A sample submitted for hemoglobin (Hb) evaluation on a 5-day-old premature male infant with intestinal perforation, intraventricular hemorrhage, anemia, and sepsis contained 61.1% Hb A, 23.7% Hb F, 2.1% Hb A2, and peaks of 8.2% and 5.2% in the P2 and P3 regions of the Bio-Rad Variant II HPLC β thalassemia assay (Fig. 1). Isoelectric focusing showed Hb A, Hb F, Hb A2, and a band comigrating with Hb A1c but no other variants. Hb A1c elutes in the P2 region of this HPLC method (1).

Fig. 1. Hb profile of a newborn by HPLC (Bio-Rad Variant II) β thalassemia assay.

Questions

  1. What Hb variants are present in healthy newborns?
  2. Do newborns express Hb A1c?
  3. What can explain this unusual Hb profile?

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