Skip to main content
AACE 2024 Annual Meeting Main banner
Back

Diabetes/Prediabetes/Hypoglycemia

(9.11) Inaccurate Venous Blood Glucose Values after Hydroxyurea Administration for Leukemia

Friday, May 10, 2024
10:30 AM – 10:45 AM CDT
Location: ePoster Showcase, Empire Ballroom Foyer, Level 2

    Submitter(s)

  • Yahya El Soufi, MD

    Internal Medicine Resident
    One Brooklyn Health - Brookdale University Hospital Medical Center , United States

Introduction : Venous plasma glucose (VPG) is usually considered the gold standard test that reflects the actual glycemic state of the patient. However, in certain rare circumstances, the p</span>oint-of-care glucose (POCG) testing on capillary blood specimens may provide a better evaluation for glucose level. We reported a rare case of falsely severe hypoglycemia measured by VPG in a leukemia patient. POCG is a highly accepted method of glucose measurement in hospitals worldwide, given the growing need for frequent and fast glucose measurement with minimally invasive techniques. The accuracy of VPG levels and the comparable POCG are crucial for glycemic control and prevention of life-threatening hypoglycemia.  

Case(s) Description : The p</span>atient was an 82-year-old male with type 2 diabetes mellitus who was diagnosed with Chronic Neutrophilic Leukemia (CNL) and started on hydroxyurea recently. The p</span>atient developed low VPG readings on multiple occasions with normal or even high POCG readings. He had no hypoglycemic signs or symptoms. His hypoglycemia episodes mainly occurred in the morning with VPG level ranging between 11 to 49 mg/dL and POCG level ranging between 80 to 175 mg/dL. The lowest VPG was less than 11 mg/dL while the POCG was 181 mg/dL around the same time. HbA1C was 6.3%. The patient also had anemia and chronic kidney disease stage 4. However, pseudohypoglycemia episodes only occurred when the patient had leukocytosis and was on hydroxyurea.  

Discussion : Arbitrarily, a discrepancy between venous and capillary blood glucose levels should not exceed 15-20 mg/dL. Multiple studies have shown that especially in the fasting period, venous and capillary blood glucose levels are not significantly different. Regardless of whether the sample is from capillary or venous blood, it is essential that the patient displays a Whipple’s triad before attributing a low glucose level to hypoglycemia. Previous studies showed the artefactual hypoglycemia in the setting of severe leukocytosis may be due to glucose consumption in vitro. It is also well known that hydroxyurea administration may cause inaccurate glucose sensor values. Whether our patient’s pseudohypoglycemia episodes were related to the direct interfering effect of CNL leading to in vitro glucose consumption or induced by hydroxyurea remains unclear. Although POCG from capillary blood is usually not as accurate as serum blood specimens, p</span>hysicians should be cautious that discrepancies in blood sugar measurements can occur with a falsely low serum glucose level. As such, any abnormal glucose reading needs to be correlated clinically for proper medical management.