2005HbA1c操作规范指引.docVIP

2005年HbA1c操作規範指引 HbA1c是用來評估糖尿病病患： 平均血糖index of mean glycemia。 併發症的危機risk for the development of diabetes complications。 糖尿病照護的品質管理(quality of diabetes care)。 由於HbA1c的監控是與糖尿病病患的治療追踪與與併發症的發生有密切相關，因此特訂定此操作規範指引，提高HbA1c檢驗的準確度，嘉惠病患，提高其生活品質。 Ⅰ、Pre-analytical variations：(分析前變異附：NGSP網頁) Patient variables:對age、sex、ethnicity 或 season 皆不受影響。 造成紅血球壽命短少的情況，會使HbA1c偽性下降。 參NGSP網頁資訊 (/~diabetes/ngsp.html) Hemoglobin Variants and Derivatives: Genetic variants (e.g. HbS trait, HbC trait) and chemically modified derivatives of hemoglobin (e.g. carbamylated Hb in patients with renal failure, acetylated Hb in patients taking large amounts of aspirin) can affect the accuracy of GHB measurements. The effects vary depending on the specific Hb variant or derivative and the specific GHB method. Table 1 contains information for most of the commonly used GHB methods for the some of the more common Hb variants and derivatives. Interferences from less common Hb variants and derivatives are discussed in Bry, et al (1). When selecting an assay method, laboratories should take into consideration characteristics of the patient population served, (i.e., high prevalence of hemoglobinopathies or renal failure). Shortened Erythrocyte Survival: Any condition that shortens erythrocyte survival or decreases mean erythrocyte age (e.g., recovery from acute blood loss, hemolytic anemia) will falsely lower GHB test results regardless of the assay method used (25). GHB results from patients with HbSS, HbCC, and HbSC must be interpreted with caution given the pathological processes, including anemia, increased red cell turnover, transfusion requirements, that adversely impact. GHB as a marker of long-term glycemic control. Alternative forms of testing such as glycated serum protein (fructosamine) should be considered for these patients. 維生素C 及維生素E可能經由抑制血色素的糖化而偽性下降HbA1c，但有些方法維生素C反而會使HbA1c偽性上升。 大多數的干擾是因方法而異 (method specific)，因此在決定使用方法前或進行檢驗前一定要詳讀廠商提供的說明書或資料。 檢體處置及穩定度： 大多數廠商建議使用EDTA管(1.5mg/ml)：全血在4℃可以穩定一週，在-70℃以下至少二年