Evaluation of Diabetic Marker HbA1c and Anemia in the Context of Kidney Disease

Each year, more than 100,000 people in the United States are diagnosed with kidney failure, the final stage of kidney disease.1 The most common cause is diabetes, accounting for nearly 44 percent of new cases. Often, a consequence of kidney disease is anemia. This occurs when kidneys fail to generate enough erythropoietin hormone to trigger adequate red blood cell production. For decades, clinicians have successfully used the hemoglobin A1c (HbA1c or A1C) assay to monitor long-term blood glucose control for patients with chronic diabetes. More recently, researchers have studied the HbA1c assay’s use as a potential diagnostic marker for diabetes complications such as kidney disease.

The HbA1c test measures average plasma glucose—hemoglobin in a red blood cell that was combined with glucose over the previous eight to 12 weeks. The higher the HbA1c value, the greater the risk that the diabetes patient will develop kidney disease, and perhaps, anemia, a common consequence of renal disease. However, a chemically modified derivative of hemoglobin called carbamylated hemoglobin (CHb) can affect the accuracy of the HbA1c test results. Studies have shown that the formation of CHb due to abnormal urea concentration is linked to both the severity and the duration of renal failure. Research findings have inspired conflicting viewpoints on the efficacy of HbA1c test results in the presence of CHb and on the level of CHb it takes to affect results. This article explores the links between diabetes and renal failure. It discusses what research has discovered about the effect of CHb on HbA1c testing. Finally, it shows how testing technology has improved to ensure HbA1c testing accuracy.

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Source: MedicalLaboratoryObserver

Point-Of-Care Hemoglobin Testing: Methods And Relevance To Combat Anemia

Anemia is a condition that causes a high degree of personal disability but, historically, has lacked adequate resourcing in many public health systems. This situation is even less understandable when you consider that the main diagnostic, hemoglobin testing, is one of the most commonly used point-of-care (POC) tests, and one of the easiest to perform.

POC hemoglobin testing is often needed in settings where the use of a benchtop laboratory hematology analyzer is not practical. It is ideal for use in settings where resources are poor, or there is a need for mobility and simplicity in field use, or where turnaround time (TAT) for the test result needs to be short, as in acute clinical situations.

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Source: MedicalLaboratoryObserver

Tibetans Inherited High-Altitude Gene From Ancient Human

A “superathlete” gene that helps Sherpas and other Tibetans breathe easy at high altitudes was inherited from an ancient species of human. That’s the conclusion of a new study, which finds that the gene variant came from people known as Denisovans, who went extinct soon after they mated with the ancestors of Europeans and Asians about 40,000 years ago. This is the first time a version of a gene acquired from interbreeding with another type of human has been shown to help modern humans adapt to their environment.

Researchers have long wondered how Tibetans live and work at altitudes above 4000 meters, where the limited supply of oxygen makes most people sick. Other high-altitude people, such as Andean highlanders, have adapted to such thin air by adding more oxygen-carrying hemoglobin to their blood. But Tibetans have adapted by having less hemoglobin in their blood; scientists think this trait helps them avoid serious problems, such as clots and strokes caused when the blood thickens with more hemoglobin-laden red blood cells.

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Breathing easy. This Tibetan inherited a beneficial high-altitude gene from archaic Denisovan people.

Beijing Genomics Institute

Source: sciencemag

Hemoglobin Review

Much of our understanding of human physiology, and of many aspects of pathology, has its antecedents in laboratory and clinical studies of hemoglobin. Over the last century, knowledge of the genetics, functions, and diseases of the hemoglobin proteins has been refined to the molecular level by analyses of their crystallographic structures and by cloning and sequencing of their genes and surrounding DNA. In the last few decades, research has opened up new paradigms for hemoglobin related to processes such as its role in the transport of nitric oxide and the complex developmental control of the α-like and β-like globin gene clusters. It is noteworthy that this recent work has had implications for understanding and treating the prevalent diseases of hemoglobin, especially the use of hydroxyurea to elevate fetal hemoglobin in sickle cell disease. It is likely that current research will also have significant clinical implications, as well as lessons for other aspects of molecular medicine, the origin of which can be largely traced to this research tradition.

Introduction

During the past 60 years, the study of human hemoglobin, probably more than any other molecule, has allowed the birth and maturation of molecular medicine. Laboratory research, using physical, chemical, physiological, and genetic methods, has greatly contributed to, but also built upon, clinical research devoted to studying patients with a large variety of hemoglobin disorders.

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Source: bloodjournal

Anemia

Anemia is a condition characterized by an inadequate amount of red blood cells, which are produced in your bone marrow. Red blood cells contain hemoglobin, a substance that picks up oxygen from your lungs, carries it throughout your body, and gives it to your cells. Your cells need oxygen to perform the basic functions that generate energy and keep you alive. In addition, hemoglobin picks up some of the carbon dioxide given off by your cells and returns it to the lungs, where it is exhaled when you breathe out. Without enough red blood cells to transport oxygen to your cells and carbon dioxide away from your cells, your body functions at a less than optimal level.

There are many causes of anemia, which can be broadly grouped into three categories:

Blood Loss

If you are bleeding heavily, you will rapidly become anemic and may develop severe symptoms including shock. Slower leakage of blood that you are unaware of, such as bleeding from a stomach ulcer or from colon cancer , can also exceed your bone marrow’s ability to replace blood supplies, eventually resulting in anemia.

Failure to Make Enough Normal Red Blood Cells or Hemoglobin

Dietary intake of iron, folic acid, and vitamin B 12 are necessary for red blood cell formation. Deficiencies of these nutrients can impair bone marrow function, thus reducing production of adequate numbers of red blood cells. In addition, cancers, certain drugs and toxins, allergic reactions to medicines, and chronic illness can cripple the bone marrow so that it makes defective or insufficient red blood cells. Hereditary defects, such as sickle cell disease , also may lead to anemia. When the bone marrow fails completely the condition is known as aplastic anemia.

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Source: Nucleus Medical Media