February 9, 2004
A1c (Glycohemoglobin, HgbA1c), Other Illnesses
Question from Portland, Oregon, USA:
I am in great need of a second opinion. My 2 1/2 year old was diagnosed with type 1 on November 3, 2003. In hematology records (total of 3, one being last week) his blood is showing moderate levels of microcytes, slight poikilocytosis, few schistocytes, hypocromasia, burr cells and tear drop cells. In looking this up on the Internet I have found numerous cause, all scary. Our endocrinologist is not at all well informed and simply say’s she does not know.
My son has had low A1c test, not reflecting the 14 day average of 180s. Our endocrinologist treats me like I am crazy, or simply doesn’t believe me because of the A1c. I am so frustrated and scared for my son. He constantly complains of feeling cold and hurting, has dark circles under his eyes, and looks to be about 6 months pregnant because his stomach is suddenly bigger. A friend of mine who is a nephrologist at our doctors clinic decided to go over the endo’s head and order an Hb electrophoresis (still pending). Any ideas as to what may be going on would be greatly appreciated, as well as recommendations as to who else to see if anyone. How this may impact his diabetes? Also what is the A1c situation?
Most likely your child has a red blood cell problem causing the abnormal cell description. This is not likely related to diabetes at all but is important to know since the hemoglobin A1c test may be inaccurate for assessing the past 1-2 months blood glucose averages. I would suggest that you have your diabetologist order a fructosamine test since this has nothing to do with red blood cell hemoglobin or its variants/abnormalities.
Separately, you should await the results of the hemoglobin electrophoresis and consider obtaining a consultation with a hematologist to get a more specific diagnosis. Could be something as simple as thalassemia or its variants or one of many different kinds of hemoglobin problems. If the red blood cells do not live a normal 3-4 month life span, then the A1c test cannot be used to assess glucose control in a standard fashion – but the fructosamine test would serve this similar function – just short time periods of assessment.