Hemoglobinopathy Fractionation Profile Without Solubility

CPT: 83021
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Test Details

Synonyms

  • Hemoglobin Electrophoresis

Test Includes

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

Use

Diagnose thalassemias and hemoglobin variants

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%

Specimen Requirements

Specimen

Whole blood

Volume

1 mL

Minimum Volume

0.5 mL

Container

Lavender-top (EDTA) tube

Collection

To avoid delays in turnaround time, please submit a separate lavender-top tube for each test requiring a lavender-top.

Storage Instructions

Refrigerate at 2°C to 8°C.

Stability Requirements

Temperature

Period

Room temperature

14 days

Refrigerated

14 days

Frozen

14 days

Freeze/thaw cycles

Stable x3

Clinical Information

Special Instructions

State the patient's age, ethnic background, MCV, transfusion history, and any other known hematological data on the test request form.

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
122101 Hgb Frac. w/o Solubility 121706 Hgb F % 4576-5
122101 Hgb Frac. w/o Solubility 121702 Hgb A % 4546-8
122101 Hgb Frac. w/o Solubility 121703 Hgb S % 4625-0
122101 Hgb Frac. w/o Solubility 121704 Hgb C % 4563-3
122101 Hgb Frac. w/o Solubility 121705 Hgb A2 % 34660-1
122101 Hgb Frac. w/o Solubility 121707 Hgb Variant % 42248-5
122101 Hgb Frac. w/o Solubility 121708 Interpretation 12710-0
Reflex Table for Interpretation
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 121088 LCA Hemoglobin Lab INTERP 121089 LCA Hemoglobin Lab INTERP 12710-0

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CPT Statement/Profile Statement

The LOINC® codes are copyright © 1994-2018, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC® codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Additional information regarding LOINC® codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf