Hemoglobin Evaluation Reflexive Cascade
2005792
 
Ordering Recommendation
Optimal test for the initial and confirmatory diagnosis of any suspected hemoglobinopathy. A faculty hematopathologist personally directs and interprets each stage of testing to completion. A comprehensive report is provided. Do not use for the follow-up of an individual with a known diagnosis.
Mnemonic
HB CASCADE
Methodology
High Performance Liquid Chromatography/Electrophoresis/RBC Solubility/Polymerase Chain Reaction/Fluorescence Resonance Energy Transfer/Sequencing
Performed
Sun-Sat
Reported
Varies
New York DOH Approval Status
Specimens from New York clients will be sent out to a New York DOH approved laboratory.
Specimen Required
Patient Preparation
 
Collect
Lavender (EDTA) or pink (K2EDTA).  
Specimen Preparation
Transport 5 mL whole blood. (Min: 2 mL)  
Storage/Transport Temperature
Refrigerated.  
Unacceptable Conditions
Frozen or room temperature specimens.  
Remarks
Patient history form, including information from a recent CBC, is required for interpretation.  
Stability
Ambient: Unacceptable; Refrigerated: 1 week; Frozen: Unacceptable  
Reference Interval
Effective August 19, 2013
HPLC testing
Age-​Defined Normal Hemoglobin Reference Intervals
Age Hb A Percent Hb A2 Percent Hb F Percent Hb S Percent Hb C Percent Hb E Percent Hb Other Percent
0-​1 month 7.6-​54.8 0.0-​1.4 45.8-​91.7 0.0 0.0 0.0 0.0
2 months 14.7-​70.1 0.0-​2.0 32.7-​85.2 0.0 0.0 0.0 0.0
3 months 26.6-​81.8 0.1-​2.6 14.5-​73.7 0.0 0.0 0.0 0.0
4 months 43.0-​89.5 0.8-​3.0 4.2-​56.9 0.0 0.0 0.0 0.0
5 months 60.8-​94.0 1.5-​3.3 1.0-​38.1 0.0 0.0 0.0 0.0
6-​8 months 78.2-​96.6 1.8-​3.5 0.9-​19.4 0.0 0.0 0.0 0.0
9-​12 months 86.1-​97.2 1.9-​3.5 0.6-​11.6 0.0 0.0 0.0 0.0
13-​23 months 85.1-​97.7 1.9-​3.5 0.0-​8.5 0.0 0.0 0.0 0.0
2 years and older 95.0-​97.9 2.0-​3.5 0.0-​2.1 0.0 0.0 0.0 0.0
Interpretive Data
Note
The Hemoglobin Evaluation Reflexive Cascade begins with HPLC analysis. If an abnormal hemoglobin is detected or if the CBC data is suggestive of a hemoglobinopathy, appropriate testing will be performed at an additional charge. Depending on findings, one or more reflexive tests may be required in order to provide a clinical interpretation. Tests added may include electrophoresis, solubility testing, mutational analysis and/or sequencing.

Quantitation of hemoglobin by HPLC or electrophoresis is most definitive in individuals one year of age and older. If quantitation of hemoglobin was performed before one year of age, repeat testing is recommended. Abnormal hemoglobin variants may require additional testing, which increases TAT up to 21 days.
CPT Code(s)
83021,
If reflexed to Sickle Cell Solubility, add 85660; if reflexed to Hemoglobin, Acid Electrophoresis, add 83020; if reflexed to Hemoglobin, Alkaline Electrophoresis, add 83020; if reflexed to Capillary Electrophoresis, add 83021
If reflexed to Beta Globin (HBB) HbS, HbC, & HbE Mutations (ARUP test code 0051421), add: 81401
If reflexed to Alpha Thalassemia (HBA1 &HBA2) 7 Deletions (ARUP test code 0051495), add: 81257
If reflexed Beta Globin (HBB) Gene Sequencing (ARUP test code 0050578), add: 81404
If reflexed to Alpha Globin (HBA1 and HBA2) Sequencing (ARUP test code 2001582), add: 81405
If reflexed to Hemoglobin Lepore (HBD/HBB Fusion) 3 Mutations (ARUP test code 2004686), add: 81479
If reflexed to Hereditary Persistence of Fetal Hemoglobin (HPFH) 8 Mutations (ARUP test code 2005408), add: 81479
Components
Component Test Code*Component Chart Name
0050295Hemoglobin A
0050300Hemoglobin A2
0050305Hemoglobin C
0050310Hemoglobin E
0050315Hemoglobin F
0050320Hemoglobin - Other
0050325Hemoglobin S
0050611Hemoglobin Evaluation
0081268Hemoglobin, Acid Electrophoresis
0081269Hemoglobin, Alkaline Electrophoresis
0081270Sickle Cell Solubility
2005799Beta Globin (HBB) Mutations
2005800Beta Globin Full Gene Sequencing
2005801Alpha Thalassemia, 7 Deletions
2005802Alpha Thalassemia HBA1 and HBA2 Seq
2005803Hereditary Persistent Fetal Hemoglobin
2005804Hemoglobin Lepore (HBD/HBB) 3 Mutations
2005805Hemoglobin Cascade Interpretation
2008793Hemoglobin, Capillary Electrophoresis
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, contact interface support at interface.support@aruplab.com.
Cross References
  • A2 Hemoglobin
  • Alpha Globin (HBA1 and HBA2) Sequencing
  • Alpha Globin Variant
  • Alpha Thalassemia (HBA1 &HBA2) 7
  • Barts Hemoglobin
  • Beta Globin (HBB) Gene Sequencing
  • Beta Globin (HBB) HbS, HbC, & HbE Mutations
  • Beta Globin Variant
  • Beta-Thalassemia
  • Fetal Hemoglobin
  • fetaldex (Hemoglobin F)
  • Hemoglobin A2
  • Hemoglobin Cascade
  • Hemoglobin Electrophoresis Cascade Level 1
  • Hemoglobin F
  • Hemoglobin Lepore (HBD/HBB Fusion) 3 Mutations
  • Hemoglobin Mass Spec Stud
  • Hereditary Persistence of Fetal Hemoglobin (HPFH) 8 Mutations
  • Sickle Cell Solubility