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Abstract
Introduction. Since the variability of glycosylated hemoglobin (HbA1c) is significantly lower compared to plasma glucose, its determination is used to diagnose and assess the degree diabetes mellitus (DM) compensation. When analyzing the study results, it is necessary to take into account the presence of concomitant pathology in the patient, which can affect the level of HbA1c. Aim. To analyze the importance of taking into account analytical and clinical interference when interpreting the results of the study of HbA1c and making a diagnosis on the example of a clinical case (a patient with vitamin В12-deficient anemia). Description of the case. The article presents an analysis of a clinical case of a patient with vitamin В12-deficiency anemia and a concomitant increase in the level of HbA1c. The incorrect interpretation of the obtained examination results was accompanied by further incorrect diagnostic and therapeutic tactics. Clinical symptoms were analyzed, pathological changes in the results of additional examinations were presented, differential diagnosis of anemia was carried out. The dynamics of indicators after treatment is presented. Discussion. The factors influencing the HbA1c level at the measurement stage were analyzed. These factors are associated with the peculiarities of the applied method and refer to analytical interferences. Factors which must be taken into account when interpreting the research results were also analyzed: the physiological or pathological characteristics of the patient. This group of factors is referred to clinical interferences. In this case, the result of determining HbA1c is correct, however, due to the physiological or pathological characteristics of the patient himself, the traditional target value of HbA1c, which focused on clinician, does not apply to this patient. Conclusions. To diagnose or assess the degree of DM compensation in patients with concomitant anemia, after recent blood loss or blood transfusion, against the background of hemodialysis, erythropoietin therapy, only the determination of glucose in blood plasma should be used.
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