Falsely elevated HbA1c — RACP Paediatrics MCQ

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HardEndocrineFalsely elevated HbA1cRACP Paediatrics

A child with T1DM has an HbA1c of 108 mmol/mol. The family claims good glucose control. What factor could cause a falsely elevated HbA1c?

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Correct answer: A — HbA1c

HbA1c reflects average glucose over 2-3 months (RBC lifespan). Falsely elevated HbA1c can occur with: iron deficiency anaemia (prolonged RBC lifespan), chronic kidney disease, and certain haemoglobin variants. Falsely low HbA1c occurs with: haemolytic anaemia, blood transfusion, and pregnancy. CGM data (time in range) should be compared with HbA1c to identify discrepancies.

Reference: ISPAD – 2022; RCH Melbourne – 2023 – T1DM CPG