Test ID: HPFH
Hemoglobin F, Red Cell Distribution, 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
Distinguishing hereditary persistence of fetal hemoglobin from other conditions with increased amounts of fetal hemoglobin
Special Instructions and Forms Describes specimen collection and preparation information, test algorithms, and other information pertinent to test. Also includes pertinent information and consent forms to be used when requesting a particular test
Method Name A short description of the method used to perform the test
Flow Cytometry
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
Fetal Hemoglobin
Hemoglobin F, Red Cell Distribution, Blood - NOT FOR MATERNAL BLEED
HEMOGLOBIN-F DISTRIBUTION (RBC)
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: Lavender top (EDTA)
Specimen Volume: 3 mL
Additional Information:
1. Patient's age and sex are required.
2. Indicate the percent of hemoglobin F. If this is not indicated, we will perform HBF/8269 Hemoglobin F, Blood. If HBF/8269 Hemoglobin F, Blood gives normal results, HPFH/8270 Hemoglobin F, Red Cell Distribution, Blood will not be performed.
3. Indicate the reason for testing.
4. For information on thalassemias and appropriate test ordering, see Thalassemia Tests in Special Instructions.
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 reject; Gross reject |
| Lipemia | Mild OK; Gross OK |
| 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 EDTA | Refrigerated | 10 days |
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.
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
Interpretation Provides information to assist in interpretation of the test results
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.
Clinical Reference 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
Method Description Describes how the test is performed and provides a method-specific reference
This assay uses a flow cytometric method with a monoclonal antibody to hemoglobin F (Hb F). Specimens are analyzed by single-color flow cytometry using fluorescein anti-Hb F. In normal adults, a single peak is seen with minimal fluorescence, which corresponds to Hb A. In neonates, a single peak with bright fluorescence is seen, which corresponds to Hb F. In cases of hereditary persistence of fetal hemoglobinonly, a single peak is observed, which has a fluorescence intensity intermediate between the normal Hb A and Hb F peaks. This pattern corresponds to the homocellular (pancellular) pattern obtained by the Kleihauer-Betke (K-B) method. In contrast, specimens from infants, transfused neonates, and cases of beta-thalassemia or delta/beta-thalassemia showed both Hb A and Hb F peaks, corresponding to the heterocellular pattern of the K-B method. In patients with Hb S/hereditary persistence of fetal hemoglobin, a single peak was observed in contrast to patients with homozygous S in which 2 peaks were observed. (Hoyer JD, Penz CS, Fairbanks VF, Katzmann JA: A flow cytometric method for measurement of Hb F in red cells: applications in the evaluation of hereditary persistence of fetal hemoglobin [HPFH] and other conditions with elevated Hb F levels. Blood 1998;92:40b)
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; Continuously
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.
88184
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 |
|---|---|---|
| 8270 | Hemoglobin F, Red Cell Distrib, B | 4579-9 |
| 2104 | Interpretation | 59466-3 |
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