cpdclinicalbiochem.co.ukCPDCLINICALBIOCHEM.CO.UKCPDCLINICALBIOCHEM.CO.UK3008-044410.61336/cpdcb/2004-01-08Anaemia and Haemoglobin A1c level: Is there a case for redefining reference ranges and therapeutic goals?Segun NoneAdeoyeSherly NoneAbrahamIrina NoneErlikhSylvester NoneSarfrazTomas NoneBordaLap NoneYeungMD, MS. Attending Physician, University of Pittsburgh Medical Center, Horizon, Greenville, Pennsylvania, USA.MD, Attending Physician, The Department of Family Medicine, The Brooklyn Hospital Center, New York City, New York, USAMD, Attending Physicinan, Department of Family Medicine,The Brooklyn Hospital Center, New York City, New York, USA.MD, Fellow, Geriatric Medicine, Brown University/Rhode Island University, Providence, Rhode Island.MD, Volunteer Researcher, Department of Family Medicine,The Brooklyn Hospital Center, New York City, New York, USA.MD, Volunteer Researcher, Department of Family Medicine,The Brooklyn Hospital Center, New York, U City, New York, USA.Background: Haemoglobin A1c (HbA1c) has been adopted by physicians as a surrogate for monitoring glycemic control. There exists concern that other factors      beyond      serum      glucose      concentration      may      affect      glycation      rates      and      by      extrapolation      HbA1c       levels. Study Objectives: The study attempts to discern clinical differences in HbA1c levels in patients with anaemia compared to patients without anaemia, quantifying and showing the direction of such differences.Study Design: Using a convenient sampling method and a set of inclusion and exclusion criteria, it examined (retrospectively) patterns in [Hb] and HbA1c in non-diabetics with and without anaemia.Results: The study observed a statistically significant 0.4units (8%) difference in the mean HbA1c in anaemia vs. non-anaemic populations. Reference ranges of HbA1c for non-anaemic population and anaemia subtypes was computed. Computed ranges for anaemia group and its subgroups were significantly wider compared to non-anaemia population. Modest but statistically significant correction of anaemia did not result in significant changes in HbA1c.Discussion: i. The linear relationship between [Hb] and HbA1c holds true for anaemic and non-anaemia populations. ii. Non-diabetic, anaemic have a significantly lower mean HbA1c (5.3% vs. 5.7%), but a similar upper limit of reference range due to a higher variance. iii. The variance and proposed reference ranges for anaemia group and its subtypes was greater than in non-anaemia group, perhaps due to homogenization of clinically heterogeneous entities. iv. Modest correction anaemia did not cause significant change in HbAIc, perhaps the increase in [Hb] was too modest or persistence of correction was too short to be impactful.Conclusion: It makes the case for defining HbA1c reference ranges for each anaemia subtype, as well as utilizing other surrogates for monitoring glycemic control in populations with anaemia.