Professional Documents
Culture Documents
Prepared by:
BASALINGAPPA.B.G.
2ND M.Sc. Medical Biochemistry
JSS Medical college Mysore
TITLE OF HbA1C
• Terminology, Definition and Description.
• Principle
• Methods
• Structure
• Sample Preparations And Maintenance
• Advantages and disadvantages
• Normal and abnormal values
• Clinical Significance
Terminology
• Hb: haemoglobin
• HbA1: is a series of glycated variants resulting from
attachment of various carbohydrates to N terminal
valine of Hb.
Glycosylation: enzymatic addition of any sugar
(glucose)to a protein molecule.
• Glycation: when once glucose attached ,it is not removed
from the hemoglobin,therefore it remains inside the
erythrocyte, so the life span of RBCS(120Days )non enzymatic
Some terms
• A1c : Glycated haemoglobin together called HbA1
fraction.
• IFCC: International Federation of Clinical Chemistry
• NGSP: National Glycohaemoglobin Standardisation
Programme
• DCCT : Diabetes Control and Complications Trial
• ADAG : A1c derived average glucose
Definition.
• Glycated haemoglobin is a form of hemoglobin that
is measured primarily to identify the three month
average plasma glucose concentration.
• The test is limited to a three month average because
the lifespan of a red blood cell is three
months(120Days).
• It is formed in a non-enzymatic glycation pathway by
haemoglobin's exposure to plasma glucose.
Structure of hemoglobin
Principle
Glycation of proteins is a frequent occurrence, but in the case of
haemoglobin, a non enzymatic reaction occurs between glucose and the N-end
of the beta chain.
This forms a Schiff base which is itself converted to 1-deoxyfructose.
• A Schiff's base a nitrogen analog of an aldehyde or ketone in which the
C=0.group is replaced by C=N-R (amine) group. It is Usually formed by
condensation of an aldehyde or ketone with a primary amine.
• A1c is a weighted average of blood glucose levels during the life of the red
blood cells (120 days). Therefore glucose levels on days nearer to the test
contribute substantially more to the level of A1c than the levels in days
further from the test.
• This is also supported by data from practice showing that HbA1c levels
improved significantly by 20 days from the start of the intensification of
glucose-lowering treatment
Where R, may be an alkyl or an aryl group. Schiff bases that contain aryl
substituents are substantially more stable and more readily synthesized,
while those which contain alkyl substituents are relatively unstable. Schiff
bases of aliphatic aldehydes are relatively unstable and readily
polymerizable1,2 while those of aromatic aldehydes having effective
conjugation are more stable
• Once the sugar is attached to the haemoglobin, it stays there for the
life of the red blood cell, which is about 120 days (3 months).
• The higher the level of blood sugar, the more sugar attaches to
haemoglobin and the higher the per cent of haemoglobin which is
glycosylated (HbA1c).
• This is why the results are given as a percentage (for example. 7.5 %).
• When blood glucose levels are high, glucose molecules attach to the
haemoglobin in red blood cells. The longer hyperglycaemia occurs
in blood, the more glucose binds to haemoglobin in the red blood
cells and the higher the glycated haemoglobin.
Water solubility of
solute
Polarity of solute
source of inaccuracy
Sample preparation
• Whole blood primer:
• Reconstitute With 1mL of DI Water
• Allow to stand for 10-15 minutes; swirl gently
to dissolve .
• Stable for 1day at 2-8Celcius
HbA1C Calibrators:
• 2 Calibrators ( Level 1& Level 2)
• Reconstitute Each Vial with 7mL of cold
calibrator Diluent.
• Allow to stand for 5-10minutes; Swirl gently to
dissolve.
• Stable for 7 days at 2-8C
Lypochek controls:
• Reconstitute Each vial with 0.5 mL of DI Water
• Allow to stand for 5-10 minutes; swirl gently
to dissolve.
• Stable for 7 days at 2-8C
• Dilute 1:300Prior to Analysis
• (5mL of control in 1.5 ml of wash /diluent
solution).
Liquichek Controls:
• After opening Vial ,Stable for 14 days At 2-8C
• Dilute 1:200 prior to Analysis
Whole Blood Samples
• Samples Should be Collected in Vaccume
Collection tubes Containing EDTA.
• Stable For 7days At 2-8C Or 3 days at room
Temperature (15-30C)
• Allow Sample Tubes At Room temperature(15-
30C).No Sample preparation required.
Daily Maintenance Of HbA1C Pre Run
• Check that the correct method(HbA1C) is
installed.
• Check buffer/wash levels, lot numbers, And
line positions.
• Check reagent on-board expiration dates.
• Check cartridge injection Count And lot
Number.
• Check for leaks during pressure check
• Check external waste tank level.
Continued,,,,,,,,,,
• Check pump pressure with pump running
(maintain screen):
• Flow rate at 1.5mL/min,50% buffer 2.
• Pump pressure should not fluctuate more
than 5%.
• Prime the lines if needed.
• Check printer paper is there or not to supply.
Point of care instruments
• DCA Vantage
• Nycocard
• In2it (Bio-Rad)
• A1cNow( Bayer)
Bio-Rad D10
1.A1C quantitation in the presence of HbS,
HbC and HbF.
2. Optimized to minimize interference from
carbamylation, lipemia and labile A1C.
3. Traceable to the IFCC reference method.
4. NGSP(National glycohaemoglobin
standardisation programme) Certified.
2010 Consensus Statement on the Worldwide
Standardization of the HbA1C Measurement
• HbA1c test results should be standardized
worldwide
• The IFCC reference system for HbA1c represents the
only valid anchor to implement standardization
• HbA1c results are to be reported by clinical
laboratories
Description of HbA1C.
Structural and chemical investigations elucidated that glucose, in the open chain
format, binds to the N‐terminal to form an aldimine (Schiff base) before
undergoing an Amadori rearrangement to form a more stable ketamine.
HbA1C % Mean BG mg %
5 80.5
7 147.1
9 213.7
11 280.3
Diagnosis of diabetes
• Diagnosis of diabetes has always been glucose centric
: based on FBS, 2 hr post glucose , RBS
• National Diabetes Data Group (NDDG) 1979 : relied on
distributions of glucose levels
• Based on their association with DE compensation
to “overt” or symptomatic diabetes
FPG > 140 mg/dl
PPG > 200 mg/dl
HbA1c for diagnosis of diabetes
• HbA1c correlates with retinopathy
• There was a stronger correlation between A1C and
retinopathy than between fasting glucose levels and
retinopathy
• Similar correlation between A1c and Retinopathy has
been seen in DCCT/ UKPDS trials
• 1997 Expert Committee recommended against using
A1C values for diagnosis in part because of the lack of
assay standardization
How can I make use of this information?