What is a hemoglobin A1C test. How does it help in diabetes management. What do A1C test results mean. How often should you have a hemoglobin A1C test. Who should get tested for A1C. What are the recommended A1C levels for diabetics. How can you lower your A1C levels.

The Importance of Hemoglobin A1C in Diabetes Management

Diabetes affects over 34 million Americans, impacting their body’s ability to produce or utilize insulin effectively. This chronic condition requires careful monitoring and management to prevent serious health complications. One of the most valuable tools in diabetes care is the hemoglobin A1C test, which provides crucial insights into a person’s blood sugar levels over time.

The hemoglobin A1C test, also known as HbA1c or simply A1C, offers a comprehensive view of blood glucose control over a three-month period. This makes it an invaluable asset for both diagnosing diabetes and monitoring its management. But what exactly is this test, and why is it so significant?

Demystifying the Hemoglobin A1C Test

The hemoglobin A1C test is a blood test that measures the amount of glycated hemoglobin in your red blood cells. But what does this mean in simpler terms?

• Hemoglobin is a protein in red blood cells that carries oxygen throughout your body.
• When glucose (sugar) enters your bloodstream, it binds to hemoglobin, creating glycated hemoglobin.
• The more glucose in your blood, the more glycated hemoglobin you’ll have.
• The A1C test measures the percentage of your hemoglobin that has become glycated over the past 3 months.

This test is unique because it doesn’t just give a snapshot of your current blood sugar levels. Instead, it provides an average of your blood sugar control over the lifespan of your red blood cells, which is typically about 3 months. This makes it an excellent indicator of long-term blood sugar management.

Interpreting A1C Test Results: What Do the Numbers Mean?

Understanding your A1C test results is crucial for managing diabetes effectively. But what do these percentages actually signify?

• Less than 5.7%: This is considered normal
• 5.7% to 6.4%: This range indicates prediabetes
• 6.5% or higher: This suggests a diagnosis of diabetes

For those already diagnosed with diabetes, the goal is typically to maintain an A1C level below 7%. However, this target may vary depending on individual circumstances, and it’s essential to work with your healthcare provider to determine the best goal for you.

How does A1C relate to average blood sugar levels?

Your A1C result correlates with your average blood sugar levels. Here’s a general guideline:

• A1C of 6% = average blood sugar of 126 mg/dL
• A1C of 7% = average blood sugar of 154 mg/dL
• A1C of 8% = average blood sugar of 183 mg/dL
• A1C of 9% = average blood sugar of 212 mg/dL

Remember, these are averages, and your daily blood sugar readings may fluctuate above and below these numbers.

Who Should Get an A1C Test and How Often?

The Centers for Disease Control and Prevention (CDC) has clear guidelines on who should receive A1C testing and how frequently. These recommendations help ensure early detection and proper management of diabetes.

Who should get tested?

• All adults aged 45 and older
• Overweight individuals under 45 with diabetes risk factors
• People of any age with diabetes risk factors

How often should testing occur?

1. For those without diabetes:
   • If results are normal: Retest every 3 years
   • If prediabetes is detected: Retest every 1-2 years
2. For those with diabetes:
   • Test every 3-6 months, depending on how well blood sugar is controlled

Regular testing is crucial for monitoring diabetes progression and the effectiveness of treatment plans. It allows healthcare providers to make timely adjustments to management strategies, ensuring optimal blood sugar control.

The A1C Test Procedure: What to Expect

Understanding the A1C test procedure can help alleviate any anxiety about the process. How is the test conducted?

• A healthcare professional will draw a small blood sample, usually from a vein in your arm.
• The sample is sent to a laboratory for analysis.
• Results are typically available within a few days.

In some cases, point-of-care A1C tests may be available, providing results in just a few minutes. However, these are generally less accurate than laboratory tests and may need to be confirmed with a standard blood draw.

Is fasting required for an A1C test?

Unlike some other diabetes-related tests, the A1C test doesn’t require fasting. You can eat and drink normally before the test, making it a convenient option for many people.

Strategies for Lowering Your A1C Levels

If your A1C levels are higher than desired, there are several strategies you can employ to bring them down. What are some effective methods for lowering A1C?

1. Dietary changes:
   • Focus on low-glycemic index foods
   • Increase fiber intake
   • Control portion sizes
   • Limit sugary and processed foods
2. Regular exercise:
   • Aim for at least 150 minutes of moderate-intensity exercise per week
   • Include both aerobic exercises and strength training
3. Medication management:
   • Take diabetes medications as prescribed
   • Monitor blood sugar levels regularly
   • Discuss any concerns with your healthcare provider
4. Stress reduction:
   • Practice stress-management techniques like meditation or yoga
   • Ensure adequate sleep
5. Regular monitoring:
   • Keep track of your blood sugar levels
   • Attend regular check-ups with your healthcare provider

Remember, lowering your A1C levels is a gradual process. It’s important to be patient and consistent with your efforts. Celebrate small victories along the way, as even modest improvements can have significant health benefits.

The Role of A1C in Diabetes Prevention

The A1C test isn’t just for managing existing diabetes; it also plays a crucial role in diabetes prevention. How does A1C testing contribute to preventing diabetes?

• Early detection of prediabetes
• Opportunity for lifestyle interventions
• Monitoring of high-risk individuals

By identifying prediabetes early, individuals have the chance to make lifestyle changes that can prevent or delay the onset of type 2 diabetes. This proactive approach can significantly reduce the risk of developing diabetes and its associated complications.

What lifestyle changes can help prevent diabetes?

• Maintaining a healthy weight
• Engaging in regular physical activity
• Following a balanced, nutritious diet
• Quitting smoking
• Limiting alcohol consumption

These lifestyle modifications not only help prevent diabetes but also contribute to overall health and well-being.

Limitations and Considerations of the A1C Test

While the A1C test is a valuable tool in diabetes management, it’s important to understand its limitations. What are some factors that can affect A1C results?

• Certain medical conditions (e.g., anemia, kidney disease)
• Pregnancy
• Recent blood loss or transfusions
• Certain medications
• Genetic factors affecting hemoglobin

In some cases, your healthcare provider may recommend additional tests to get a complete picture of your blood sugar control. These may include fasting blood glucose tests or oral glucose tolerance tests.

Is the A1C test suitable for everyone?

While the A1C test is appropriate for most people, there are some situations where it may not be the best choice. For example, people with certain hemoglobin variants may need alternative testing methods. Always discuss your individual circumstances with your healthcare provider to determine the most suitable testing approach for you.

The Future of Diabetes Management: Beyond A1C

As our understanding of diabetes continues to evolve, so do the tools and strategies for managing the condition. What emerging technologies and approaches are shaping the future of diabetes care?

• Continuous Glucose Monitoring (CGM) systems
• Artificial pancreas technology
• Advanced insulin delivery systems
• Personalized medicine approaches
• Digital health solutions for diabetes management

While these advancements hold great promise, the A1C test remains a cornerstone of diabetes management. It provides a long-term view of blood sugar control that complements the real-time data offered by newer technologies.

How might diabetes management change in the coming years?

As technology continues to advance, we may see more integrated approaches to diabetes management. This could include:

• AI-powered predictive algorithms for blood sugar trends
• More precise, personalized treatment plans based on genetic and lifestyle factors
• Improved remote monitoring capabilities for healthcare providers
• Enhanced patient education and support through digital platforms

Despite these exciting developments, the fundamental principles of diabetes management – including regular monitoring, healthy lifestyle choices, and adherence to treatment plans – will likely remain crucial for optimal health outcomes.

In conclusion, the hemoglobin A1C test is a powerful tool in the fight against diabetes. By providing a comprehensive view of blood sugar control over time, it enables both early detection and effective management of this chronic condition. Whether you’re at risk for diabetes, newly diagnosed, or have been managing the condition for years, understanding your A1C levels is key to maintaining your health and preventing complications. Regular testing, coupled with a proactive approach to lifestyle management, can help you stay on top of your diabetes and lead a healthier, more fulfilling life.

Hemoglobin A1C > Fact Sheets > Yale Medicine

Overview

More than 34 million Americans have diabetes, meaning their bodies either do not produce insulin or can’t use it properly. (Insulin is a hormone that helps the cells in our bodies take up glucose [sugar] in our blood, which we use for energy.)  

Over time uncontrolled diabetes can lead to a host of serious health issues, so it’s important for those with diabetes to keep their blood sugar levels in a healthy range—meaning it’s neither too low nor too high.  

A hemoglobin A1C test is a blood test that can provide information about average blood sugar levels. The test not only helps diabetes patients know if they are managing their blood sugar levels well; it also helps doctors provide a diagnosis of diabetes or pre-diabetes to those who are unaware they have the condition.  

The Centers for Disease Control and Prevention (CDC) recommends that all adults ages 45 and older should receive a hemoglobin A1C test to assess their risk of pre-diabetes or diabetes. The test may also be administered to overweight people with diabetes risk factors who are younger than 45.
 

People of any age with diabetes risk factors whose test results are in the normal range should be tested again every three years. Those who are found to have pre-diabetes should be retested every one to two years.
 

Those diagnosed with diabetes during a screening hemoglobin A1C test should work with their doctors to manage the chronic condition. They’ll need to have their blood sugar levels checked with a hemoglobin A1C test every 3 to 6 months, depending on how well they’re able to control their diabetes.  

“The A1C test is a great way for physicians to get an initial sense of someone’s average glucose level over the three months before the test,” says Yale Medicine endocrinologist Raimund Herzog, MD, MHS. “In addition, it provides us with a great way to monitor treatment effects and progress over time.”

What is a hemoglobin A1C test?

Hemoglobin A1C is a blood test that provides doctors with information about a person’s blood sugar levels. Interestingly, although a patient may provide a blood sample on a single day, the A1C test doesn’t provide details about their blood sugar levels on that particular day. Rather, the test gives doctors insights into the overall state of their blood sugar levels during the three-month period leading up to the test. This is possible because red blood cells live for an average of three months.  

Red blood cells contain a protein called hemoglobin, which gives blood its red color. Hemoglobin is responsible for carrying oxygen throughout the body, from the lungs to other organs and body parts. Another substance, blood sugar (glucose), which comes from food sources, also travels through the bloodstream.  

When blood sugar encounters red blood cells, it attaches itself to hemoglobin, where it remains. Once linked, glucose and hemoglobin become what’s called “glycated hemoglobin,” also known as A1C. The hemoglobin A1C test measures the percentage of red blood cells in the bloodstream that have glucose attached to hemoglobin.
 

Thus, the hemoglobin A1C test results show how much glycated hemoglobin has built up in a person’s bloodstream during the previous three months. A higher percentage of red blood cells containing glycated hemoglobin means that a person has higher levels of blood sugar in their bloodstream. For people with diabetes, this means the disease is not well-controlled. For those who have not been diagnosed before, this may mean that they have pre-diabetes or diabetes.  

All people have some glycated hemoglobin within their red blood cells, and a lower percentage is considered normal.

How do you take a hemoglobin A1C test?

People may have their blood drawn by a nurse at the doctor’s office or by a phlebotomist at a lab. It’s also possible to use an at-home finger prick test, but a blood draw by professionals is the preferred method for the hemoglobin A1C test. After the blood is drawn, a lab will determine the test results and share that information with doctors and patients.

What do A1C test results mean?

When A1C test results are:

• Lower than 5.7%, that is considered “normal”
• Between 5.7% and 6.4%, that indicates a diagnosis of pre-diabetes
• 6.5% or higher, a person has diabetes

Doctors recommend that people with diabetes should strive to keep their A1C levels below 7%. Together, doctors and patients may achieve this goal with a plan that includes dietary changes, weight loss, exercise, and/or medication.

How often should you have a hemoglobin A1C test?

The Centers for Disease Control and Prevention (CDC) recommends that all adults ages 45 and older should receive a hemoglobin A1C test to assess their risk of pre-diabetes or diabetes. The test may also be administered to overweight people with diabetes risk factors who are younger than 45.
 

People of any age with diabetes risk factors whose test results are in the normal range should be tested again every three years. If you are Those who are found to have pre-diabetes you should be retested every one to two years.
 

People who have been diagnosed with diabetes should receive a hemoglobin A1C test from their doctor on a recurring basis, two to four times per year. If your hemoglobin A1C test results are higher than they should be, your doctor can work with you to help achieve better control over your diabetes and to lower your blood sugar levels.

Is a hemoglobin A1C test better than other available blood sugar tests?

If you have diabetes, the A1C test is the best way to check your average blood sugar levels over a three-month period, to gauge whether or not you are managing your condition effectively.
 

There are other blood tests that may be used to diagnose pre-diabetes or diabetes, including:

• A fasting blood sugar test, for which you must fast overnight before having your blood drawn
• A glucose tolerance test, for which you must drink a sweet liquid containing glucose, then wait in the doctor’s office for a set time period before having your blood drawn
• A random blood sugar test, which doesn’t require any special preparation, but it only screens for diabetes.

Doctors may use one or more of these tests to diagnose pre-diabetes or diabetes. Although the A1C test is effective, people with certain health conditions may not get accurate results from it. Thus, another test should be used to confirm a diabetes or pre-diabetes diagnosis in those cases.
 

Hemoglobin A1C test results may not be accurate when people have health conditions such as:

• Sickle cell anemia
• Thalassemia
• Anemia
• Kidney failure
• Liver disease, including cirrhosis
• Enlarged spleen
• Blood transfusions
• Blood hemorrhage
• High triglyceride levels
• Organ transplantation
• Pregnancy
• Alcohol use disorder, also known as alcoholism
• Vitamin B12 deficiency
• Jaundice
• Inherited blood disorders, such as spherocytosis

Certain medications or dietary supplements may also affect the test, giving people inaccurate results. They include:

• Opioids
• Certain drugs that are used to treat HIV
• Iron supplements
• Vitamin C supplements

What are the risks associated with a hemoglobin A1C test?

To perform a hemoglobin A1C test, a sample of blood must be given, either by finger prick or simple blood draw. Very few risks are associated with these blood-sampling methods. A bit of short-lived pain from the needle pricking the skin is normal and expected. Some people may develop a bruise at the site where the needle was inserted.

What is a dangerous level of A1C, and how can people lower it?

The A1C test measures the body’s average blood sugar levels over the past 3 months. High A1C levels are a risk for diabetes and other complications. Lifestyle changes can help manage A1C levels.

The A1C test, also known as the hemoglobin A1C, HbA1C, glycated hemoglobin, or glycohemoglobin test, measures the amount of sugar attached to hemoglobin in the blood.

Hemoglobin is a protein present in red blood cells (RBCs), and sugar naturally attaches to it. However, as people with higher blood sugar levels have more sugar-coated hemoglobin, it is a useful test to help check and monitor diabetes status.

As higher A1C levels are often associated with diabetes complications, it is important to reach and maintain target A1C results. An individual’s personal A1C goal will depend on many factors, including age and any other medical conditions. Although it is an important tool for managing diabetes, testing A1C levels does not replace other strategies, such as regular blood sugar testing at home.

A person can work toward lowering and maintaining their A1C level by following their treatment plan, getting regular physical exercise, and taking steps to lose weight, if the doctor has advised doing so.

In this article, we discuss healthy and concerning A1C levels, the possible complications of high levels, and strategies to reduce A1C levels.

A1C test results represent how well the body is maintaining blood glucose levels by showing the average percentage of sugar-bound hemoglobin in a blood sample. A higher A1C level suggests a higher risk of diabetes and its complications.

When discussing A1C levels, a doctor may also refer to estimated average glucose, or eAG. The eAG corresponds to A1C, but it appears as milligrams per deciliter (mg/dl), as with blood sugar. Both A1C and eAG refer to a person’s average 3-month blood glucose levels.

However, A1C level recommendations can vary among individuals due to a number of factors. What may be high for one person might be within range for another person.

For example, people with more advanced diabetes will have higher A1C targets than those without diabetes. Various underlying conditions, including blood disorders, can also have an effect, as can potentially modifiable factors, such as stress, medications, and lifestyle changes.

A person with an A1C level indicating prediabetes may wish to consider making lifestyle changes, such as adopting a well-balanced diet and staying active, to help manage or even reverse the condition before it progresses to type 2 diabetes.

If a person has a higher A1C level, suggesting diabetes, it is advisable for them to contact a doctor. The doctor will be able to run further diagnostic tests to confirm the person’s diabetes status.

The A1C goal for most people with diabetes is 7% or less. However, personal targets can vary, and a diabetes care team may consider other factors to help a person set their own individual goals.

If a person with diabetes has an A1C test result that is much higher than their set target, a doctor can help advise lifestyle and medication changes to lower their A1C level.

The A1C test is a blood test that measures a person’s average blood sugar levels over the past 3 months. In particular, it measures the percentage of hemoglobin in the blood with an attached molecule of glucose.

When glucose attaches to hemoglobin, experts refer to the resulting compound as glycosylated hemoglobin. The name of the test derives from the fact that about 95–98% of the hemoglobin present in the body is type A1. Type A1 hemoglobin has subtypes, including A1C. As this is the most abundant subtype, it is a good marker for glucose control.

The test uses a 3-month average because RBCs typically live for about 3 months. Therefore, this timeframe reflects the sugar exposure to the cells over that time. The test does not require any specific preparations, so a person does not need to fast prior to the test, and a doctor can perform it at any time of the day.

The A1C test estimates the average blood sugar level over the past 3 months. The test is able to measure this by identifying the percentage of glycosylated hemoglobin in the blood.

If there is more glucose present in the blood, more glucose is available to attach to hemoglobin. Therefore, if a person has a high percentage of glycosylated hemoglobin, it indicates that they have had high blood sugar for an extended period.

A high A1C level can be concerning, as it may indicate that an individual has a higher risk of diabetes complications. For those without a diabetes diagnosis, it suggests that, without interventions, they may develop the condition. For individuals living with diabetes, it may indicate that their current treatment plan is not effective and that they should contact a doctor.

Potential complications that can result from high blood sugar levels include:

• kidney disease
• eye disease
• stroke and cardiovascular disease
• metabolic syndrome
• neuropathy

As many factors can affect a suitable A1C range, there is no standardized approach when it comes to setting A1C goals. A diabetes healthcare team can help provide an individual with a target level that accounts for various factors, including the current A1C value and the date of the next test.

If the test result is already within a healthy range, the goal should be to maintain that. However, if a person enters the higher ranges, a doctor can suggest changes to their goals and treatment plans. They can help the person determine a reasonable target and the best strategy to achieve that goal.

If a person’s A1C level is above their target, a doctor can provide suggestions to help lower it and reduce the risk of potential complications. A person should discuss any drastic lifestyle changes with a doctor before making them. Suggestions to help lower A1C levels may include:

• Reviewing medication: This may involve changing to a different medication or increasing the current dosage. It is also important to ensure that a person is correctly following their treatment plan.
• Regular physical exercise: Physical activity is good for general health, and as the body requires glucose to exercise, it can be a beneficial way to lower blood sugar levels.
• Healthy diet: A balanced and nutritious diet can help with managing sugar levels. Additionally, it can help people achieve any weight loss goals.
• Stopping smoking: Smoking has many potential health risks, and quitting smoking may also help improve blood flow.
• Diabetes education courses: Some people may benefit from attending educational courses and learning strategies to manage their sugar levels more effectively.

An A1C test is a diagnostic tool that measures blood sugar levels over the last 3 months. It can help doctors identify people at risk of developing diabetes and monitor the effectiveness of treatments in those living with the condition.

It measures the percentage of hemoglobin in red blood cells that has an attached glucose molecule. If a person has high blood sugar, more glucose is available to attach to hemoglobin. This means that individuals with high blood sugar will have a higher percentage of glycosylated hemoglobin and an increased risk of potential complications.

People can work toward lowering their A1C levels by implementing different strategies, such as following their current treatment plan, getting regular exercise, and taking steps to lose weight, if necessary.

Glycated hemoglobin blood sugar test

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Glycated (glycosylated) hemoglobin A1c is a specific compound of erythrocyte hemoglobin with glucose. The value of this component in the blood is used in medical diagnostics to determine the average content of glucose in the blood over a period of approximately three months.

A blood test for glycated hemoglobin A1c is carried out using a colorimetric method. The reference value of glycated hemoglobin A1c in the blood is up to 6%. In people with diabetes, the value of this type of hemoglobin can be exceeded by 2-3 times.

Indications for testing

Glycated hemoglobin A1c blood test is performed to control glucose levels in patients with diabetes to minimize the risk of damage to the kidneys, nervous and cardiovascular systems.

It is also used when it is necessary to determine the level of glucose over a long period of time, as well as a means of monitoring the effectiveness of the treatment of patients with diabetes and to adjust therapy.

For newly diagnosed diabetic patients, the glycated hemoglobin A1c test is indicated to detect uncontrolled spikes in blood sugar, and the test may be ordered at certain intervals. In addition, this test allows you to diagnose diabetes in the early stages, so it is used for preventive purposes.

Depending on the type of diabetes and how it is treated, a glycated hemoglobin A1c test may be performed 2 to 4 times a year. It is recommended to take the test if you have the following symptoms:

• increased fatigue and weakness;
• frequent urination;
• intense thirst regardless of the amount of liquid drunk;
• a sharp deterioration in vision.

You can get a hemoglobin test at our centers at an affordable price. You can also save if you sign up for the delivery of biomaterial on our website.

Other test names

• Glycated hemoglobin blood test
• Glycohemoglobin
• HbA1c
• Hemoglobin A1c
• A1c
• HgbA1c
• Hb1c

Before donating blood for glycated hemoglobin A1c, the following recommendations should be followed:

• donate blood in the morning on an empty stomach or not earlier than 2-4 hours after a meal;
• the use of water without gas is allowed;
• on the eve of the glycemic blood test, you should give up alcohol, exclude physical and emotional overstrain;
• stop smoking 30 minutes before the study;
• Do not donate blood during the period of taking medications, unless otherwise prescribed by a doctor.

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Glycated hemoglobin A1c – SanaTest laboratory

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Compound of hemoglobin with glucose, which allows to assess the level of glycemia and 1-3 months prior to the study.

It is formed as a result of the slow non-enzymatic addition of glucose to hemoglobin A contained in erythrocytes. Glycated (the term “glycosylated” is also used) hemoglobin is present in the blood in healthy people.

The rate of this reaction and the amount of glycated hemoglobin formed depend on the average blood glucose level over the lifetime of red blood cells. As a result of the reaction, several variants of glycated hemoglobins are formed: HbA1a, HbA1b, HbA1c. The latter form quantitatively predominates and gives a closer correlation with the severity of diabetes mellitus.

Glycated hemoglobin reflects hyperglycemia that occurred during the lifetime of erythrocytes (up to 120 days). Erythrocytes circulating in the blood have different ages. Usually they are guided by an average period of 60 days. The level of glycated hemoglobin is an indicator of the compensation of carbohydrate metabolism during this period. Normalization of the level of glycated hemoglobin in the blood occurs on the 4-6th week after reaching a normal glucose level. In diabetic patients, the level of this compound can be increased by 2-3 times.

According to WHO recommendations, this test is considered optimal and necessary for the control of diabetes mellitus. Patients with diabetes are recommended to conduct a study of the level of glycated hemoglobin at least once a quarter. Values ​​may vary between laboratories depending on the analytical method used, so monitoring over time is best done in the same laboratory, or at least by the same method. When monitoring diabetes treatment, it is recommended to maintain glycated hemoglobin levels below 7% and reconsider therapy when glycated hemoglobin content is more than 8% (the indicated values ​​\u200b\u200bare applicable only for certified methods for determining glycated hemoglobin with a reference limit of 4-6%).

Clinical studies using certified methods show that a 1% increase in glycated hemoglobin is associated with an average increase in plasma glucose of approximately 2 mmol/l. Glycated hemoglobin is used as an indicator of the risk of complications of diabetes. It has been proven that a 1/10 decrease in glycated hemoglobin values ​​is associated with an approximately 45% reduction in the risk of progression of diabetic retinopathy.

Test results may be falsely affected by any condition that affects the average lifespan of red blood cells. Bleeding or hemolysis causes a false decrease in the result; blood transfusions naturally distort the result; with iron deficiency anemia, a false increase in the result of determining glycated hemoglobin is observed.

Test indications:

Diagnosis and screening of diabetes mellitus. Long-term monitoring of the course and control over the treatment of patients with diabetes mellitus. Determining the level of diabetes compensation. Supplement to the glucose tolerance test in the diagnosis of prediabetes, sluggish diabetes. Examination of pregnant women (hidden diabetes).

Preparation for the study : the level of glycated hemoglobin does not depend on the time of day, physical activity, food intake, prescribed medications, or the emotional state of the patient. Conditions that cause a shortening of the mean “age” of red blood cells (after acute blood loss, with hemolytic anemia) may falsely lower the test result.

• Increased values:

Diabetes mellitus and other conditions with impaired glucose tolerance. iron deficiency. Splenectomy. A false increase may be due to a high concentration of fetal hemoglobin (HbF).

Decreased values ​​

Hypoglycemia. hemolytic anemia. Bleeding. Blood transfusion.

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