患者男,74岁,因感右下肢无力加重,口齿不清等症状转入我院,收集实验室资料及详细病史.检查HbA1c为1.5％,后又检测糖化血清白蛋白(GA)、直接和间接抗人球蛋白抗体等,最后诊断为温抗体型自身免疫性溶血性贫血.该患者因存在温抗体导致外周血红细胞破坏加快,血红蛋白被糖类物质经非酶促作用缩合时间大大缩短,导致HbA1c显著降低.因此,对于有自身免疫性溶血等影响红细胞寿命疾病的患者,HbA1c不能反映真实血糖的控制情况,应用血糖和GA的测定代替.%A 74 -year-old male with aggravated right lower limb weakness and slurred speech was admitted into our hospital and his laboratory data and detailed medical history were collected In the examination, the level of his HbA1c was 1. 5%. After the glycated albumin (GA) and direct and indirect anti-human globulin antibodies were checked, he was finally diagnosed as warm antibody autoimmune hemolytic anemia. The existence of warm antibody caused the accelerated destruction of red blood cells in peripheral blood, the non-enzymatic condensation time of hemoglobin by carbohydrate was greatly shortened, therefore, his HbA1c was significantly lowered. HbA1c was not able to reflect the true condition of control of blood glucose in those patients with autoimmune hemolytic anemia or other diseases affecting the life of erythrocytes. In this case, the determination of glucose and GA should be applied instead of HbA1c.
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