Test ID: HBF
Hemoglobin F, Blood
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Quantitating the percent of fetal hemoglobin present
Assisting in the diagnosis of disorders with elevated levels of fetal hemoglobin
Method Name A short description of the method used to perform the test
Ion-Exchange/High-Performance Liquid Chromatography (HPLC)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Container/Tube:
Preferred: Lavender top (EDTA)
Acceptable: ACD (solution B), sodium heparin
Specimen Volume: 3 mL
Collection Instructions: Do not transfer blood to other containers.
Forms: If not ordering electronically, please submit a Hematopathology/Molecular Oncology Request Form (Supply T241) with the specimen.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross OK |
| Lipemia | NA |
| Icterus | NA |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Whole blood | Refrigerated | 10 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Fetal hemoglobin concentration is usually between 5% to 15% of the total hemoglobin in the high F or delta/beta-type of thalassemia minor. In beta-thalassemia major, fetal hemoglobin may be 30% to 90% or even more of the total hemoglobin.
Slight increases in hemoglobin F concentration are found in a variety of unrelated hematologic disorders, such as aplastic anemia, hereditary spherocytosis, and myeloproliferative disorders. In homozygous sickle cell disease, hemoglobin F concentration is often slightly increased.
Higher concentrations of hemoglobin F occur in hemoglobin S/beta O-thalassemia, in patients who are doubly heterozygous for the hemoglobin S gene, and in patients who have a gene for hereditary persistence of fetal hemoglobin (HPFH). These disorders may be differentiated by family studies or by flow cytometry studies for fetal hemoglobin, which reveals uniform intraerythrocytic distribution of hemoglobin F in HPFH and nonuniform distribution in hemoglobin S/beta-thalassemia. The electrophoretic finding of small quantities of hemoglobin A in a patient who has mostly hemoglobin S and a moderate increase in hemoglobin F is strong evidence of hemoglobin S/beta zero thalassemia (if the patient has not had a transfusion).
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.
1-30 days: 22.8-92.0%
1-2 months: 7.6-89.8%
3-5 months: 1.6-42.2%
6-8 months: 0.0-16.7%
9-12 months: 0.0-10.5%
13-17 months: 0.0-7.9%
18-23 months: 0.0-6.3%
> or =24 months: 0.0-0.9%
Interpretation Provides information to assist in interpretation of the test results
See Clinical Information and Reference Values.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Hemoglobin F is elevated in newborns, reaching adult levels by 12 months. It is also commonly increased to as much as 5% to 10% in normal pregnancy.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
Fairbanks VF, Klee GG: Biochemical aspects of hematology. In Tietz Textbook of Clinical Chemistry. Third edition. Edited by CA Burtis, ER Ashwood, Philadelphia, WB Saunders Company, 1999, pp 1657-1669
Method Description Describes how the test is performed and provides a method-specific reference
The beta-thalassemia short program utilizes the principles of cation-exchange high-performance liquid chromatography.
Hemolyzed specimens are maintained at 12 degrees C +/- 2 degrees C in the automatic specimen chamber. The specimens are then sequentially injected into the analysis stream at 6.5 minute intervals for a throughput of 9 specimens per hour. Two dual-piston pumps and a pre-programmed gradient control the elution buffer mixture passing through the analytical cartridge. The ionic strength of the elution buffer mixture is increased by raising the percentage contribution of elution buffer 2. As the ionic strength of the mixture increases, more strongly retained hemoglobins will elute from the analytical cartridge.
A dual-wavelength filter photometer (415 and 690 nm) monitors the elution from the cartridge. As the hemoglobins elute from the cartridge and pass through the photometer flow cell, changes in absorbance at 415 nm are detected. The 690 nm secondary filter corrects the baseline for changes caused by the mixing of buffers with different ionic strengths. Changes in absorbance are monitored versus time, producing a chromatogram. A built-in integrator performs reduction of the raw detector signal data collected from each analysis.
The elapsed time from the injection of the specimen to the apex of a hemoglobin peak is called the retention time. Each hemoglobin has a characteristic retention time. Windows are established from the most frequently occurring hemoglobins based on their characteristic retention times to aid in the interpretation of results.(Kim HC, Adachi K, Scwartz E: Separation of hemoglobins. In Williams Hematology. Fifth edition, Edited by E Beutler, MA Lichtman, BS Coller, TJ Kipps. McGraw-Hill Inc, 1995 pp L37-L38; Fairbanks VF: Thalassemias and related disorders. In Hemoglobinopathies and Thalassemias. Edited by BC Decker, New York, Thieme-Stratton Inc, 1980, pp 18-27; Ou CN, Buffone GJ, Reimer GL: High-performance liquid chromatography of human hemoglobins on a new cation exchanger. J Chromatogr 1983;266:197-205)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Saturday
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
83021
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 8269 | Hemoglobin F, B | 42246-9 |
| 6812 | Comment | 48767-8 |
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