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HemoglobinelectrophoresisFrom: Betsy Hyde (elishyde@mindspring.com)Fri Jul 18 18:42:27 2003
What does everyone do regarding screening for hemoglobinopathies? We have a very mixed client population, with lots of African-Americans, Africans, Hispanics, Asians, people from the Mediterranean countries, and we are trying to figure out a cost effective method of screening for hemoglobinopathies. I personally ask everyone if they, their partner, or anyone in their families are black, Hispanic, Asian, Mediterranean, Jewish, French Canadian. I will order hemoglobin electrophoresis if they or family members are black, Hispanic, Mediterranean, Asian. I will also order a hemoglobin electrophoresis if they have a low MCV (<80) on their prenatal CBC. My first question: When do *you* order a hemoglobin electrophoresis? Do any of you order it on each woman? Our lab frequently gives results with normal A1, normal F, normal A2. Hemoglobin variant = NONE DETECTED. What is my problem , you might ask? They then sometimes add the following *if* the hematocrit/hemoglobin/MCV are all low: "possible alpha thal trait or iron deficiency anemia exist. Also iron deficiency anemia in conjection with beta thal may cause a depression of hemoglobin A2 into the normal range. Adequate treatment of the iron deficiency anemia should restore the elevated hemoglobin A2". Obviously, if the MCV is normal, it is unlikely there is either alpha or beta thal trait. The problem is iron deficiency in conjunction with alpha or beta thal trait/low MCV. Checking transferrin sat, ferritin and maybe fe and TIBC to diagnose iron deficiency costs money, takes time. Treatment of iron deficiency anemia takes time....and the woman may then be out of the window for fetal diagnosis of a hemoglobinopathy. second question:
if presented with
> "possible alpha thal trait or iron deficiency anemia exist. Also iron would you: 1) do hemoglobin electrophoresis on FOB? 2) do anemia workup on mother, then hemoglobin electrophoresis on FOB if she is not fe-deficient? 3) do anemia workup on mother, treat fe deficiency, then repeat hemoglobin electrophoresis to r/o beta thal trait? 4) other....and please state your workup. We are a group of 7 MDs and 6 CNMs and are trying to come up with a consistent protocol for our practice. Thanks for your help!
-- Betsy Hyde CNM Branford, CT
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