What this test measures
Cellulose acetate electrophoresis at alkaline pH separates Hb variants by charge: HbA (normal adult), HbF (fetal — should be <1% in adults), HbS (sickle), HbC, HbA2 (raised in beta-thalassemia trait), HbD, HbE, and others. Citrate agar electrophoresis at acid pH is often run secondarily to confirm specific variants (e.g., distinguish HbS from HbD). Many modern labs prefer HPLC (more sensitive, quantitative); classical electrophoresis remains widely used in India for cost.
Why it matters
India has very high carrier rates of haemoglobinopathies — beta-thalassemia trait ~4% nationally (up to 15-20% in Sindhis, Gujaratis, Punjabis), sickle cell trait / disease in tribal central India (Madhya Pradesh, Chhattisgarh, Odisha, Maharashtra) and Kerala (5-30%), HbE in north-east India (~50% in some tribes), HbD in Punjab. National Sickle Cell Mission targets premarital, antenatal, neonatal screening. Adult electrophoresis is the workhorse — for couple screening (prenatal counselling), workup of microcytic anaemia not explained by iron deficiency, family screening of probands.
How to prepare
No fasting required. Disclose any recent blood transfusion (within 3-4 months — donor Hb confounds interpretation; test BEFORE transfusion or 3 months after). Note ethnicity / community, family history of thalassemia / sickle cell, current anaemia symptoms.
Markers & reference ranges
Reference ranges below are typical adult values. Your lab's reported range may differ slightly based on the assay platform and patient demographics — always read your report against the range printed on it.
| Marker | Normal range | If low | If high |
|---|---|---|---|
| HbA (Adult) (%) | 95 – 98 | Reduced HbA → presence of variants. Severely reduced HbA + raised HbF + raised HbA2 = beta-thalassemia major. Reduced HbA + HbS dominant = sickle disease. | Slightly elevated — non-specific. |
| HbA2 (%)[1] | 2.5 – 3.5 | < 2.5 — iron deficiency, alpha-thalassemia, sideroblastic anaemia. | 3.5 – 5.0 — beta-thalassemia trait (most common cause). > 5 — possible HbA2 variant or interpretation issue; confirm by HPLC or DNA. |
| HbF (Adult) (%) | < 1 | Low / absent — normal adult. | Raised adult HbF: 5-15% in beta-thal trait, 30-90% in beta-thal major, 30-100% in HPFH, 5-30% in sickle cell disease. |
| HbS (%) | 0 | 0 — no sickle gene. | 30-45% (with dominant HbA) — sickle cell trait. 60-90% (with low HbA) — sickle cell disease. |
Adult Hb electrophoresis patterns
| Diagnosis | HbA | HbA2 | HbF | HbS | Other |
|---|---|---|---|---|---|
| Normal AA | 95-98% | 2.5-3.5% | <1% | 0 | — |
| β-thalassemia trait | 92-95% | >3.5% | 1-5% | 0 | — |
| β-thalassemia major | 0-5% | Variable | 30-90% | 0 | — |
| Sickle cell trait (AS) | 55-60% | 2-3% | <1% | 40-45% | — |
| Sickle cell disease (SS) | 0-20% | 2-3% | 5-15% | 70-95% | — |
| HbE trait | 60-70% | 2-3% | <1% | 0 | HbE 25-30% |
| HbE/β-thal | Low | Variable | Raised | 0 | HbE 60-90% |
Frequently asked questions
Should I do HPLC or electrophoresis?
HPLC is more sensitive and quantitative — better for very low variant levels and quantifying HbA2 precisely. Electrophoresis is cheaper and adequate for most diagnostic needs in India. Some labs offer both for cross-confirmation.
How does iron deficiency affect the test?
Iron deficiency can lower HbA2, potentially masking mild beta-thalassemia trait. Repeat after iron repletion if borderline; DNA analysis is definitive.
Should I get this before marriage?
If both partners are from high-carrier communities (Sindhi, Gujarati, Punjabi, Bengali, tribal central India), premarital screening is highly recommended. Carrier-carrier marriages risk 25% per pregnancy of severely affected child.
What if I had a recent blood transfusion?
Wait at least 3 months — donor Hb confounds your own variant percentages. Pre-transfusion sample is ideal.
Will pregnancy affect the result?
Slightly — HbA2 can fall a little in pregnancy and with iron deficiency. Repeat post-partum if borderline.
Related Histopathology / Cytology tests
Tests commonly ordered alongside ADULT HEMOGLOBIN ELECTROPHORESIS, or that help interpret an unexpected result.
Sources & references
- ICMR — Haemoglobinopathies in India · accessed 2026-05-30T00:00:00.000Z
- BSH — Haemoglobinopathy Screening · accessed 2026-05-30T00:00:00.000Z
- WHO — Sickle Cell Disease · accessed 2026-05-30T00:00:00.000Z
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