A 28- year old woman delivered a 9.5-lb infant.

The infant was above the 95th percentile for

weight and length. The mother’s history was incomplete; she claimed to have had no medical
care through her pregnancy. Shortly after birth, the infant became lethargic and flaccid. A whole
blood glucose and ionized calcium were performed in the nursery with the following results:

Whole blood glucose 25 mg/dL

Ionized calcium 4.9 mg/dL

Plasma glucose was drawn and analyzed in the main laboratory to confirm the whole blood
findings

Plasma glucose 33 mg/dL

An intravenous glucose solution was started and whole blood glucose was measured hourly

Questions:
1. Give the possible explanation for the infant’s large birth weight and size.
○ Large Gestational Age (LGA) babies are most often caused by diabetes in the
mother. When a woman is pregnant and has diabetes, her blood sugar (glucose)
flows to the baby. Because of this, the baby's body makes insulin. All that extra
sugar and insulin release can cause the body to grow and store fat too quickly,
which makes the baby bigger.
2. If the mother was a gestational diabetic, why was her baby hypoglycemic?
○ Hypoglycemia indicates the baby's blood sugar is too low right after birth. This
problem happens when the mother's blood sugar has been high for a long time,
which makes the baby have a lot of insulin in its blood. When a baby is born, its
insulin level stays high, but it no longer gets the high level of glucose from its
mother. This makes the baby's blood glucose level drop very low.
3. Why was there a discrepancy between the whole blood glucose concentration and the
plasma glucose concentration?
○ The glucose concentration in whole blood is approximately 11% lower than the
glucose concentration plasma. Serum or plasma must be refrigerated and
separated from the cells within1 hour to prevent substantial loss of glucose by
the cellular fraction particularly if the white blood cell count is elevated.
4. If the mother had been monitored during pregnancy, what laboratory tests should have
been performed and what criteria would have indicated that she has gestational
diabetes?
○ An Oral Glucose Tolerance Test (OGTT) in which the blood is drawn every hour
for 2 to 3 hours for a doctor to diagnose gestational diabetes. High blood glucose
levels at any two or more blood tests times—fasting, 1 hours, 2 hours, or 3 hours
— mean you have gestational diabetes.
14-7. For three consecutive quarters, a fasting glucose and glycosylated hemoglobin were
performed on a patient. The results are as follows:

Quarter 1 Quarter 2 Quarter 3

Plasma glucose, 280 mg/dL 85 mg/dL 91 mg/dL

fasting

Glycosylated 7.8% 15.3% 8.5%

hemoglobin

Questions:
1. In which quarter was the patient’s glucose best controlled? the least controlled?
○ Quarter 2 is at which the patient’s glucose is controlled and the least controlled is
the Quarter 1.
2. Do fasting plasma glucose and glycosylated hemoglobin match? Why or why not?
○ Only in quarter 3 matches glucose and glycosylated hemoglobin, because
normal glucose fasting ranging 70-120 mg/dL requires 6.5-8.5% of glycosylated
hemoglobin.
3. What methods are used to measure glycosylated hemoglobin?
○ Electrophoresis, chromatography, and immunoassay are some of the ways that
the amount of bound hemoglobin and glucose can be found. The idea behind all
of these is that hemoglobin bound to glucose is different from hemoglobin
unbound to glucose..
4. What potential conditions might cause erroneous results?
○ Genetic variants that cause higher levels of fetal hemoglobin and chemically
modified hemoglobin derivatives can make HbA1c readings less accurate. The
results change based on the type of Hb or its derivative and the HbA1c method
used.