This article originally posted 25 March, 2009 and appeared in Issue 461
Test Your Knowledge Issue 461
A 46-year-old woman in whom Type 2 diabetes was recently diagnosed wants to achieve the best glycemic control possible.
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However, her fasting glucose level is consistently greater than 150 mg/dL (8.32 mmol/L) and occasionally greater than 200 mg/dL (11.1 mmol/L). Her hemoglobin A1c values are repeatedly below 6.5%. She is asymptomatic and has long-standing mild anemia that has been stable with a hematocrit in the range of 32% to 34%.
Laboratory Studies
Hematocrit
34%
Hemoglobin
11.1 g/dL (111 g/L)
Mean corpuscular volume
84 fL
Mean corpuscular hemoglobin
27.2 pg
Mean corpuscular hemoglobin concentration
34.2 g/dL (342 g/L)
Leukocyte count
8700/µL (8.7 × 109/L)
Platelet count
158,000/µL (158 × 109/L)
Reticulocyte count
3.9%
Lactate dehydrogenase
350 U/L
Which of the following types of anemia is the most likely explanation for the discrepancy between this patient's glucose and hemoglobin A1c values?
A. Hemolytic anemia
B. Iron deficiency anemia
C. Myelodysplastic syndrome
D. Vitamin B 12 deficiency
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