Hematology laboratories play a major role in the diagnosis of hemoglobinopathies. These disorders encompassing both abnormal hemoglobins and thalassemias are unique among recessive genetic diseases, in that the majority of healthy carriers can be identified, and their genotype predicted, by simple hematologic and biochemical tests. These tests include a CBC, and a screening method to identify and measure normal and abnormal hemoglobin fractions.
While the most commonly used screening methods are electrophoretic, many laboratories are converting to high-performance liquid chromatography (HPLC) or capillary electrophoresis, which combine screening with accurate quantitation of the hemoglobin fractions. Molecular testing is also routinely available. These new technologies increase the complexity of interpretation, as many variants that are silent by routine electrophoresis are identified. In addition genetic test results require correlation with the hematologic and biochemical findings. Consequently, genetic counselors, general practitioners, pediatricians, obstetricians, and hematologists are increasingly turning to laboratorians engaged in the diagnosis of hemoglobinopathies for guidance in test ordering and interpretation.