Hemoglobin Electrophoresis Ordering Guidelines

Primary Indications

The American Gastroenterological Association recommends ordering hemoglobin electrophoresis when microcytosis with hypochromia is identified in patients with normal iron studies, particularly in those from ethnic backgrounds at risk for hemoglobinopathies, to prevent unnecessary gastrointestinal investigations 1
The American Gastroenterological Association suggests ordering hemoglobin electrophoresis specifically when MCV is reduced with normal ferritin, transferrin saturation, and iron levels 1
Pay particular attention when MCV is disproportionately low relative to the degree of anemia, which suggests thalassemia trait 1
Order hemoglobin electrophoresis when clinical presentation suggests sickle cell disease: normocytic normochromic anemia with hemolysis markers, painful crises, or family history 2

The American College of Pathology recommends using HPLC or capillary electrophoresis as the primary method for hemoglobin electrophoresis, with HPLC being the gold standard for both screening and quantification 3
Alkaline pH electrophoresis (pH 8.6) serves as initial screening, but requires confirmatory testing 3
Electrophoresis alone is insufficient, as some variants are electroforetically silent and will be missed 3, 4

Women with known sickle cell disease should be managed in specialized obstetric units given 1-3% maternal mortality and 1-8% perinatal mortality rates, and have a high incidence of complications: 57% painful crises, 38% cesarean delivery, 23% ICU admission 5

Never skip family studies when hemoglobinopathy is identified, as this is essential for genetic counseling and family planning 4
Do not interpret HbA1c in patients with hemoglobinopathies unless using assays without interference 3
Avoid ordering hemoglobin electrophoresis in neonates or recently transfused patients if using solubility testing, as false negatives occur 2
Do not order hemoglobin electrophoresis for routine anemia workup without first evaluating iron studies and red cell indices 1
Always clearly communicate suspected diagnosis on laboratory request forms to ensure appropriate processing and interpretation 2