Extremely Low HbA1c Masking Glucose Intolerance in a Pregnant Woman with Autoimmune Hemolytic Anemia: A Case Report.

IF 0.9 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Annals of clinical and laboratory science Pub Date : 2026-01-01

Qi Zhang, Jia Mai, Xiakeerzhati Xiaohalati, Yingying Li, Ling Yang, Hongjian Xie

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引用次数: 0

Abstract

Objective: Hemoglobin A1c (HbA1c) is unreliable in conditions shortening red blood cell (RBC) lifespan, such as autoimmune hemolytic anemia (AIHA). We report a rare case of extremely low HbA1c masking glucose intolerance in a pregnant woman.

Case report: A 34-year-old woman at 20+2 weeks' gestation had HbA1c 2.02% (reference: 4.0-5.7%). A 75g Oral Glucose Tolerance Test (OGTT) confirmed gestational diabetes mellitus (GDM). Investigations revealed mild anemia, elevated reticulocytes, spherocytes, and positive IgG direct antiglobulin test (DAT), confirming AIHA. Both conditions were managed successfully; postpartum OGTT showed impaired glucose tolerance.

Conclusion: AIHA-induced shortening of the RBC lifespan causes falsely low HbA1c. We suggest that an HbA1c level < 4.0% in pregnancy should serve as a clinical "red flag," necessitating immediate 75g OGTT and a comprehensive hematologic workup (e.g., CBC and DAT) to prevent the masking of GDM and ensure optimal maternal-fetal outcomes.

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极低的HbA1c掩盖了自身免疫性溶血性贫血孕妇的葡萄糖耐受不良：1例报告

目的：血红蛋白A1c （HbA1c）在缩短红细胞（RBC）寿命的情况下是不可靠的，如自身免疫性溶血性贫血（AIHA）。我们报告一例罕见的极低HbA1c掩盖葡萄糖耐受不良的孕妇。病例报告：34岁女性，妊娠20+2周，HbA1c 2.02%（参考文献：4.0-5.7%）。75g口服葡萄糖耐量试验（OGTT）证实妊娠期糖尿病（GDM）。调查显示轻度贫血，网织红细胞，球细胞升高，IgG直接抗球蛋白试验（DAT）阳性，证实AIHA。这两种情况都得到了成功的管理；产后OGTT显示糖耐量受损。结论：aiha诱导的红细胞寿命缩短导致HbA1c虚低。我们建议妊娠期HbA1c水平< 4.0%应作为临床“危险信号”，需要立即进行75g OGTT和全面的血液学检查（如CBC和DAT），以防止GDM的掩盖，并确保最佳的母胎结局。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of clinical and laboratory science 医学-医学实验技术

CiteScore

1.60

自引率

0.00%

发文量

112

审稿时长

6-12 weeks

期刊介绍： The Annals of Clinical & Laboratory Science welcomes manuscripts that report research in clinical science, including pathology, clinical chemistry, biotechnology, molecular biology, cytogenetics, microbiology, immunology, hematology, transfusion medicine, organ and tissue transplantation, therapeutics, toxicology, and clinical informatics.