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Hemoglobin Electrophoresis and Abnormal Hemoglobins

Hemoglobin Electrophoresis and Abnormal Hemoglobins is a topic covered in the Davis's Lab & Diagnostic Tests.

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Synonym/Acronym:
Hemoglobin F (fetal hemoglobin), hemoglobin S (sickle cell test), methemoglobin (hemoglobin M, MetHb, Hgb M).

Rationale
To assist in evaluating hemolytic anemias and identifying hemoglobin variants, diagnose thalassemias and sickle cell anemia. To assess for cyanosis and hypoxemia associated with pathologies affecting hemoglobin.

Patient Preparation
There are no food, fluid, activity, or medication restrictions unless by medical direction.

Normal Findings
Method: Electrophoresis for hemoglobin (Hgb) electrophoresis. Spectrophotometry for methemoglobin. Hemoglobin high-salt solubility for sickle cell screen.

Hgb A
AdultGreater than 95%
Hgb A2
Adult1.5%–3.7%
Hgb CNone
Hgb DNone
Hgb ENone
Hgb F
Newborns and infants
 1 day–3 wk70%–77%
 6–9 wk42%–64%
 3–4 mo7%–39%
 6 mo3%–7%
 8–11 mo0.6%–2.6%
Adult–older adultLess than 2%
Hgb HNone
Methemoglobin (Hgb M)Less than 1% of total Hgb
Hgb S (sickle cell screen)None (negative screen)

Critical Findings and Potential Interventions

Methemoglobin

Cyanosis can occur at levels greater than 10%.

Dizziness, fatigue, headache, and tachycardia can occur at levels greater than 30%.

Signs of central nervous system depression can occur at levels greater than 45%.

Death may occur at levels greater than 70%.

Timely notification to the requesting health-care provider (HCP) of any critical findings and related symptoms is a role expectation of the professional nurse. A listing of these findings varies among facilities.

Possible interventions include airway protection, administration of oxygen, monitoring neurological status every hour, continuous pulse oximetry, hyperbaric oxygen therapy, and exchange transfusion. Administration of activated charcoal or gastric lavage may be effective if performed soon after the toxic material is ingested. Emesis should never be induced in patients with no gag reflex because of the risk of aspiration. Methylene blue may be used to reverse the process of methemoglobin formation, but it should be used cautiously when methemoglobin levels are greater than 30%. Use of methylene blue is contraindicated in the presence of glucose-6-phosphate dehydrogenase deficiency.

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Citation

Bladh, Mickey Lynn., and Anne M. Van Leeuwen. "Hemoglobin Electrophoresis and Abnormal Hemoglobins." Davis's Lab & Diagnostic Tests, 7th ed., F.A. Davis Company, 2017. Nursing Central, nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425275/0/Hemoglobin_Electrophoresis_and_Abnormal_Hemoglobins.
Bladh ML, Van Leeuwen AM. Hemoglobin Electrophoresis and Abnormal Hemoglobins. Davis's Lab & Diagnostic Tests. 7th ed. F.A. Davis Company; 2017. https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425275/0/Hemoglobin_Electrophoresis_and_Abnormal_Hemoglobins. Accessed August 18, 2019.
Bladh, M. L., & Van Leeuwen, A. M. (2017). Hemoglobin Electrophoresis and Abnormal Hemoglobins. In Davis's Lab & Diagnostic Tests. Available from https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425275/0/Hemoglobin_Electrophoresis_and_Abnormal_Hemoglobins
Bladh ML, Van Leeuwen AM. Hemoglobin Electrophoresis and Abnormal Hemoglobins [Internet]. In: Davis's Lab & Diagnostic Tests. F.A. Davis Company; 2017. [cited 2019 August 18]. Available from: https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425275/0/Hemoglobin_Electrophoresis_and_Abnormal_Hemoglobins.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hemoglobin Electrophoresis and Abnormal Hemoglobins ID - 425275 A1 - Bladh,Mickey Lynn, AU - Van Leeuwen,Anne M, BT - Davis's Laboratory & Diagnostic Tests UR - https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425275/0/Hemoglobin_Electrophoresis_and_Abnormal_Hemoglobins PB - F.A. Davis Company ET - 7 DB - Nursing Central DP - Unbound Medicine ER -