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Alpha Thalassemia (HBA1 and HBA2) Deletion/Duplication with reflex to Hb Constant Spring, Fetal
Ordering Recommendation
Diagnostic testing for alpha thalassemia in fetus with suggestive clinical findings or at risk for alpha thalassemia due to familial HBA1/HBA2 deletions or hemoglobin Constant Spring (HbCS) variant. Use to detect common as well as rare and novel deletions or duplications of the alpha globin gene cluster and the HbCS variant.
New York DOH Approval Status
Specimen Required
Fetal Cultured amniocytes or Cultured CVS AND Maternal Whole Blood Specimen: Lavender (EDTA), pink (K2EDTA), or yellow (ACD solution A or B).
Cultured Amniocytes or Cultured CVS: Transfer cultured amniocytes or cultured CVS to two T-25 flasks at 80 percent confluence. (Min: one T-25 flask at 80 percent confluence). Backup cultures must be retained at the client's institution until testing is complete. If ARUP receives a sample below the minimum confluence, Cytogenetics Grow and Send (ARUP test code 0040182) will be added on by ARUP, and additional charges will apply. If clients are unable to culture specimens, Cytogenetics Grow and Send should be added to initial order.
Maternal Whole Blood Specimen: Transport 2 mL whole blood. (Min: 1 mL)
Cultured Amniocytes or CVS : CRITICAL ROOM TEMPERATURE. Must be received within 48 hours of collection due to viability of cells.
Maternal Whole Blood Specimen: Room temperature.
Cultured Amniocytes or Cultured CVS: Room temperature: 48 hours; Refrigerated: Unacceptable; Frozen: Unacceptable
Maternal Whole Blood Specimen : Room temperature: 7 days; Refrigerated: 1 month; Frozen: Unacceptable
Methodology
Multiplex Ligation-Dependent Probe Amplification (MLPA)/Sequencing
Performed
Varies
Reported
9-10 days
If culture is required, an additional 1 to 2 weeks is required for processing time.
Reference Interval
By report
Interpretive Data
Background Information: Alpha Globin (HBA1 and HBA2) Deletion/Duplication
Characteristics: Decreased or absent synthesis of the hemoglobin (Hb) alpha-chain resulting in clinical presentations ranging from asymptomatic silent carriers to severe anemia and fetal lethality. Alpha thalassemia silent carrier commonly results from deletion of a single alpha globin gene (-a/aa) and is clinically asymptomatic. Alpha thalassemia trait may be caused by deletion of a single alpha globin gene from both chromosomes (-a/-a), or deletion of the HBA1 and HBA2 globin genes from the same chromosome (--/aa). Heterozygosity for Hb Constant Spring (HbCS) is usually asymptomatic but may be associated with mild microcytic anemia. Homozygous HbCS is characterized by overt hemolytic anemia, jaundice and splenomegaly. Hemoglobin H disease occurs due to inactivation of three alpha globin genes and results in hemolysis with Heinz bodies, moderate anemia, and splenomegaly. Hb Bart hydrops fetalis syndrome results from deletion of all four alpha globin genes (--/--) and is lethal in the fetal or early neonatal period. Alpha globin gene duplication results in three or more active alpha globin genes on a single chromosome.
Epidemiology: Carrier frequency of alpha thalassemia in African, African American (1:3), Mediterranean (1:30-50), Middle Eastern, Southeast Asian (1:20).
Inheritance: Autosomal recessive.
Cause: Pathogenic variants in the alpha globin gene cluster (HBZ, HBM, HBA2, HBA1, HBQ1) or regulatory region.
Clinical Sensitivity: Varies by ethnicity, at least 90 percent.
Methodology: Multiplex ligation-dependent probe amplification (MLPA) for the HBZ, HBM, HBA2, HBA1, and HBQ1 genes, the HS-40 regulatory region, and Hb Constant Spring (HbCS) HBA2 c.427T>C; p.Ter143Gln. To determine copy number of HbCS in absence of a concurrent deletion of HBA2, PCR and bidirectional sequencing for HbCS is performed.
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 variants of similar size. Nondeletional variants within the coding or regulatory regions of the alpha globin cluster genes, other than HbCS, will not be detected. Fetuses 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 gene variants will not be detected.
Counseling and informed consent are recommended for genetic testing. Consent forms are available online.
Laboratory Developed Test (LDT)
Note
If a concurrent deletion of HBA2 is not identified, PCR and bidirectional sequencing for the HbCS copy number will be performed. Additional charges apply.
Hotline History
CPT Codes
81269; 81265; if reflexed, add 81257
Components
| Component Test Code* | Component Chart Name | LOINC |
|---|---|---|
| 0050548 | Maternal Contamination Study Fetal Spec | 59266-7 |
| 0050612 | Maternal Contam Study, Maternal Spec | 66746-9 |
| 3003658 | Specimen HBA DDCSFE | 66746-9 |
| 3003659 | HBA DDCSFE Interpretation | 55234-9 |
Aliases
- A globin
- Alpha globin gene analysis
- Alpha globin mutations
- Alpha thalassemia
