Shadi Almassri/ LinkedIn
Jun 1, 2026, 12:35
Shadi Almassri: Conditions That Can Cause False High or False Low HbA1c Results
Shadi Almassri, Endocrinology Consultant at NEOM, shared a post on LinkedIn:
“HbA1c is unreliable whenever red blood cell lifespan is altered or hemoglobin is abnormal.
In these situations, the HbA1c value may be falsely high or falsely low and not reflect the patient’s true glycemic control.
Falsely Low HbA1c Conditions that shorten red blood cell survival:
- Hemolytic anemia
- Acute or chronic blood loss
- Recent blood transfusion
- Splenomegaly
- Treatment with erythropoietin
- Recovery from iron, vitamin B12, or folate deficiency
- Advanced chronic kidney disease (especially dialysis patients)
Falsely High HbA1c
Conditions that prolong red blood cell survival:
- Iron deficiency anemia
- Vitamin B12 deficiency
- Folate deficiency
- Asplenia (absence of spleen)
Hemoglobin Variants
HbA1c may be inaccurate in patients with:
- Sickle Cell Disease
- Hemoglobin C, D, or E variants
- Thalassemias (depending on assay method)
Other Situations
- Pregnancy (especially 2nd and 3rd trimester)
- Advanced liver disease
- Severe hypertriglyceridemia
- Severe hyperbilrubinemia”
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