Chromatographic evaluation of minor hemoglobins: clinical significance of hemoglobin A1d, comparison with hemoglobin A1c, and possible interferences.

Using an HPLC procedure, we evaluated > 10 minor hemoglobins (Hbs) in healthy adults, individuals on long-term aspirin therapy, diabetic subjects, and uremic patients. Hb A1c and Hb A1d3 were the most abundant and important minor Hb components, respectively, accounting for 4.10% +/- 0.50% and 3.46% +/- 0.43% of total Hb in 361 healthy subjects. Acetylated Hb A was a potential interferent in the measurement of Hb A1c. The amounts of both Hb A1d3 and Hb A1carb were significantly increased in uremic patients, indicating that these Hb adducts may be carbamylated. There was a significant correlation (r = 0.69, P < 0.0001) between the amounts of Hb A1d3 and plasma urea in uremic patients. Nonuremic subjects were clearly separated from uremic patients with regard to the Hb A1d3 content of their total Hb. Our data suggest that Hb A1d3 is useful for assessment of the uremic state and that the combination of Hb A1c and Hb A1d3 could be well-suited for simultaneous control of carbohydrate and urea metabolism.