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Re: Hemoglobin electrophoresis vs solubilityFrom: Barbara Nicol MD (blnicol@ix.netcom.com)Thu Sep 14 14:47:37 2006
Hi Jane! The hemoglobin solubility (or SickleDex) does not screen for thalassemia trait and therefore is helpful but insufficient IMHO. I use a hemoglobin electropheresis in patients of African, Mediterranean, Asian, and Hispanic family origins. (In our practice, we have a leetle problem of remembering that we _don't_ have to send it on the occasional Caucasian or Native American, oops!) However, you could argue for testing Middle Eastern/African/Hispanic with hgb electropheresis plus CBC/indices and SE Asian/Mediterranean with just CBC and indices, then hgb electropheresis for low MCV. This is UCSF's approach and it makes sense if you consider the distributions of the disease. In practice, however, too many patients were being left unscreened with this approach in our group and we got confused at times (what is Cyprus, genetically, I mean - is it Mediterranean or Middle Eastern for the purposes of thalassemia? What about Arabs of North African origin?) and we found it simpler from a quality perspective to screen all patients in the abovementioned risk groups. So far our insurers have not objected. Now I expect everyone to throw evidence-based rocks at us and talk about cost control, but we do find various thal traits with some regularity. (For alpha thal we look at MCV, r/o iron deficiency and then send alpha thal DNA in low MCV with normal iron. It's amazing how often you can find it if you look. Often the poor patients have been given high-dose iron for _years_ with no effect, except for the constipation.). How's the new job? - Barb Nicol, M.D.,F.A.C.O.G.
At Thu, 14 Sep 2006, Jane Helwig, MD wrote:
>
-- Barbara Nicol MD St. Luke's Health Care Center San Francisco CA USA
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