Department of Obstetrics & Gynecology
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Protocols

 
Subject:          Hemoglobin Electrophoresis
This comes from our standing orders at Lincoln
 
Screening/Diagnosis:  All patients should be tested for hemoglobinopathies as part of the initial prenatal lab work.
 
Hemoglobin electrophoresis results show:   
                                               
  1. AA- This is a normal finding, no action is necessary except  to record the result on the lab screen of the prenatal record.
  2. Sickle cell trait (AS) or sickle C trait (AC)
  3. Sickle cell disease (SS) or (SC)
  4. Beta thalassemia trait – A2 quant > 3.5%
 
Hemoglobin electrophoresis cannot identify individuals with alpha-thalassemia trait; only molecular genetic testing can identify this condition. If the MCV on a complete blood count (CBC) is below normal, iron deficiency anemia has been excluded, and the hemoglobin electrophoresis is not consistent with beta-thalassemia trait (ie, there is no elevation of Hb A2 or Hb F present), then the patient should be referred to the genetic counselor at Duke.  DNA-based testing should be used to detect alpha-globin gene deletions characteristic of alpha-thalassemia.
 
Implement the following actions when sickle cell or thalassemia trait is present:
 
  1. Document the lab results on the lab sheet of the prenatal record.
  2. Document the trait on the problem list.
  3. Counsel the patient about the implications of the findings.
  4. For sickle cell trait S, obtain a urine culture each trimester (refer to standing orders for urine cultures).
  5. Request sickle cell status of the father of the baby (FOB). If his status is unknown, encourage testing.
  6. If  FOB’s status is unknown or he is positive for S, C or thalassemia trait, offer genetic counseling,
 
If the patient has sickle cell disease or thalassemia major (the disease as opposed to the trait:
 
  1. Refer the patient to the High Risk OB Clinic
  2. Document the results on the lab screen of the prenatal record
  3. Document on the problem list:    “Sickle Cell Disease – Transfer to High Risk OB Clinic.”
 
Reference:
ACOG  Practice Bulletin No. 78: Hemoglobinopathies in Pregnancy, January, 2007.
 
 
The Clinical Care Guidelines Development Committee of the Perinatal Improvement Board of Duke University Health System has developed a series of multi-disciplinary protocols to offer guidance to health care providers who are caring for pregnant women with high risk conditions.
 
These protocols are designed to assist health care providers in the management of a variety of problems that occur in pregnancy and the time of delivery. They should not be interpreted as standard of care, but instead represent only general guidelines for the care of pregnant women with high risk conditions.  We recognize that services offered by individual providers depend not only on their training, experience and institutional resources, but on the medical facts and circumstances of the specific care situation.
The protocols remain the intellectual property of the Duke University Health System.  They cannot be reproduced in whole or part without the expressed permission of the Health System.
 
These protocols are reviewed by the Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, the Department of Pediatrics Division of Neonatology and the Department of Anesthesiology Division of Women’s Anesthesia.  Please contact Andra H. James (andra.james@duke.edu), Chair, Clinical Care Guidelines Development Committee of the Perinatal Improvement Board with ideas for additional protocols.
 
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