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HelpTest Code HGBELM Hemoglobin Electrophoresis Cascade, Blood
Additional Codes
MAYO: HBELC
EPIC: LAB2529
Reporting Name
HGB Electrophoresis CascadeUseful For
Diagnosis and comprehensive classification of thalassemias and hemoglobin variants
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| A2F | Hemoglobin A2 and F | No | Yes |
| HBEL | Hemoglobin Electrophoresis, B | No | Yes |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| SDEX | Hemoglobin S, Scrn, B | Yes | No |
| IEF | IEF Confirms | No | No |
| MASS | Hb Variant by Mass Spec, B | No | No |
| UNHB | Unstable Hemoglobin, B | No | No |
| ATHAL | Alpha-Globin Gene Analysis | Yes | No |
| WASQR | Alpha Globin Gene Sequencing, B | Yes, (Order WASEQ) | No |
| WBSQR | Beta Globin Gene Sequencing, B | Yes, (Order WBSEQ) | No |
| WBDDR | Beta Globin Cluster Locus Del/Dup,B | Yes, (Order WBDD) | No |
| HBELA | HGB Electrophoresis Summary Interp | No | No |
| HPFH | Hemoglobin F, Red Cell Distrib, B | No | No |
| WGSQR | Gamma Globin Full Gene Sequencing | No | No |
Testing Algorithm
Hemoglobin electrophoresis cascade will always include hemoglobin A(2) and F and hemoglobin electrophoresis utilizing cation exchange HPLC and capillary electrophoresis methods.
Hemoglobin electrophoresis reflex testing, performed at additional charge, may include any or all of the following to identify rare hemoglobin variants present: sickle solubility (hemoglobin S screen), hemoglobin heat and isopropanol stability studies (unstable hemoglobin), isoelectric focusing, intact globin chain mass spectrometry (hemoglobin variant by mass spectrometry), Hb F distribution by flow cytometry (hemoglobin F red cell distribution), DNA (Sanger) testing for beta chain variants and the most common beta thalassemias (beta-globin gene sequencing), multiplex ligation-dependent probe amplification (MLPA) testing for beta cluster locus large deletions and duplications, including large deletional hereditary persistence of fetal hemoglobin (HPFH), delta-beta (DBT), delta thalassemias, gamma-delta-beta (GDBT), and epsilon-gamma-delta-beta (EGDBT) thalassemias (beta globin cluster locus del/dup), large deletional alpha thalassemias and alpha gene duplications (alpha-globin gene analysis), alpha chain variants and non-deletional alpha thalassemias (alpha-globin gene sequencing), and gamma chain variants and non-deletional HPFH (gamma globin full gene sequencing).
If a Thalassemia/Hemoglobinopathy Patient Information sheet (T358) is received with the sample, the reported clinical features or clinical impression will be considered in the interpretation and focus of the evaluation. Our laboratory has extensive experience in hemoglobin variant identification and many cases can be confidently classified without molecular testing. However, molecular confirmation is always available. If no molecular testing or, conversely, specific molecular tests are desired, utilize the appropriate check boxes on the information sheet. If the information sheet or other communication is not received, the reviewing hematopathologist will select appropriate tests to sufficiently explain the clinical impression or reported CBC results, which may or may not include molecular testing.
Hemoglobin (HGB) Electrophoresis Summary Interpretation, an additional consultative interpretation that summarizes all testing, will be provided after test completion to incorporate subsequent results into an overall evaluation if 1 or more of the following molecular tests are reflexed on the HBELC / Hemoglobin Electrophoresis Cascade, Blood:
-ATHAL / Alpha-Globin Gene Analysis
-WASQR / Alpha-Globin Gene Sequencing, Blood
-WBSQR / Beta-Globin Gene Sequencing, Blood
-WBDDR / Beta-Globin Cluster Locus Deletion/Duplication, Blood
-WGSQR / Gamma-Globin Full Gene Sequencing
See Benign Hematology Evaluation Comparison in Special Instructions.
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
Whole Blood EDTAAdvisory Information
Alpha-thalassemias with only 1 or 2 alpha-globin gene deletions are not recognized by this testing protocol. ATHAL / Alpha-Globin Gene Analysis is required to identify 1 or 2 globin gene deletions.
Necessary Information
Include recent transfusion information.
Include most recent CBC results.
Specimen Required
Container/Tube:
Preferred: Lavender top (EDTA)
Acceptable: ACD (solution B), green top (sodium heparin)
Specimen Volume: 10 mL
Collection Instructions: Send specimen in original tube. Do not aliquot.
Specimen Minimum Volume
1 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Whole Blood EDTA | Refrigerated | 7 days |
Special Instructions
Reference Values
HEMOGLOBIN A
1-30 days: 5.9-77.2%
1-2 months: 7.9-92.4%
3-5 months: 54.7-97.1%
6-8 months: 80.0-98.0%
9-12 months: 86.2-98.0%
13-17 months: 88.8-98.0%
18-23 months: 90.4-98.0%
≥24 months: 95.8-98.0%
HEMOGLOBIN A2
1-30 days: 0.0-2.1%
1-2 months: 0.0-2.6%
3-5 months: 1.3-3.1%
≥6 months: 2.0-3.3%
HEMOGLOBIN F
1-30 days: 22.8-92.0%
1-2 months: 7.6-89.8%
3-5 months: 1.6-42.2%
6-8 months: 0.0-16.7%
9-12 months: 0.0-10.5%
13-17 months: 0.0-7.9%
18-23 months: 0.0-6.3%
≥24 months: 0.0-0.9%
VARIANT
No abnormal variants
VARIANT 2
No abnormal variants
VARIANT 3
No abnormal variants
Day(s) and Time(s) Performed
Monday through Saturday
Test Classification
This test has been modified from the manufacturer's instructions. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.CPT Code Information
Hemoglobin Electrophoresis Cascade
83020-Quantitation by electrophoresis
83021-Quantitation by HPLC
IEF Confirms
82664-Electrophoresis, not elsewhere specified (if appropriate)
Hemoglobin, Unstable, Blood
83068 (if appropriate)
Hemoglobin Variant by Mass Spectrometry (MS), Blood
83789 (if appropriate)
Hemoglobin F, Red Blood Cell Distribution, Blood
88184 (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| HBELC | HGB Electrophoresis Cascade | 94538-6 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 2380 | Hemoglobin A | 20572-4 |
| 2381 | Hemoglobin A2 | 42245-1 |
| 2382 | Hemoglobin F | 42246-9 |
| 2383 | Variant | 32017-6 |
| 29224 | Variant 2 | 32017-6 |
| 29225 | Variant 3 | 32017-6 |
| 2101 | Interpretation | 78748-1 |
Reject Due To
All specimens will be evaluated by Mayo Clinic Laboratories for test suitabilityMethod Name
A2F: Cation Exchange/High-Performance Liquid Chromatography (HPLC)
HBEL: Capillary Electrophoresis
IEF: Isoelectric Focusing
MASS: Mass Spectrometry (MS)
HPFH: Flow Cytometry
UNHB: Isopropanol and Heat Stability
HBELA: Consultative Interpretation
Forms
1. New York Clients-Informed consent is required. Document on the request form or electronic order that a copy is on file. The following documents are available in Special Instructions:
-Informed Consent for Genetic Testing (T576)
-Informed Consent for Genetic Testing-Spanish (T826)
2. Metabolic Hematology Patient Information (T810) in Special Instructions
3. If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:
-General Request (T239)
-Benign Hematology Test Request (T755)