Appropriateness of the National Academy of Clinical Biochemistry recommendation of repeating HbA1c analysis for extreme results in clinical practice

This version was published on 1 March 2009

Ann Clin Biochem 2009;46:165-166
© 2009 Association for Clinical Biochemistry


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P Yalamati,
B J Jones and
P J Twomey

Department of Clinical Biochemistry, The Ipswich Hospital, Ipswich, Suffolk IP4 5PD, UK

Corresponding author: Dr Patrick J Twomey. Email: ptwomey{at}

Background: The National Academy of Clinical Biochemistry (NACB) recommends that the presence of a variant or modified haemoglobin be considered when any HbA1c result is below the lower limit of the reference interval or ≥15%. In those instances where a variant haemoglobinis suspected, repeat measurement using an alternative methodis the usual course of action. In the present study, we undertookto determine the impact of this guideline on our identificationof variant and modified haemoglobins.

Methods: All requests for HbA1c estimation received over a 32-month period,and which gave a result of <4% or >15% were re-analysedby a different method and the results compared.

Results: Over the 32-month period, 94 samples with a HbA1c result of <4% or ≥15% were identified. Of these, 80 were re-analysedusing a different method. No chromatographic abnormalities wereseen and there were no significant differences between the resultsobtained using the two methods.

Conclusions: No variant or modified haemoglobins were identified in thisstudy and this observation is likely to be representative ofthe ethnic makeup of our patient population. On the basis ofthis finding, we recommend that laboratories consider localfactors when deciding whether to comply with the NACB guidelines.

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