Measuring postmortem glycated hemoglobin - A comparison of three methods.

Glycated hemoglobin (HbA1c) is a glycoprotein formed as a result of the non-enzymatic addition of d-glucose to the hemoglobin β-chain. The amount of HbA1c in the blood is dependent on mean glucose levels present during the 1-2 months preceding measurement, and it is an indicator of long-term glycemic levels. HbA1c is a useful marker in postmortem biochemistry in determining cause of death in acetonemic cases by allowing to distinguish diabetic ketoacidosis (DKA) from starvation or alcoholic ketoacidosis (AKA) and intoxication by acetone or isopropanol. We evaluated three methods for postmortem HbA1c measurement: Mono S cation exchange HPLC, affinity chromatography using point-of-care analyzer and a direct enzymatic method by. Additionally, optimization of sample storage and preservatives was performed and interpretation of the results in autopsy cases is discussed. Our results indicate that the HbA1c levels of postmortem samples can be reliably measured with Mono S HPLC. EDTA is the preferable preservative, as samples can be measured after as long as 4 weeks storage at +4°C. Our study shows that HbA1c analysis is a valuable tool alongside glucose and ketone body analysis in determining the metabolic state of deceased persons in medicolegal autopsies.