Fructosamine, Serum
Sources
Fructosamine, Serum
Longitudinal Data
| Date | Value | Flag | Context/Notes | Source |
|---|---|---|---|---|
| 2026-04-22 | 310 | H | Dr Lal PathLabs NRL - Elevated, reflects short-term hyperglycemia (1–2 weeks) | raw/labs/2026-04-29_ISHAMMA.pdf |
Trend Analysis
First fructosamine measurement. Result is elevated at 310 µmol/L (reference 122–236), indicating suboptimal glucose control over the preceding 1–2 weeks.
Clinical Context
Fructosamine reflects short-term glycemic control (2–3 weeks), in contrast to HbA1c which reflects 2–3 months. Fructosamine measures glycated serum proteins (primarily albumin) and is not affected by red cell turnover, hemolysis, or transfusions.
Fructosamine vs HbA1c Discordance
This elevated fructosamine result contradicts the improving HbA1c trend documented in Hba1C:
| Marker | Timeframe | Most Recent Result | Interpretation |
|---|---|---|---|
| HbA1c | 2–3 months | 5.7% (Mar 2, 2026) | Pre-diabetic range, improved from 6.8% |
| Fructosamine | 1–2 weeks | 310 µmol/L (Apr 22, 2026) | Elevated, indicates poor recent control |
Possible Explanations
- HbA1c artificially lowered by AML treatment — The "improvement" in HbA1c (6.8% → 5.7%) may be spurious due to:
- Increased red cell turnover from azacitidine/venetoclax
- Shorter RBC lifespan in hematologic malignancy
-
Transfusion dilution (if transfusions given)
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True hyperglycemia masked by unreliable HbA1c — Fructosamine may be the more accurate marker of actual glucose control in this patient with AML. Albumin turnover is normal (albumin 4.4 g/dL, normal), so fructosamine should be reliable.
-
Recent dietary change or steroid exposure — Worsening glucose control in the 2 weeks prior to Apr 22. No documented steroid use, but possible undocumented dexamethasone for nausea or appetite stimulation.
Recommendation
Fructosamine is the preferred glycemic marker in patients with hemolytic anemias, active hematologic malignancy, or transfusion dependence. This result suggests true diabetes is likely still present despite the "improving" HbA1c.
Consider:
- Repeat fructosamine in 4 weeks to confirm trend
- Home glucose monitoring if not already done
- Re-evaluate need for diabetes-specific medication (no DM meds currently documented)
- Glycated albumin (GA) as alternative marker (may be more widely available than fructosamine)
Related
- Diabetes Mellitus — Type 2 DM, active
- Hba1C — HbA1c trend may be unreliable in setting of AML
- Aml — Active hematologic malignancy affects RBC turnover
Created 2026-04-29 during ingest of Dr Lal PathLabs fructosamine report.