A Case Report of Pseudohypoglycemia in a Patient with Leukocytosis

A 65-year-old male with a history of gout was admitted for evaluation of hematuria. Labs during his admission revealed a venous blood glucose of 43mg/dl. Point of care glucose checks were not ordered on admission as the patient was not diabetic. The patient was fully alert and oriented with no somnolence, diaphoresis or palpitations. He was not taking any antihyperglycemic medications at home, and he had an HbA1c of 6.2%. He was hemodynamically stable with no signs of infection. The only other lab abnormality noted was a leukocytosis of 95,000/μL. Point of care glucose checks were ordered with meals and at bedtime. A subsequent venous blood glucose was 27mg/dL, but the patient remained asymptomatic and a simultaneous point of care glucose was 92mg/dL. A close evaluation of the case revealed a delay between phlebotomy time and processing of the venous sample. Immediate processing of the following venous sample revealed a normal glucose (90mg/dL) that correlated with the simultaneous point of care glucose. Repeat testing with quick processing of the sample clarified that the measurements of low venous blood glucose levels were due to in vitro glucose consumption by leukocytes that occurred between the times of phlebotomy and sample analysis.