Hemoglobin (Hb) Fractionation, Spot Blood (Pediatric)

CPT: 83021
Updated on 1/26/2018
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Test Details

Synonyms

  • Hb Fractionation
  • Hemoglobin Electrophoresis
  • Pediatric Hemoglobin Fractionation
  • Spot Blood Hemoglobin Fractionation

Test Includes

Identification and relative percentages of hemoglobins (A, A2, F, S, C) including variants, if present; interpretation

Use

Diagnose hemoglobin abnormalities (A, F, S, and C) in newborns

Methodology

High-pressure liquid chromatography (HPLC)

Reference Interval

• Hb A:

– <7 months: Not established

– 7 months to 1 year: 94.6% to 98.5%

– ≥2 years: 96.4% to 98.8%

• Hb F:

− <7 months: Not established

− 7 months to 1 year: 0.1% to 6.8%

− ≥2 years : 0.0% to 2.0%

• Hb S, D, G: 0%

• Hb C, E, O: 0%

• Hb A2:

– <7 months: Not established

– 7 months to 1 year: 1.9% to 2.8%

– ≥2 years: 1.8% to 3.2%

• Hb A:

– <7 months: Not established

– 7 months to 1 year: 94.6% to 98.5%

– ≥2 years: 96.4% to 98.8%

• Hb F:

− <7 months: Not established

− 7 months to 1 year: 0.1.% to 6.8%

− ≥2 years : 0.0% to 2.0%

• Hb S, D, G: 0%

• Hb C, E, O: 0%

• Hb A2:

– <7 months: Not established

– 7 months to 1 year: 1.9% to 2.8%

– ≥2 years: 1.8% to 3.2%

• Hb A:

– <7 months: Not established

– 7 months to 1 year: 94.6% to 98.5%

– ≥2 years: 96.4% to 98.8%

• Hb F:

− <7 months: Not established

− 7 months to 1 year: 0.1% to 6.8%

− ≥2 years : 0.0% to 2.0%

• Hb S, D, G: 0%

• Hb C, E, O: 0%

• Hb A2:

– <7 months: Not established

– 7 months to 1 year: 1.9% to 2.8%

– ≥2 years: 1.8% to 3.2%

Specimen Requirements

Specimen

Whole blood spots on filter paper or whole blood

Volume

Three filled circles (S & S N° 903 filter paper from finger- or heelstick) or 1 mL whole blood

Minimum Volume

One full circle or 0.5 mL blood

Container

Schleicher and Scheull N° 903 filter paper, lavender-top (EDTA) tube, or green-top (heparin) tube

Collection

Pediatric: Fill three circles on Schleicher and Scheull N° 903 filter paper with a single application of blood from patient finger- or heelstick, or 0.5 mL EDTA whole blood or heparinized whole blood (lavender-top, green-top, or capillary tubes).

Storage Instructions

Maintain specimen at room temperature.

Stability Requirements

Temperature

Period

Room temperature

14 days

Refrigerated

14 days

Frozen

14 days

Freeze/thaw cycles

Stable x3

Causes for Rejection

Incompletely filled filter paper circles

Clinical Information

Special Instructions

State patient's age and any known hematological data on the request form.

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
121442 Hgb Fractionation, Spot Blood 121443 Hgb A % 4546-8
121442 Hgb Fractionation, Spot Blood 121444 Hgb S % 4625-0
121442 Hgb Fractionation, Spot Blood 121445 Hgb C % 4563-3
121442 Hgb Fractionation, Spot Blood 121446 Hemoglobin A2, Qn % 34660-1
121442 Hgb Fractionation, Spot Blood 121447 Hgb Fetal % 4576-5
121442 Hgb Fractionation, Spot Blood 121448 Hgb Variant % 42248-5
121442 Hgb Fractionation, Spot Blood 121449 Interpretation 12710-0

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