Hemoglobin F, Red Cell Distribution, Blood
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
In the common form of the genetic trait hereditary persistence of fetal hemoglobin (HPFH), all of the erythrocytes contain hemoglobin F (Hb F).
More than 75% of the hemoglobin of the newborn is Hb F; it diminishes over a period of several months to adult levels, becoming <2% by 1 year of age.
Hb F may constitute 90% of the total hemoglobin in patients with beta-thalassemia major.
Hb F is often moderately elevated in sickle cell disease, aplastic anemia, acute leukemia, myeloproliferative disorders, hereditary spherocytosis, and alpha-thalassemia minor. It is commonly increased in all hemoglobinopathies associated with hemolysis. Hb F increases to as high as 10% during normal pregnancy.
Distinguishing hereditary persistence of fetal hemoglobin from other conditions with increased amounts of fetal hemoglobin
Homocellular distribution of fetal hemoglobin is found in hereditary persistence of fetal hemoglobin
Heterocellular distribution is found in beta-thalassemia trait
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
For hereditary persistence of fetal hemoglobin only. Not to be ordered for fetal-maternal bleed (see FMB/88841 Fetomaternal Bleed, Flow Cytometry, Blood).
With hemoglobin F values >35%, most specimens show a homocellular pattern; this does not necessarily indicate hereditary persistence of fetal hemoglobin. Clinical correlation is needed.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Reported as heterocellular or homocellular
Clinical References Provides recommendations for further in-depth reading of a clinical nature
1. Kleihauer E, Braun H, Betke K: Demonstration von fetalem Hamoglobin in den Erythrocyten eines Blutaustrichs. Klin Wschr 1957;35:637-638
2. Shepard MK, Weatherall DJ, Conley CC: Semi-quantitative estimation of the distribution of fetal hemoglobin in red cell populations. Bull Johns Hopkins Hospital 1962;110:293-310
3. Davis BH, Olsen S, Bigelow NC, Chen JC: Detection of fetal red cells in fetomaternal hemorrhage using a fetal hemoglobin monoclonal antibody by flow cytometry. Immunohematology 1998;35:749-756