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RECENT Artery Conversations

Hgb A1c rate of change

I'm investigating a question from a hospitalist regarding an inpatient who's A1c went from 7.9% to 8.6% in 12 days (I don't know why they were ordered at such a short interval -- error I suspect). 57 yr old man with insulin dependent type 2 DM. Hgb 14.6 gm/dL, MCV 75.2 (no iron studies), no known hemoglobinopathy, no transfusions, lipids and Bili normal. Cr was 1.6 when A1c was 7.9%, Cr was 2.7 when A1c was 8.6%, and Cr went as high as 4.8 in between. During this interval glucose ranges from 183 - 499, mean 292, median 268 (13 data points). A1c testing is performed at another hospital in our system using Beckman's turbidimetric immunoinhibition method on AU analyzer. They tell me there were no issues with QC (QC CV's 3.5% and 3% for low and high levels, respectively). Is this rise in A1c over a short time attributable to the glucose levels during that interval? Could uremia be responsible (package insert says no for falsely elevated level)? The low MVC suggests Fe deficiency anemia and resultant low RBC turnover (known to falsely elevate A1c)? Give feedback online


We will be switch from N-ProBNP to BNP when we go live on our Abbott Architect. We plan on communicating the change ahead of time to our physicians. What kind of response should I expect?

Capillary Blood Gas tubes - glass vs plastic

Many years ago, I recall we did a study comparing glass and plastic capillary blood gas results. In that study, it basically showed good comparisons for pH, pCO2, pO2, Na & K, but not for Ionized Calcium, therefore we have continued on with the use of glass capillary blood gas collection devices. Unfortunately, I cannot seem to locate that study. I know the general recommendation for safety concerns is to go to plastic. Has anyone done more recent studies to validate use of plastic vs glass capillary tubes for ionized calcium testing? Are you using glass or plastic?