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Glycosylated Hemoglobin
Glycosylated Hemoglobin
GLYCOSYLATED
HEMOGLOBIN
Lecture
Asst.Lec. Zahraa Jameel
TERMINOLOGY:
Glycated hemoglobin is preferred over glycosylated hemoglobin to reflect
the correct (non-enyzmatic) process. Early literature often used glycosylated
as it was unclear which process was involved until further research was
performed. The terms are still sometimes used interchangeably in English-
language literature.
A1c is a weighted average of blood glucose levels during the life of the red
blood cells (117 days for men and 106 days in women). 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 clinical practice showing that HbA1c
levels improved significantly after 20 days from start or intensification of
glucose-lowering treatment.
DESCRIPTION OF HBA1c:
Hemoglobin, found in red blood cells, carries oxygen to the tissues
and facilitates removal of carbon dioxide from the body. Hemoglobin is a
tetrameric molecule made up of four globin chains attached to four heme
groups. The majority of hemoglobin in normal adults is designated as
hemoglobin A, or A1, which contains two alpha and two beta chains (Figure
1). Hemoglobin A1c is an in vivo glycosylated form of hemoglobin A1 with
a glucose molecule irreversibly attached to the N terminal amino group of
the beta chain.
HEME Oxygen
HC N CH
N Fe N
HC N CH
HEME
α1
α1 α2α2
β1
β1 β2β2
Macrovascular Disease affects the heart and larger blood vessels. Diabetes
accelerates atherosclerosis, leading to coronary heart disease, strokes, and
pain in the lower extremities due to decreased blood supply.
CONCLUSION:
Based on the above discussion, it appears that boronate affinity
chromatograph is the best method for accurately detecting HbA1c. However,
there are limitations. Boronate affinity chromatography cannot detect that a
variant hemoglobin is present. When a hemoglobinopathy is present, HbA1c
testing results may not accurately reflect long-term glycemic control.
General recommendations regarding testing for HbA1c include evaluating
samples with a glycated hemoglobin value of greater than 15%. This
includes examining chromatographs manually and obtaining the clinical
history of the patient. Samples with clinically silent hemoglobin variants
should be analyzed by a second method with a different assay principle,
preferably boronate affinity.
REFERENCES:
Wikipedia | Glycated hemoglobin
https://en.wikipedia.org/wiki/Glycated_hemoglobin