Undetectable high-performance liquid chromatography haemoglobin A1c on variant haemoglobin E phenotype: a case report

The gold standard for long-term monitoring of diabetic patients is glycated haemoglobin (HbA1c), which is routinely tested for glycaemic control. Furthermore, the National glycohemoglobin standardization program (NGSP) has designated high-performance liquid chromatography (HPLC) as the reference method for HbA1c measurement. A woman from the Sumba tribe, Indonesia, aged 52, visited the Internal Medicine Clinic for a routine check-up. She had been taking diabetic and hypertension medicines on a regular basis for over 10 years. The HPLC procedure yielded “no result” for the patient’s HbA1c assessment and there was no peak on the HPLC graphic. However, there was a discrepancy between the data history of HbA1c measured by turbidimetric method (average of 51 mmol/mol, reference range < 48 mmol/mol), fasting blood glucose (average of 7.7 mmol/L, reference range < 7.0 mmol/L) and 2-hour plasma glucose (average of 13 mmol/L, reference range < 11.1 mmol/L). Glycated albumin was 3.1 mmol/L (reference range 1.8-2.4 mmol/L). Haemoglobin electrophoresis identified homozygote haemoglobinopathy E (HbE). Patients with haemoglobin variants are proposed to utilize glycated albumin.