Preferred first-tier genetic test for confirmation of suspected alpha thalassemia or alpha thalassemia trait. Detects common, rare, and novel deletions or duplications of the alpha globin gene cluster.
- Patient Preparation
- Lavender (EDTA), pink (K2EDTA), or Yellow (ACD Solution A or B).
- Specimen Preparation
- Transport 3 mL whole blood. (Min: 2 mL)
- Storage/Transport Temperature
- Unacceptable Conditions
- Ambient: 72 hours; Refrigerated: 1 week; Frozen: Unacceptable
Characteristics: Alpha thalassemia is caused by decreased or absent synthesis of the hemoglobin alpha-chain resulting in variable clinical presentations. Alpha (+) thalassemia results from mutation of a single alpha2 globin gene (-a/aa) and is clinically asymptomatic (silent carrier). Alpha (0) thalassemia (trait) is caused by mutation of both alpha2 globin genes (-a/-a), or mutations in the alpha1 and alpha2 globin genes on the same chromosome, (--/aa) and results in mild microcytic anemia. Hemoglobin H disease occurs due to mutation of three alpha globin genes (--/-a) and results in hemolysis with Heinz bodies, moderate anemia, and splenomegaly. Hb Bart Hydrops Fetalis Syndrome results when mutations occur in all four alpha globin genes (--/--) and is lethal in the fetal or early neonatal period. Alpha globin gene triplications result in three active alpha globin genes on a single chromosome.
Incidence: Carrier frequency in Mediterranean (1:30-50), Middle Eastern, Southeast Asian (1:20), African, African-American (1:3).
Inheritance: Autosomal recessive.
Cause: Pathogenic mutations in the alpha globin gene cluster.
Clinical Sensitivity: Varies by ethnicity, up to 95 percent.
Methodology: Multiplex ligation-dependent probe amplification (MLPA) of the alpha globin gene cluster (HBZ, HBM, HBA2, HBA1, HBQ1) and its HS-40 regulatory region.
Analytical Sensitivity and Specificity: 99 percent.
Limitations: Diagnostic errors can occur due to rare sequence variations. Specific breakpoints of large deletions/duplications will not be determined; therefore, it may not be possible to distinguish mutations of similar size. This assay does not assess for non-deletional mutations within the coding or regulatory regions of the alpha globin cluster genes. Individuals carrying both a deletion and duplication within the alpha globin gene cluster may appear to have a normal number of alpha globin gene copies. Rare syndromic or acquired forms of alpha thalassemia associated with ATRX mutations will not be detected.
|Component Test Code*||Component Chart Name||LOINC|
|2011623||Alpha Globin (HBA1/2) DelDup Specimen|
|2011624||Alpha Globin (HBA1/2) DelDup Interp|
- A globin
- Alpha globin gene analysis
- Alpha globin mutations
- Alpha thalassemia