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NC Department of Health and Human Services
State Laboratory of Public Health
N.C. Public Health Home

Newborn Screening: Hemoglobinopathies

Newborn Screening includes a screening test for abnormal hemoglobins S, C, D, and E and is performed only on infants six months of age or younger. 

Hemoglobinopathy testing is offered as a follow-up test on specimens reported as abnormal by Newborn Screening and on infants greater than six months of age. It tests only for hemoglobin identification. This test is also used to screen blood samples from individuals and family studies for hemoglobin S (sickle cell) and other hemoglobinopathies. Isoelectric focusing (IEF) and high performance liquid chromatography (HPLC) are utilized in the testing process. Hemoglobinopathy services are available to public and private providers for the purposes of prenatal screening, family studies, and follow-up testing. The laboratory does not have the capacity to perform sickle cell trait testing for the purposes of school and college athletics.

Specimen Identification, Collection and Shipment for Filter Paper Spots

  1. A hemoglobin electrophoresis filter paper collection form (DHHS 1859) can be ordered from the Laboratory Mailroom by using the portal system to order supplies.
  2. Complete the entire identification section on the form with ballpoint pen, making sure all copies are legible. It is imperative that the following information is given: patient's name or unique identifier, patient address, sex, race, birth date, blood specimen collection date, transfusion information, Medicaid number, complete name and address of submitter, and EIN.
  3. Follow your institution’s procedures for performing heel or finger punctures. After skin is cleansed with alcohol, puncture heel or finger with sterile lancet.
  4. Fill each circle on the form with blood, making sure it soaks completely through the paper.
  5. Allow the sample to dry 4-6 hours at room temperature before mailing. Do not expose the sample to temperature extremes (heating or freezing), as this will render the sample unsatisfactory for use in the testing procedures.
  6. Ship dried blood spot (DBS) specimen within 24 hours of collection using overnight delivery. Write return address on the package. Do not mail specimens in plastic bags, use paper or cardboard mailers. DBS specimens received > 14 days post collection will be rejected.

Whole Blood Specimen Submission and Testing

  • The laboratory may request an EDTA whole blood sample in order to perform follow-up testing for certain previously reported hemoglobin screening results. Samples from the patient and/or both of the patient’s biological parents are necessary in order to provide definitive results.
  • Listed below are the conditions by which whole blood family study and/or follow-up testing may be requested:
    • Disease states
    • FA+Variant or A+Variant
    • Not Definitive results
    • Trait patients who are pregnant. Whole blood testing on the partners can be requested.
    • Diseased patients being monitored by medical facilities.
    • Abnormal results on original patient. Whole blood testing may be requested by physician when sibling/parent studies are needed.
    • Suspected Beta Thalassemia due to family history (Please add requesting physician’s name to form).
  • Complete a DHHS form #1859WB for each specimen collected. Include patient name, patient number, address, birth date, race, sex, Medicaid number, patient phone number, date specimen collected, blood transfusion information, complete name and address of submitter, and EIN. For family study specimen submission, provide the original laboratory reference number, original name as submitted for newborn screening and date of birth of the infant. This information will allow the laboratory personnel to reference and link the family study results to each other. It is IMPERATIVE that the forms are filled out completely. Any missing information could result in longer turn-around time or unsatisfactory reports.
  • Submit 5-7 ml of well-mixed whole blood collected in an EDTA (lavender top) specimen collection tube. If the patient is an infant or young child, submit 0.5-1 ml of blood collected in EDTA (lavender top) microtainer specimen collection device. Write patient name and date of birth on the specimen tube label. If using an adhesive label, do not cover up the tube expiration date or obscure view of the specimen because the lab personnel must assess specimen integrity before testing. Clotted blood is unsatisfactory for use. Blood submitted in expired EDTA tubes will be rejected. EDTA whole blood specimens not received cold on frozen ice packs or received > 6 days post collection will be rejected.
  • Mail the specimen(s) on the same day of collection, if possible. Refrigerate at 2-8 degrees Celsius until specimen can be transported. If the specimen could be subjected to extreme temperatures during transit in summer, place a cold gel pack with the specimen in an insulated box for transport to the NCSLPH.

Reporting and Follow-up Procedures

  • Normal results on blood spot specimens are usually reported within 1 week after receipt in the Laboratory. Abnormal results are reported after further testing. A copy of each diseased patient report is sent to the Sickle Cell Program and Regional Counselors for follow-up.
  • The whole blood methodology requires a longer time for completion than that of blood spot testing. Please allow a MINIMUM of 14 business days, from the time of receipt in the lab, before expecting patient results.
  • There are testing limitations with respect to the identification of some hemoglobin variants. In these instances, the lab suggests referrals to a local hematologist.

Newborn Screening Information