Hgb electrophoresis is performed when a disorder associated with abnormal hemoglobin (hemoglobinopathy) is suspected. The test is used primarily to diagnose diseases involving these abnormal forms of hemoglobin, such as sickle cell anemia and thalassemia.

Blood transfusions within the previous 12 weeks may alter test results.

Hemoglobin (Hgb) is comprised of many different types, the most common being A1, A2, F, S, and C.

Hgb A1 is the major component of hemoglobin in the normal red blood cell. Hgb A2 is a minor component of normal hemoglobin, comprising approximately 2–3% of the total.

Hgb F is the major hemoglobin component in the fetus, but usually exists only in minimal quantities in the normal adult. Levels of Hgb F greater than 2% in patients over three years of age are considered abnormal.

Hgb S is an abnormal form of hemoglobin associated with the disease of sickle cell anemia, which occurs predominantly in African-Americans. A distinguishing characteristic of sickle cell disease is the crescent-shaped red blood cell. Because the survival rate of this type of cell is limited, patients with sickle cell disease also have anemia.

Hgb C is another hemoglobin variant found in African Americans. Red blood cells containing Hgb C have a decreased life span and are more readily destroyed than normal red blood cells, resulting in mild to severe hemolytic anemia.

Each of the major hemoglobin types has an electrical charge of a different degree, so the most useful method for separating and measuring normal and abnormal hemoglobins is electrophoresis. This process involves subjecting hemoglobin components from dissolved red blood cells to an electric field. The components then move away from each other at different rates, and when separated form a series of distinctly pigmented bands. The bands are then compared with those of a normal sample. Each band can be further assessed as a percentage of the total hemoglobin, thus indicating the severity of any abnormality.

This test requires a blood sample. No special preparation is needed before the test.

Risks for this test are minimal, but may include slight bleeding from the blood-drawing site, fainting or feeling lightheaded after venipuncture, or hematoma (blood accumulating under the puncture site).

Normal reference values can vary by laboratory, but are generally within the following ranges.

Adults:

• Hgb A1: 95–98%
• Hgb A2: 2–3%
• Hgb F: 0.8–2.0%
• Hgb S: 0%
• Hgb C: 0%.

Child (Hgb F):

• 6 months: 8%
• greater than 6 months: 1–2%
• newborn (Hgb F): 50–80%

Abnormal reference values can vary by laboratory, but when they appear within these ranges, results are usually associated with the conditions that follow in parentheses.

Hgb A2:

• 4–5.8% (β-thalassemia minor)
• under 2% (Hgb H disease)

Hgb F:

• 2–5% (β-thalassemia minor)
• 10–90% (β-thalassemia major)
• 5–35% (Heterozygous hereditary persistence of fetal hemoglobin, or HPFH)
• 100% (Homozygous HPFH)
• 15% (Homozygous Hgb S)

Homozygous Hgb S:

• 70–98% (Sickle cell disease).

Homozygous Hgb C:

• 90–98%(Hgb C disease)