Interpretation of Glycohemoglobin and Fructosamine Levels in a Patient with Liver Disease

 

Potential problems that may arise:

(1) very low laboratory values for one or both tests

(2) belief that glucose control is better than it actually is

 

Risk factors for a falsely low glycohemoglobin and/or fructosamine:

(1) advanced liver disease

(1a) cirrhosis

(1b) chronic viral hepatitis C treated with ribavirin

(2) hemolytic anemia

 

where:

• Ribavirin therapy may be associated with a hemolytic anemia.

• A reticulocyte count be a useful test to indicate increased erythrocyte turnover.

• Hemoglobin electropheresis should also be considered, since a hemoglobinopathy can cause both hemolytic anemia and abnormal glycated hemoglobins.

 

In these patients frequent glucose monitoring may offer the best insight into glucose control.