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
This test is New York DOH approved.
Specimen Required
Patient Preparation
Collect

Lavender (K2EDTA) or Pink (K2EDTA).

Specimen Preparation

Transport 5 mL whole blood. (Min: 2 mL)

Storage/Transport Temperature

Refrigerated. Separate specimens must be submitted when multiple tests are ordered.

Unacceptable Conditions
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



Compliance Category

Laboratory Developed Test (LDT)

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.

Hotline History
N/A
CPT Codes

83021. If reflexed additional CPT codes may apply; refer to the reflexed test code for applicable codes.

Components
Component Test Code* Component Chart Name LOINC
0050295 Hemoglobin A 4547-6
0050300 Hemoglobin A2 4551-8
0050305 Hemoglobin C 4563-3
0050310 Hemoglobin E 4575-7
0050315 Hemoglobin F 4576-5
0050320 Hemoglobin - Other 48343-8
0050325 Hemoglobin S 4625-0
0050611 Hemoglobin Evaluation 21026-0
0081270 Sickle Cell Solubility 6864-3
2005800 Beta Globin Full Gene Sequencing
2005802 Alpha Thalassemia HBA1 and HBA2 Seq
2005804 Hemoglobin Lepore (HBD/HBB) 3 Mutations
2005805 Hemoglobin Cascade Interpretation 50398-7
2008793 Hemoglobin, Capillary Electrophoresis 13514-5
2010236 Beta Globin (HBB) Del/Dup Result
2011645 Alpha Globin (HBA1 and HBA2) Del/Dup Rst
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, please click the sidebar link to access the Interface Map.
Aliases
  • A2 Hemoglobin
  • Alpha Globin (HBA1 and HBA2) Sequencing
  • Alpha Globin Variant
  • Alpha Thalassemia (HBA1 &HBA2) 7
  • Barts Hemoglobin
  • Beta Globin (HBB) Sequencing and Deletion/Duplicaton
  • 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
  • Sickle Cell Solubility
Hemoglobin Evaluation Reflexive Cascade