What is hemoglobin electrophoresis?

Hemoglobin electrophoresis is a test that measures the different types of hemoglobin in the blood. It also checks for hemoglobinopathy, disorders involving abnormal types of hemoglobin. Hemoglobin is a protein in your red blood cells. It carries oxygen from your lungs to the rest of your body. There are a few different types of normal and abnormal hemoglobin.

Normal types of hemoglobin include:

• Hemoglobin (Hgb) A, the most common type of hemoglobin in healthy adults.
• Hemoglobin (Hgb) F, fetal hemoglobin. This type of hemoglobin is found in unborn babies and newborns. HgbF is usually replaced by HgbA by age one to two years.

If levels of HgbA or HgbF are too high or too low, it can be a sign of certain types of anemia.

Normal, healthy red blood cells are flexible, so they can move easily through blood vessels. But abnormal hemoglobin can change the size and shape of your red blood cells. This can cause the cells to clump and block blood flow, making it difficult to carry oxygen in your body well. Your body may break down these cells sooner than usual, causing anemia.

Abnormal types of hemoglobin include:

• Hemoglobin (Hgb) S. This type of hemoglobin causes sickle cell disease. Sickle cell disease is a group of disorders in which you have stiff, sticky, sickle-shaped red blood cells. These sickle cells can get stuck in the blood vessels. This can block the blood flow to the organs, which can cause severe and chronic pain, infections, and other complications. Sickle cell disease is inherited (passed down in families). In the United States, it is most common in Black and African American people.
• Hemoglobin (Hgb) C. This type of hemoglobin does not carry oxygen well. It can cause a mild form of anemia. In the United States, it is most common in Black and African American people.
• Hemoglobin (Hgb) E. This type of hemoglobin is mostly found in people of Southeast Asian descent. People with HgbE usually have no symptoms or mild symptoms of anemia.

A hemoglobin electrophoresis test applies an electric current to a blood sample. This separates the normal and abnormal types of hemoglobin. Each type of hemoglobin can then be measured individually and compared with the normal level.

Other names: Hb electrophoresis, hemoglobin evaluation, hemoglobinopathy evaluation, hemoglobin fractionation, Hb ELP, Hb IEF, sickle cell screen

What is it used for?

Hemoglobin electrophoresis measures hemoglobin levels and looks for abnormal types of hemoglobin. If your hemoglobin type levels are too high or low, it could be a sign of a hemoglobin disorder. It's most often used to help diagnose anemia, sickle cell disease, and other hemoglobin disorders.

Why do I need hemoglobin electrophoresis?

You may need testing if you have symptoms of a hemoglobin disorder such as anemia or sickle cell disease.

Symptoms of anemia may include:

• Shortness of breath
• Weakness or fatigue
• Headache
• Dizziness
• Arrhythmia (a problem with the rate or rhythm of your heartbeat)

Symptoms of sickle cell disease may include:

• Painful swelling of the hands and feet
• Fatigue or fussiness in infants (from the anemia caused by sickle cell disease)
• Growth problems (in children)
• Jaundice, a condition that causes your skin and eyes to turn yellowish
• Severe pain

If you've just had a baby, your newborn will be tested as part of a newborn screening. Newborn screening is a group of tests given to most American babies shortly after birth. The screening checks for many different serious conditions. If these conditions are found early, treatment can start right away. Early treatment may help prevent serious health problems for the baby.

You may also want testing during pregnancy if you are at risk of having a child with sickle cell disease or another inherited hemoglobin disorder. Risk factors include:

• Family history, including already having a child with a hemoglobin disorder.
• Ethnic background:
  • In the United States, most people with sickle cell disease are Black or African American.
  • Thalassemia, another inherited hemoglobin disorder, is most common among people of Italian, Greek, Middle Eastern, Southern Asian, and African descent.

What happens during hemoglobin electrophoresis?

A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

To test a newborn, a health care provider will clean your baby's heel with alcohol and poke the heel with a small needle. The provider will collect a few drops of blood and put a bandage on the site.

Will I need to do anything to prepare for the test?

You don't need any special preparations for a hemoglobin electrophoresis test.

Are there any risks to hemoglobin electrophoresis?

There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

Your baby may feel a little pinch when the heel is poked, and a small bruise may form at the site. This should go away quickly.

What do the results mean?

Your results will show the types of hemoglobin found and the levels of each.

Hemoglobin type levels that are too high or too low may be a sign of:

• Thalassemia, a condition that affects the production of hemoglobin. In this condition, your body makes normal hemoglobin, but it doesn't make enough of it. Symptoms range from mild to severe.
• Sickle cell trait. In this condition, you have one sickle cell gene and one normal gene. Most people with sickle cell trait do not have health issues. But you can pass the sickle cell gene on to their children.
• Sickle cell disease.
• Hemoglobin C disease, a condition that causes a mild form of anemia and sometimes an enlarged spleen and joint pain.
• Hemoglobin S-C disease, a condition that causes a mild or moderate form of sickle cell disease.

Your results may also show whether a specific disorder is mild, moderate, or severe.

There are several options for treating thalassemia, anemia, sickle cell disease, and other hemoglobin disorders. Until recently, treatment options for sickle cell disease were limited. But now, new therapies have become available. If you or your child was diagnosed with a sickle cell disease or another hemoglobin disorder, talk to your provider about treatment options.

To understand the results of a hemoglobin electrophoresis test, your provider will consider your symptoms, medical history, and the results of other blood tests. Hemoglobin electrophoresis test results are often compared with other tests, including a complete blood count and a blood smear.

Let your provider know if you've had a blood transfusion in the last 12 weeks since this can affect your results.

If you have questions about your results, talk to your provider.

Learn more about laboratory tests, reference ranges, and understanding results.

Is there anything else I need to know about hemoglobin electrophoresis?

If you are at risk of having a child with an inherited hemoglobin disorder, you may want to speak to a genetic counselor. A genetic counselor is a specially trained professional in genetics and genetic testing. He or she can help you understand the disorder and your risk of passing it along to your child.