affected.
    teddybear200 replied to nwsmom's response:
    Okay now I am confused - my A1c is 5.4% not on meds. My Contour Meter is reading my glucose correctly according to the lab tests - I have tested with my meter at the same time as blood draws with a drop of the blood from the same spot- my meter says 100 the lab draw was 99.

    I have iron deficient anemia - which is causing CKD my GFR at last check was 47, yes I am seeing a kidney Dr for this. I can not take the iron pills because of the constipation issues.

    So what you are saying is the A1c is lower in people with anemia. I believe mine is 5.4% because I work at it - by keeping my sugars in control.

    I had more blood work done yesterday for my Kidney doc and will be seeing him next week, I will see then how I am doing. Deb
    One day I will soar on wings of an Eagle - Deb
    brunosbud replied to teddybear200's response:

    The A1C test assumes a certain lifespan of red blood cells in your body (90-120 days). Therefore, anything that reduces that assumed lifespan can falsely lower A1C. The condition of hemolysis by staph infection or hemolytic anemia is such an example. I've also read excessive use of acetaminophen (Tylenol) may cause similar reactions...

    Iron deficient anemia works the opposite from my understanding. It actually raises A1C. Therefore, iron treatment for this type of anemia will tend to lower A1C.

    There are other conditions the can affect A1C. That's why your endocrinologist wants to see your "sheets" (or download your glucometer) when you come in for your check-up even though they have your lab results. The A1C is not "bullet-proof".
    brunosbud replied to brunosbud's response:
    Just a thought...Maybe this might explain why being sick or suffering chronic stress can have an adverse effect on A1C at times. These conditions might create changes in cell chemistry or shorten cell life in some way. Either case, Dr. D would likely have the best input on such issues.
    nwsmom replied to teddybear200's response:
    Teddybear200, No, I'm not saying that the A1c is lower in people with anemia (or higher). I'm saying that severe anemia or polycythemia (too many cells) may cause a skewed result. In most cases, the lab methods account for these patients.
    teddybear200 replied to nwsmom's response:
    Dr Dansinger can you help us on this one - Anemia and A1c?
    One day I will soar on wings of an Eagle - Deb
    Laurie Anderson, MSN, RNP, CDOE replied to teddybear200's response:
    Hi, Anemias that are caused by the red cells being broken up ("hemolytic anemia") and anemias caused by bleeding and rapid blood loss will cause the body to have to make red blood cells as quickly as possibly to prevent bodily injury. The A1C test is based on the fact that the average red blood cell (RBC) lives for about 120 days. Each RBC gets "glycated" as blood glucose attaches to them in order to be delivered to the cells. When we draw a random blood sample for the A1C we get cells which are brand new, and others are in a range up to about 120 days old. This results in an average blood glucose number over this time period. So you can see that if there is a rapid turn-over causing there to be a lot of new RBCs in the body it would result in many of them not having the chance to become glycated. This will cause the the A1C to be falsely low. Anemias caused by iron deficiency don't cause this rapid turnover in RBCs so despite a lower overall cell count, the live span of RBCs in a random sample still have the new cell to 120 day old cell age range. Despite this, iron deficiancy DOES have some impact on A1C, especially at the low end of the range, so an A1C that is 5.5% can appear to be 6-6.5%. As you can see this impacts the reliability of using the A1C to diagnose pre-diabetes and diabetes in the metabolic syndrome patient who is overweight and has any combination of increased lipids (low HDL and high triglycerides), elevated blood pressure, and abdominal obesity (the "apples").

    Hope this helps! Laurie
    teddybear200 replied to Laurie Anderson, MSN, RNP, CDOE's response:
    Laurie now I am not sure I really understand this. So having iron deficient anemia my current A1c 5.4% from Oct. is probably higher? Which makes this a false reading? Is there any reason why I get tested for the A1c if it is going to be wrong?

    My last Lipid panel last year showed Total C at 171, Trigs at 104, HDL at 57 and LDL at 93. At that time my A1c was 5.8% which also was when the anemia diagnosis came in.

    I am scheduled for another lipid panel in March 2012. What am I to expect?
    One day I will soar on wings of an Eagle - Deb
    Michael Dansinger, MD replied to Laurie Anderson, MSN, RNP, CDOE's response:
    I'm impressed by your explanation. The rate of red cell turnover is a key consideration in interpreting the A1c in light of anemia.
    Michael Dansinger, MD replied to teddybear200's response:
    My best guess is that your A1c level in the normal range is an accurate reflection of normal or near-normal glucose control. You have made considerable effort to control your blood sugar, and your A1c has improved previously in response to your efforts. If I recall correctly you have had A1c's over 6.0% in the past.

    Having said that, It is harder to say whether the more recent change from 5.8% to 5.4% is a meaningful indicator of health improvement, or due to fluctuation in red cell lifespan or simply due to some degree of variability in the A1c testing. In such cases, we sometimes check the "fructosamine" level, which is an indicator of average glucose levels over the past 3 or 4 weeks because it measures the glycosylation of albumin and other proteins in the serum. This test is not affected by anemia. In the end, I think these issues are more theoretical than actual in your case. I encourage you to see what your medical team thinks.

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