Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
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Effect of Iron Deficiency Anemia on Hemoglobin A1c Levels

  • Sinha, Nitin (Department of Medicine, Lok Nayak Hospital) ;
  • Mishra, T.K. (Department of Biochemistry, Maulana Azad Medical College) ;
  • Singh, Tejinder (Department of Pathology, Maulana Azad Medical College) ;
  • Gupta, Naresh (Department of Medicine, Lok Nayak Hospital)
  • Published : 2012.01.01
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Abstract

Background: Iron deficiency anemia is the most common form of anemia in India. Hemoglobin A1c (HbA1c) is used in diabetic patients as an index of glycemic control reflecting glucose levels of the previous 3 months. Like blood sugar levels, HbA1c levels are also affected by the presence of variant hemoglobins, hemolytic anemias, nutritional anemias, uremia, pregnancy, and acute blood loss. However, reports on the effects of iron deficiency anemia on HbA1c levels are inconsistent. We conducted a study to analyze the effects of iron deficiency anemia on HbA1c levels and to assess whether treatment of iron deficiency anemia affects HbA1c levels. Methods: Fifty patients confirmed to have iron deficiency anemia were enrolled in this study. HbA1c and absolute HbA1c levels were measured both at baseline and at 2 months after treatment, and these values were compared with those in the control population. Results: The mean baseline HbA1c level in anemic patients (4.6%) was significantly lower than that in the control group (5.5%, P <0.05). A significant increase was observed in the patients' absolute HbA1c levels at 2 months after treatment (0.29 g/dL vs. 0.73 g/dL, P < 0.01). There was a significant difference between the baseline values of patients and controls (0.29 g/dL vs. 0.74 g/dL, P <0.01). Conclusions: In contrast to the observations of previous studies, ours showed that HbA1c levels and absolute HbA1c levels increased with treatment of iron deficiency anemia. This could be attributable to nutritional deficiency and/or certain unknown variables. Further studies are warranted.

Keywords

References

  1. Telen MJ and Kaufman RE. The mature erythrocyte. In: Greer JP, Forester J, et al., eds. Wintrobe's clinical hematology. 11th ed. Lippincot Williams and Wilkins, 2004:230.
  2. American Diabetes Association. Position statement: Standards of medical care in diabetes- 2007. Diabetes Care 2007;30(S1):S9. https://doi.org/10.2337/dc06-2395
  3. Horton BF and Huisman TH. Studies on the heterogeneity of hemoglobin. VII. Minor hemoglobin components in haematological diseases. Br J Haematol 1965;11:296-304. https://doi.org/10.1111/j.1365-2141.1965.tb06589.x
  4. Eberentz-Lhomme C, Ducrocq R, Intrator S, Elion J, Nunez E, Assan R. Haemoglobinopathies: a pitfall in the assessment of glycosylated haemoglobin by ion-exchange chromatography. Diabetologia 1984;27:596-598. https://doi.org/10.1007/BF00276975
  5. Bernstein RE. Glycosylated hemoglobins: hematologic considerations determine which assay for glycohemoglobin is advisable. Clin Chem 1980;26:174-175.
  6. Starkman HS, Wacks M, Soeldner JS, Kim A. Effect of acute blood loss on glycosylated hemoglobin determinations in normal subjects. Diabetes Care 1983;6:291-294. https://doi.org/10.2337/diacare.6.3.291
  7. Lind T and Cheyne GA. Effect of normal pregnancy upon the glycosylated haemoglobins. Br J Obstet Gynaecol 1979;86:210-213. https://doi.org/10.1111/j.1471-0528.1979.tb10595.x
  8. Hanson U, Hagenfeldt L, Hagenfeldt K. Glycosylated hemoglobins in normal pregnancy: sequential changes and relation to birth weight. Obstet Gynecol 1983;62:741-744.
  9. Phelps RL, Honig GR, Green D, Metzger B, Frederiksen MC, Frienkel N. Biphasic changes in hemoglobin A1c concentrations during normal human pregnancy. Am J Obstet Gynecol 1983;147:651-653. https://doi.org/10.1016/0002-9378(83)90443-X
  10. de Boer MJ, Miedema K, Casparie AF. Glycosylated haemoglobin in renal failure. Diabetologia 1980;18:437-440. https://doi.org/10.1007/BF00261697
  11. Fluckiger R, Harmon W, Meier W, Loo S, Gabbay KH. Hemoglobin carbamylation in uremia. N Engl J Med 1981;304:823-827. https://doi.org/10.1056/NEJM198104023041406
  12. Paisey R, Banks R, Holton R, Young K, Hopton M, White D, et al. Glycosylated haemoglobin in uraemia. Diabet Med 1986;3:445-448. https://doi.org/10.1111/j.1464-5491.1986.tb00788.x
  13. Shendurnikar N (Ed.). Iron deficiency is preventable. http://www. indiaparenting. com/raisingchild/data/raisingchild063.shtml (Updated on Apr 2007).
  14. Brooks AP, Metcalfe J, Day JL, Edwards MS. Iron deficiency and glycosylated haemoglobin A. Lancet 1980;2:141.
  15. Sluiter WJ, van Essen LH, Reitsma WD, Doorenbos H. Glycosylated haemoglobin and iron deficiency. Lancet 1980;2:531-532.
  16. Mitchell TR, Anderson D, Shepperd J. Iron deficiency, haemochromatosis, and glycosylated haemoglobin. Lancet 1980;2:747.
  17. van Heyningen C and Dalton RG. Glycosylated haemoglobin in iron-deficiency anaemia. Lancet 1985;1:874.
  18. Gram-Hansen P, Eriksen J, Mourits-Andersen T, Olesen L. Glycosylated haemoglobin (HbA1c) in iron- and vitamin B12 deficiency. J Intern Med 1990;227:133-136. https://doi.org/10.1111/j.1365-2796.1990.tb00131.x
  19. Rai KB and Pattabiraman TN. Glycosylated haemoglobin levels in iron deficiency anaemia. Indian J Med Res 1986;83:234-236.
  20. El-Agouza I, Abu Shohla A, Sirdah M. The effect of iron deficiency anaemia on the levels of haemoglobin subtypes: possible consequences for clinical diagnosis. Clin Lab Haematol 2002;24:285-289. https://doi.org/10.1046/j.1365-2257.2002.00464.x
  21. Coban E, Ozdogan M, Timuragaoglu A. Effect of iron deficiency anemia on the levels of hemoglobin A1c in nondiabetic patients. Acta Haematol 2004;112:126-128. https://doi.org/10.1159/000079722
  22. Rastogi T and Mathers C (Eds.). Global burden of iron deficiency anaemia in the year 2000. http://www.who.int/entity/healthinfo/statistics/bod_ irondeficiencyanaemia.pdf (Updated on Apr 2007).
  23. Conrad ME (Ed.). Iron deficiency http://www.emedicine.com/med/topic1188. htm (Updated on Apr 2007).

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