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26312 Hemoglobin Electrophoresis Evaluation, Blood (HBEL1)

Hemoglobin Electrophoresis Evaluation, Blood (HBEL1)
Test Code: HBESO
Synonyms/Keywords

​A2 Hemoglobin, Alpha Globin Variant, Alpha Thalassemia, Barts Hemoglobin, Beta Globin Variant, Beta Thalassemia, H Disease, Hemoglobin A2, Hemoglobin Cascade, Hemoglobin Electrophoresis Cascade Level 1, Hemoglobin Molecular studies, Hemoglobin Variant, HGB (Hemoglobin) Electrophoresis, Isoelectric Focusing, Capillary electrophoresis, HPLC, High performance liquid chromatography, Mass Spectrometry, Microcytosis, Sickle cell, Sickling Test, Thalassemia

Useful For

​Diagnosis and classification of hemoglobin disorders, including thalassemias and hemoglobin variants

Specimen Requirements
Fasting RequiredSpecimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
​No​Whole blood EDTA​EDTA Lavender Top Tube (LTT)

ACD (solution B)

or

Sodium Heparin Green Top Tube(GTT)​

​10 mL

​1 mL (This volume will limit reflex testing possibilities)

or

3 mL (If multiplex ligation-dependent probe amplification is desired)

Collection Processing Instructions

​Include recent transfusion information.

Include most recent complete blood cell count results.

Filling out Mayo Clinic Laboratories' Metabolic Hematology Patient Information (T810) is strongly recommended. 

Specimen Stability Information
Specimen TypeTemperatureTime
​Whole Blood EDTA​Refrigerated​7 days
Rejection Criteria
All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.
Interference

​Some hemoglobin disorders and variants are not detected by the screening methods including common alpha thalassemia conditions and require further reflex testing to identify. If a family history of a known hemoglobin disorder, prior therapy for a hemoglobin disorder, or otherwise unexplained lifelong/familial symptoms such as hemolysis, microcytosis, erythrocytosis/polycythemia, cyanosis, or hypoxia are present, this should be clearly communicated to Mayo Clinic Laboratories so appropriate reflex testing can be added, see Metabolic Hematology Patient Information (T810).

Recent transfusion may mask protein results including hemoglobin electrophoresis, hereditary persistence of hemoglobin F (HPFH) by flow cytometry, stability studies, and sickle solubility studies depending on percentage of transfused cells present.

Some hemoglobin variants can originate from the donor blood product and not from the tested recipient. These are typically found in low percentage.

If the patient has undergone a bone marrow transplant, the results may show atypical results and should be interpreted in the context of clinical information.

Some therapies cause artefactual effects in protein studies, including hydroxyurea and decitabine (increased Hb F levels), Voxelotor (artefactual peaks) and gene therapy (alternate protein detection, Beta T87Q, by mass spectrometry). Clear communication of prior therapy is strongly recommended.

Performing Laboratory Information
Performing LocationDay(s) Test PerformedAnalytical TimeMethodology/Instrumentation
​Mayo Clinic Laboratories​Monday through Saturday2-25 days​

HBELI: Consultative Interpretation

HGBCE: Capillary Electrophoresis (CE)

HPLC: Cation Exchange/High-Performance Liquid Chromatography (HPLC)

IEF: Isoelectric Focusing (IEF)

MASS: Mass Spectrometry (MS)

HPFH: Flow Cytometry

UNHB: Isopropanol and Heat Stability

HBEL0: Medical Interpretation

Reference Lab
Test Information

​A large number of variants of hemoglobin (Hb) have been recognized. Although many do not result in clinical or hematologic effects, clinical symptoms that can be associated with Hb disorders include microcytosis, sickling disorders, hemolysis, erythrocytosis/polycythemia, cyanosis/hypoxia, anemia (chronic, compensated or episodic), and increased methemoglobin or sulfhemoglobin results (M-hemoglobins).

For many common Hb variants (e.g. Hb S, Hb C, Hb D and Hb E, among many others), protein studies will be sufficient for definitive identification. However, some Hb conditions may be difficult to identify by protein methods alone and may require molecular methods for confirmation. Hb disorders commonly occur as compound disorders (2 or more genetic variants) that can have complex interactions and variable phenotypes. In these situations molecular testing may be necessary for accurate classification. It is important to note that although powerful as an adjunct for a complete and accurate diagnosis, molecular methods without protein data can give incomplete and possibly misleading information due to limitations of the methods. Accurate classification of hemoglobin disorders and interpretation of genetic data requires the incorporation of protein analysis results. This profile is well-suited for the classification of hemoglobin disorders.

Mayo Clinic Laboratories receives specimens from a wide geographic area and nearly one-half of all specimens tested exhibit abnormalities. The most common abnormality is an increase in Hb A2 to about 4% to 8%, which indicates beta-thalassemia minor when present in the correct clinical context. A wide variety of other hemoglobinopathies are also frequently encountered. Ranked in order of relative frequency, these are: Hb S (sickle cell disease and trait), C, E, Lepore, G-Philadelphia, Hb H disease, D-Los Angeles, Koln, Constant Spring, O-Arab. Other variants associated with hemolysis, erythrocytosis/polycythemia, microcytosis, cyanosis/hypoxia are routinely identified; however, some will not be detected by routine screening methods and require communication of clinical findings to prompt indicated reflex testing options. Alpha-thalassemia genetic variants are very common in the United States, occurring in approximately 30% of African Americans and accounting for the frequent occurrence of microcytosis in persons of this ethnic group. Some alpha-thalassemia conditions (e.g. Hb H, Barts) can be identified in the hemoglobin electrophoresis protocol, although Hb Constant Spring may or may not be evident by protein methods alone dependent upon the percentage present. It is important to note, alpha-thalassemias that are from only 1 or 2 alpha-globin gene deletions are not recognized by protein studies alone and alpha gene deletion and duplication testing is required.

Reference Range Information
Performing LocationReference Range
​Mayo Clinic Laboratories

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%

> or =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%

> or =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%

> or =24 months: 0.0-0.9%

 

VARIANT 1

0.0

VARIANT 2

0.0

VARIANT 3

0.0

Interpretation

​The hemoglobin (Hb) fractions, including Hb variants are identified and quantitated. An interpretive report that summarizes all testing, including the significance of the findings, is issued.

Outreach CPTs
CPTModifier
(if needed)
QuantityDescriptionComments
​83020​1​Quantitation by electrophoresis
​83021​1​Quantitation by HPLC
​82664​1​Electrophoresis, not elsewhere specified​if appropriate
​83068​1​if appropriate
​83789​1​if appropriate
​88184​1​if appropriate
Synonyms/Keywords

​A2 Hemoglobin, Alpha Globin Variant, Alpha Thalassemia, Barts Hemoglobin, Beta Globin Variant, Beta Thalassemia, H Disease, Hemoglobin A2, Hemoglobin Cascade, Hemoglobin Electrophoresis Cascade Level 1, Hemoglobin Molecular studies, Hemoglobin Variant, HGB (Hemoglobin) Electrophoresis, Isoelectric Focusing, Capillary electrophoresis, HPLC, High performance liquid chromatography, Mass Spectrometry, Microcytosis, Sickle cell, Sickling Test, Thalassemia

Ordering Applications
Ordering ApplicationDescription
​COM​HGB Electrophoresis
​CERNER​HGB Electrophoresis (HBEL1)
​Centricity​HGB Electrophoresis (HBEL1)
​Portal​HGB Electrophoresis (HBEL1)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting RequiredSpecimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
​No​Whole blood EDTA​EDTA Lavender Top Tube (LTT)

ACD (solution B)

or

Sodium Heparin Green Top Tube(GTT)​

​10 mL

​1 mL (This volume will limit reflex testing possibilities)

or

3 mL (If multiplex ligation-dependent probe amplification is desired)

Collection Processing

​Include recent transfusion information.

Include most recent complete blood cell count results.

Filling out Mayo Clinic Laboratories' Metabolic Hematology Patient Information (T810) is strongly recommended. 

Specimen Stability Information
Specimen TypeTemperatureTime
​Whole Blood EDTA​Refrigerated​7 days
Rejection Criteria
All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.
Interference

​Some hemoglobin disorders and variants are not detected by the screening methods including common alpha thalassemia conditions and require further reflex testing to identify. If a family history of a known hemoglobin disorder, prior therapy for a hemoglobin disorder, or otherwise unexplained lifelong/familial symptoms such as hemolysis, microcytosis, erythrocytosis/polycythemia, cyanosis, or hypoxia are present, this should be clearly communicated to Mayo Clinic Laboratories so appropriate reflex testing can be added, see Metabolic Hematology Patient Information (T810).

Recent transfusion may mask protein results including hemoglobin electrophoresis, hereditary persistence of hemoglobin F (HPFH) by flow cytometry, stability studies, and sickle solubility studies depending on percentage of transfused cells present.

Some hemoglobin variants can originate from the donor blood product and not from the tested recipient. These are typically found in low percentage.

If the patient has undergone a bone marrow transplant, the results may show atypical results and should be interpreted in the context of clinical information.

Some therapies cause artefactual effects in protein studies, including hydroxyurea and decitabine (increased Hb F levels), Voxelotor (artefactual peaks) and gene therapy (alternate protein detection, Beta T87Q, by mass spectrometry). Clear communication of prior therapy is strongly recommended.

Useful For

​Diagnosis and classification of hemoglobin disorders, including thalassemias and hemoglobin variants

Reference Range Information
Performing LocationReference Range
​Mayo Clinic Laboratories

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%

> or =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%

> or =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%

> or =24 months: 0.0-0.9%

 

VARIANT 1

0.0

VARIANT 2

0.0

VARIANT 3

0.0

Interpretation

​The hemoglobin (Hb) fractions, including Hb variants are identified and quantitated. An interpretive report that summarizes all testing, including the significance of the findings, is issued.

For more information visit:
Performing Laboratory Information
Performing LocationDay(s) Test PerformedAnalytical TimeMethodology/Instrumentation
​Mayo Clinic Laboratories​Monday through Saturday2-25 days​

HBELI: Consultative Interpretation

HGBCE: Capillary Electrophoresis (CE)

HPLC: Cation Exchange/High-Performance Liquid Chromatography (HPLC)

IEF: Isoelectric Focusing (IEF)

MASS: Mass Spectrometry (MS)

HPFH: Flow Cytometry

UNHB: Isopropanol and Heat Stability

HBEL0: Medical Interpretation

Reference Lab
For billing questions, see Contacts
Outreach CPTs
CPTModifier
(if needed)
QuantityDescriptionComments
​83020​1​Quantitation by electrophoresis
​83021​1​Quantitation by HPLC
​82664​1​Electrophoresis, not elsewhere specified​if appropriate
​83068​1​if appropriate
​83789​1​if appropriate
​88184​1​if appropriate
For most current information refer to the Marshfield Laboratory online reference manual.