Uncommon causes of hemoglobin E flags identified during measurement of hemoglobin A1c by ion-exchange high-performance liquid chromatography.

We present 3 cases of discordant results from screening hemoglobin A1c (HbA1c) measured by ion-exchange high-performance liquid chromatography (HPLC) all due to various forms of interference and flagged by the instrument as "suspected hemoglobin E (HbE)." The first case was due to a rare hemoglobin variant, later confirmed to be hemoglobin Hoshida, the second due to "true" heterozygous HbE, and the third a result of analytical artifact causing splitting of the HbA1c peak without an underlying variant hemoglobin. We examine the similarities in these cases along with the laboratory work-up to classify each cause of interference to demonstrate the wide array of potential causes for the suspected HbE flag and why it warrants proper work-up. Because there is no standardized method of reporting out hemoglobin variant interference in HbA1c measurement, we discuss our laboratory's process of investigating discordant HbA1c measurements and reporting results in cases with variant interference as 1 possible model to follow, along with discussing the associated laboratory, ethical, and clinical considerations. We also examine the structure of hemoglobin Hoshida, HbE, and conduct a brief literature review of previous reports.

Electrocution Due to Fractal Wood Burning: Two Case Reports and a Review of the Medical Literature.

ABSTRACT: Fractal wood burning is a new technique of pyrography that passes an electrical current through a piece of wood resulting in decorative electrical burns. This practice has become increasingly popular with many walk-through tutorials of the process found online. This includes videos of how to build homemade devices fashioned from disassembled microwave oven transformers. There have been 31 reported deaths and many serious injuries due to fractal wood burning resulting in news headlines, warning statements, and an outright ban of the practice at certain woodworking events. The medical community has begun to recognize the danger of fractal wood burning with a few cases of severe burn injuries reported. We report 2 cases of electrocution from fractal wood burning accidents. The scene investigations were examined, including the similarities in the homemade microwave oven transformers that were used, as well as the autopsy findings. The pathophysiology of fractal wood burning and the creation of Lichtenberg figures is discussed as well as the high-voltage injury patterns seen in cases of fractal wood burning accidents. Other cases of electrical injury from fractal wood burning accidents reported in the news and medical literature were then examined in terms of demographics, burn pattern, cardiac findings, and whether a homemade wood burning device was involved.