CAPILLARYS HEMOGLOBIN(E)

CAPILLARYS HEMOGLOBIN(E) 

Ref. 2007 

2010/10

CAPILLARYS HEMOGLOBIN(E) - 2010/10 

CAPILLARYS HEMOGLOBIN(E) PROCEDURE WITH THE CAPILLARYS SYSTEM 

INTENDED USE 

The CAPILLARYS HEMOGLOBIN(E) kit is designed for the separation of the normal hemoglobins (A, F and A2) and for the detection of the major 

hemoglobin variants (especially S, C, E or D), by electrophoresis in alkaline buffer (pH 9.4) with the CAPILLARYS System. 

The CAPILLARYS performs all sequences automatically to obtain a complete hemoglobin profile for qualitative or quantitative analysis of hemoglobins. 

The assay is performed on sedimented, centrifuged or washed red blood cells ; washing red blood cells is not essential to perform the analysis. 

For In Vitro Diagnostic Use. 

PRINCIPLE OF THE TEST 

Hemoglobin is a complex molecule composed of two pairs of polypeptide chains. Each chain is linked to the heme, a tetrapyrrolic nucleus (porphyrin) 

which chelates an iron atom. The heme part is common to all hemoglobins and their variants. The type of hemoglobin is determined by the protein 

part called globin. Polypeptide chains α, ß, δ and γ constitute the normal human hemoglobins: 

• hemoglobin A ............................ = α 2 ß 2 

• hemoglobin A2 .......................... = α 2 δ 2 

• fetal hemoglobin F .................... = α 2 γ 2 

The α-chain is common to these three hemoglobins. 

The hemoglobin spatial structure and other molecular properties (like that of all proteins) depend on the nature and the sequence of the amino acids 

constituting the chains. Substitution of amino acids by mutation is responsible for formation of hemoglobin variants which have different surface charge 

and consequently different electrophoretic mobilities, which also depend on the pH and ionic strength of the buffer. 

The resulting qualitative (or structural) abnormalities are called hemoglobinopathies (9, 10, 13) . Decreased synthesis of one of the hemoglobin chains leads 

to quantitative (or regulation) abnormalities, called thalassemias. 

Hemoglobin electrophoresis is a well established technique routinely used in clinical laboratories for screening samples for hemoglobin 

abnormalities (1, 2, 3, 4, 12) . The CAPILLARYS System has been developed to provide complete automation of this testing with fast separation and good 

resolution. In many respects, the methodology can be considered as an intermediary type of technique between classical zone electrophoresis and 

liquid chromatography (8, 11) . 

The CAPILLARYS System uses the principle of capillary electrophoresis in free solution. With this technique, charged molecules are separated by 

their electrophoretic mobility in an alkaline buffer with a specific pH. Separation also occurs according to the electrolyte pH and electroosmotic flow (5) . 

The CAPILLARYS System has capillaries functioning in parallel allowing 7 simultaneous analyses for hemoglobin quantification. A sample dilution with 

hemolysing solution is prepared and injected by aspiration at the anodic end of the capillary. A high voltage protein separation is then performed and 

direct detection of the hemoglobins is made at 415 nm at the cathodic end of the capillary. Before each run, the capillaries are washed with a Wash 

Solution and prepared for the next analysis with buffer. 

The hemoglobins, separated in silica capillaries, are directly and specifically detected at an absorbance wave length of 415 nm which is specific to 

hemoglobins. The resulting electrophoregrams are evaluated visually for pattern abnormalities. 

Direct detection provides accurate relative quantification of individual hemoglobin fraction, with particular interest, such as A2 hemoglobin for 

ß thalassemia diagnostic. In addition, the high resolution of this procedure should allow the identification of hemoglobin variants, in particular, to 

differentiate hemoglobins S from D, and E from C. 

The hemoglobin A2 quantification can also be performed when hemoglobin E is present. 

By using alkaline pH buffer, normal and abnormal (or variant) hemoglobins are detected in the following order, from cathode to anode: δA’2 (A2 variant), 

C, A2/O-Arab, E, S, D, G-Philadelphia, F, A, Hope, Bart, J, N-Baltimore and H. 

The carbonic anhydrase is not visualized on the hemoglobin electrophoretic patterns, this permits to identify hemoglobin A2 variants in this migration 

zone. 

REAGENTS AND MATERIALS SUPPLIED IN THE CAPILLARYS HEMOGLOBIN(E) KIT 

ITEMS PN. 2007 

Buffer (ready to use) 

2 vials, 700 mL each 

Hemolysing solution (ready to use) 

1 vial, 700 mL 

Wash solution (stock solution) 

1 vial, 75 mL 

Dilution segments 1 pack of 90 

Filters 

4 filters 

630 tests based on maximum usage. 

FOR OPTIMAL RESULTS : 

All reagents from the same kit must be always used together and according to the package insert instructions. 

PLEASE READ THE PACKAGE INSERT CAREFULLY. 

WARNING : Do not use marketed deionized water, such as water for ironing for example (risk of important capillaries damage). Use only 

water with ultrapure quality, such as injection grade water. 

- 34 - 

SEBIA INSTRUCTIONS - English


1. BUFFER 

Preparation 

The buffer is ready to use. It contains: alkaline buffer pH 9.4 ; additives, nonhazardous at concentrations used, necessary for optimum performance. 

WARNING: See the safety data sheet. 

Use 

Buffer for analysis of hemoglobins in CAPILLARYS. 

Storage, stability and signs of deterioration 

Store the buffer refrigerated (2 to 8 °C). It is stable until the expiration date indicated on the kit package or buffer vial labels. Avoid storage at room 

temperature for a long time or close to a window or to a heat source. 

DO NOT FREEZE. 

IMPORTANT: When stored at 2 - 8 °C and prior to use, it is necessary for the buffer to reach room temperature; when it is full, let the buffer vial at 

room temperature for at least 3 hours prior to use. If this precaution is not respected, the performances of the procedure may be affected. 

WARNING: Do not pre-heat the buffer in hot water. 

Once the buffer vial has been opened and positioned on the CAPILLARYS system, it is stable for a maximum of 1 month (accumulated) at room 

temperature (15 to 30 °C). After each use, the buffer must imperatively be stored refrigerated (between 2 and 8 °C) without any delay, it is then 

stable until the expiration date indicated on the buffer vial label. 

IMPORTANT: The accumulated time of the buffer stored at room temperature must not exceed 1 month. This time of 1 month storage takes account 

of the time for the buffer to come to room temperature. 

Discard buffer if it changes its appearance, e.g., becomes cloudy due to microbial contamination. 

2. HEMOLYSING SOLUTION 

Preparation 

Hemolysing Solution is ready to use. It is a buffer with additives, nonhazardous at the concentration used, necessary for optimum performance. 

Use 

To dilute and hemolyze red blood cells and whole blood. 


Store Hemolysing Solution refrigerated (2 to 8 °C). It is stable until the expiration date indicated on the kit package or Hemolysing Solution vial label. 

Avoid storage at room temperature or close to a window or to a heat source. DO NOT FREEZE. 

WARNING: Do not pre-heat the hemolysing solution in hot water. 

IMPORTANT: After each use, close immediately and tightly the hemolysing solution vial and store it refrigerated. 

Analyses with the CAPILLARYS 2 FLEX PIERCING system: Once the hemolysing solution vial has been opened and positioned on the system, it is 

stable for a maximum of 2 months (accumulated) at room temperature (15 to 30 °C). 

Discard Hemolysing Solution if it changes its appearance, e.g., becomes cloudy due to microbial contamination. 

3. WASH SOLUTION 

Preparation 

The vial of the stock wash solution should be diluted up to 750 mL with distilled or deionized water. 


Use 

For washing the capillaries before and after hemoglobin electrophoresis. 

IMPORTANT: Before filling the wash solution container, it is recommended to wash the opening of the container, the connector and the tube with plenty 

of distilled or deionized water to avoid salts deposit. 


Store the stock and working wash solutions in closed containers at room temperature or refrigerated. The stock wash solution is stable until the 

expiration date indicated on the kit or wash solution vial label. 

Working wash solution is stable for 3 months. 

Discard working wash solution if it changes its appearance, e.g., becomes cloudy due to microbial contamination. 

4. DILUTION SEGMENTS 

Use 

Coloured single use segments for blood sample dilution on the automated instrument. They are specific for CAPILLARYS HEMOGLOBIN(E) and 

CAPILLARYS CORD BLOOD procedures. 

WARNING: Dilution segments with biological samples have to be handled with care. 

5. FILTERS 

Use 

Disposable filters for filtration of analysis buffer, hemolysing solution (for CAPILLARYS 2 FLEX PIERCING system), working wash solution and 

distilled or deionized water (used for capillaries rinsing). 

IMPORTANT: With each new kit, always change all the four filters. 

Screw one filter at the connector situated at the extremity of each tube that plunges in the vials of buffer, hemolysing solution, wash solution and 

distilled or deionized water. When setting filters on CAPILLARYS system, rinse the connectors and the tubes with distilled or deionized water. Used 

filters must be rinsed before discard. 

The filter intended for analysis buffer must be used for filtration of both buffer vials ; the three other filters are intended for filtration of hemolysing 

solution, working wash solution and distilled or deionized water (for capillary rinsing). 

Storage 

Before use, store the filters in their sealed package in a dry place at room temperature or refrigerated. 

- 35 -


REAGENTS REQUIRED BUT NOT SUPPLIED 

1. NORMAL Hb A2 CONTROL 

Composition 

The Normal Hb A2 Control (SEBIA, PN 4778) is obtained from a pool of normal human blood samples. The Normal Hb A2 Control is in a stabilized 

lyophilised form. 

Intended use 

The Normal Hb A2 Control is designed for the migration control before starting a new analysis sequence, and for the quality control of human 

hemoglobin A2 quantification with CAPILLARYS HEMOGLOBIN(E) electrophoresis procedure. 

Reconstitute each Normal Hb A2 Control vial with the exact volume of distilled or deionized water, as indicated in the package insert of the Normal 

Hb A2 Control. Allow to stand for 30 minutes and mix gently (avoid formation of foam). 

Migration control: The Normal Hb A2 Control should be used as follows: 

- Apply the reconstituted Normal Hb A2 Control in a microtube. 

- Cut the cap of the microtube. 

- Place the microtube, located on a new hemolysing tube used as a support tube (and identified with the Normal Hb A2 Control bar code label), in 

position No. 1 on the CAPILLARYS sample rack No. 0 intended for control blood sample, containing a new green dilution segment. 

- Pour 4 mL CAPILLARYS HEMOGLOBIN(E) hemolysing solution in a hemolysing tube without introducing air bubbles and place it in position No. 8 

on the sample rack No. 0. 

IMPORTANT: Ensure the absence of foam in the tube before placing it on the sample rack. 

- Start the analysis: Slide the sample rack No. 0 into the CAPILLARYS system, select "Automatic dilution" in the window which appears on the screen 

and validate. 

- After having changed the analysis buffer vial (even if the lot number is identical) or the technique, after a capillary cleaning sequence with 

CAPICLEAN, after a software upgrade or after capillaries activation, perform a second series of analyses with the control, by sliding in again 

immediately the same sample rack No. 0 with the same dilution segment containing the Normal Hb A2 Control, previously diluted during the first 

series and the empty hemolysing tube identified with the Normal Hb A2 Control bar code in position No. 1. In the window called "Hb A2 Normal 

Control" which appears on the screen, select "Manual dilution" and validate. 

The results are then automatically considered by the software for the data analysis. 

IMPORTANT: The hemoglobin A fraction of the Normal Hb A2 Control must show a minimal optical density (OD) of 0.12. Under this value, the 

recentering of the electrophoretic pattern will not occur correctly. When analysing samples, the identification of hemoglobin fractions, Hb A, Hb F, Hb A2 

and Hb C and also the determination of the migration zone of other variants, may be impossible or wrong (see the paragraph RESULT ANALYSIS). 

IMPORTANT: For optimal use of the Normal Hb A2 Control, it is necessary to use one bar code label intended to identify the hemolysing tube holding 

the microtube which contains the Hb A2 Control (cut the cap of the microtube before using it). 

NOTES: For the first use of the "HEMOGLOBIN(E)" analysis program with the CAPILLARYS instrument, it is recommended to perform 3 successive 

series of analyses with the Normal Hb A2 Control. 

After the installation of CAPILLARYS instrument, during the first sequence of blood sample analysis, a red warning signal will appear if hemoglobin A 

is absent in one sample (and the recentering of the electrophoretic pattern will not be possible, see paragraph " Result analysis "). 

It is then recommended to analyze a blood sample with hemoglobin A on the concerned capillary and to analyze again the sample without hemoglobin 

A by placing it in a position corresponding to a capillary which has already detected hemoglobin A. 

Quality control: The Normal Hb A2 Control should be used as a normal human blood. After reconstitution, use directly the Normal Hb A2 Control as 

a blood sample to analyze or as a migration control (with the sample rack No. 0, see paragraph before). It will be automatically diluted with hemolysing 

solution. It is recommended to include one analysis of Normal Hb A2 Control. The values obtained must fall within the range provided with each batch 

of Hb A2 Control. 

IMPORTANT: For optimal use of the Normal Hb A2 Control placed on a sample rack, it is necessary to use one bar code label intended to identify the 

hemolysing tube holding the microtube which contains the Hb A2 Control (cut the cap of the microtube before using it). 


Before reconstitution, store the lyophilised Normal Hb A2 Control refrigerated (2 to 8 °C). It is stable until the expiration date indicated on the box or 

vial labels. 

Store the reconstituted Normal Hb A2 Control at 2 - 8 °C. Due to the risk of microbial contamination and denaturation, use it within one week. 

The reconstituted Control may also be frozen (in aliquots) and stored at - 20 °C for 6 months maximum. 

IMPORTANT: After storage at 2 - 8 °C or at - 20 °C, homogenize the reconstituted Normal Hb A2 Control before the analysis with the CAPILLARYS 

system. 

NOTE: For optimal use with the CAPILLARYS system, it is recommended to split the Control into aliquots in microtubes before freezing. 

Before use, store the thawed Normal Hb A2 Control at 2 - 8 °C and use it within the day. Do not freeze and thaw the Control more than 15 times. 

The hemolysed Normal Hb A2 Control should be stored at 2 - 8 °C and used within one day. 

The dilution segment containing the hemolysed Normal Hb A2 Control may be frozen and stored at - 20 °C. Do not freeze and thaw the dilution 

segment with hemolysed Control more than twice. 

IMPORTANT: Do not leave the dilution segment with hemolysed Control at room temperature. 

NOTE: During transportation, the lyophilized Normal Hb A2 Control can be kept without refrigeration (15 to 30 °C) for 15 days without any adverse 

effects on performance. 

No test method can provide an absolute assurance of the absence of HIV, hepatitis B and C or other infectious agents. Therefore, handle the Normal 

Hb A2 Control as a hazardous biological material. 

This control blood was found negative on assays approved by FDA or EU equivalent regulatory agency: 

- against hepatitis B surface antigen ; 

- for antibody to HCV ; 

- for antibody to HIV1 and HIV2. 

- 36 -


2. DISTILLED OR DEIONIZED WATER 

Use 

For rinsing capillaries in automated system CAPILLARYS, SEBIA, for capillary electrophoresis. 

It is recommended to filter distilled or deionized water with 0.45 µm filter before use. 

To prevent microbial proliferation, change the water every day. In case of longer storage, add 35 µL/dL of CLEAN PROTECT (SEBIA, PN 2059, 5 mL). 

IMPORTANT: Before filling the rinse container, it is recommended to wash it with plenty of distilled or deionized water. 

3. CAPICLEAN 

Composition 

The vial of CAPICLEAN concentrated solution (SEBIA, PN 2058, 25 mL) contains : proteolytic enzymes, surfactants and additives nonhazardous at 

concentrations used, necessary for optimum performances. 


Use 

For sample probe cleaning in automated system CAPILLARYS, SEBIA, for capillary electrophoresis, during the CAPICLEAN cleaning sequence. 

IMPORTANT: Launch a CAPICLEAN cleaning sequence at least once a week and at maximum once a day, or after every 500 analyses when 

performed within less than one week. 

See the instruction sheets of CAPICLEAN, SEBIA. 

IMPORTANT: Do not re-use the dilution segment after sample probe cleaning. 


Store CAPICLEAN refrigerated (2 - 8 °C). It is stable until the expiration date indicated on the vial label. DO NOT FREEZE. 

CAPICLEAN must be free of precipitate. Discard CAPICLEAN if it changes its appearance, e.g., becomes cloudy due to microbial contamination. 

4. SODIUM HYPOCHLORITE SOLUTION (for sample probe cleaning) 

Preparation 

Prepare a sodium hypochlorite solution (2 % to 3 % chloride) by diluting 250 mL 9.6 % chloride concentrated solution to 1 liter with cold distilled or 

deionized water. 

Use 

For the sample probe cleaning in the CAPILLARYS System (weekly maintenance in order to eliminate adsorbed proteins from the probe). 

See the instruction sheets of CAPILLARYS, SEBIA. 

• Use the sample rack designed for the maintenance (No. 100). 

• Place a tube containing 2 mL diluted chlorinated solution previously prepared, in position No. 1 on this sample rack. 

• Slide the sample rack No. 100 for maintenance in the CAPILLARYS System. 

• In the "MAINTENANCE" window which appears on the screen, select "Launch the probe cleaning (chlorinated sodium hypochlorite solution)" and 

validate. 


Store the working chlorinated solution at room temperature in a closed container, it is stable for 3 months. Avoid storage in sunlight, close to heat and 

ignition source, and to acids and ammonia. 

5. CAPILLARYS / MINICAP WASH SOLUTION 

Preparation 

Each vial of the stock Wash Solution (SEBIA, PN 2052, 2 vials, 75 mL) should be diluted up to 750 mL with distilled or deionized water. 


Use 

For washing the capillaries of CAPILLARYS. This additional reagent is needed when the number of tests in series is below 40. 




Store the stock and working wash solutions in closed containers at room temperature or refrigerated. 

The stock wash solution is stable until the expiration date indicated on the kit or wash solution vial label. 

Working wash solution is stable for 3 months. Discard working wash solution if it changes its appearance, e.g., becomes cloudy due to microbial 

contamination. 

6. SALINE 

Preparation 

Make 0.15 M (0.9 g/dL) NaCl solution in distilled or deionized water. 

Use 

To wash red blood cells before storage at - 80 °C, if necessary. 


Store saline at room temperature or refrigerated. Discard after 3 months or if it changes its appearance, e.g., becomes cloudy due to microbial 

contamination. For longer storage periods, add sodium azide, 0.1 g/dL. 

EQUIPMENT AND ACCESSORIES REQUIRED 

1. CAPILLARYS System SEBIA, PN 1220 or PN 1222. 

2. Sample racks supplied with CAPILLARYS. 

3. Container Kit supplied with CAPILLARYS: Rinse (to fill with distilled or deionized water), wash solution and waste container. 

- 37 -


SAMPLES FOR ANALYSIS 

Sample collection and storage 

Fresh anticoagulated blood samples are recommended for analysis. Common anticoagulants such as those containing EDTA, citrate or heparin are 

acceptable ; avoid those with iodoacetate. Blood must be collected according to established procedures used in clinical laboratory testing. 

Samples may be stored for up to 7 days between 2 and 8 °C. 

For longer storage, samples can be frozen at - 80 °C within 8 hours of collection after having washed the red blood cells according to the following 

procedure: Centrifuge anticoagulated blood at 5 000 rpm for 5 minutes ; discard the plasma; wash the red blood cells (RBC) 2 times with 10 volumes 

of saline (centrifuge after each washing step) ; discard the excess of saline over the red blood cells pellet and vortex them before freezing. 

Frozen blood samples are stable for 3 months maximum at - 80 °C. 

IMPORTANT: For optimal storage of blood samples, store them at - 80 °C. Do not store at - 20 °C (see BIBLIOGRAPHY, J. Bardakdjian-Michau et al, 

2003). 

NOTE: Samples should not be stored at room temperature! 

Progressive hemoglobins (Hb) degradation may occur for samples stored between 2 to 8 °C. 

When the blood sample is stored for more than 7 days at 2 - 8 °C: 

• a weak fraction, corresponding to methemoglobin, appears in the Hb S migration zone, 

• when Hb C is present, a fraction corresponding to degraded Hb C appears more anodic than Hb A2 which does not interfere with it (Z4 zone, see 

the table in paragraph "Interpretation"), 

• when Hb O-Arab is present, a fraction corresponding to degraded Hb O-Arab appears in the Hb S migration zone (Z5 zone, see the table in 

paragraph "Interpretation"), 

• when Hb E is present, a fraction corresponding to degraded Hb E appears in the Z6 zone (see the table in paragraph "Interpretation"), 

• when Hb S is present, a fraction corresponding to degraded Hb S appears in the Hb F migration zone (Z7 zone, see the table in paragraph 

"Interpretation"), 

• when Hb A is present, a fraction corresponding to degraded Hb A ("aging fraction" of Hb A) appears more anodic (Z11 zone, see the table in 

paragraph "Interpretation"). 

When Hb F is present (in blood samples from newborn babies), a fraction appears in the Hb A migration zone (Z9 zone, see the table in paragraph 

"Interpretation") due to the sample degradation. 

When stored for more than 10 days, viscous aggregates in red blood cells are observed; it is necessary to discard them before the analysis. 

Sample preparation 

• Let red blood cells precipitate for several hours at 2 - 8 °C or centrifuge the blood sample at 5 000 rpm for 5 minutes. 

• Discard carefully the maximum volume of plasma (for samples collected with heparin, discard viscous aggregates located between plasma and red 

blood cells). 

• Vortex for 5 seconds. 

IMPORTANT: Do not use blood samples containing 3 mm maximum residual plasma over red blood cells; when more than 3 mm plasma is present 

in the tube, the analysis should be affected. 

Particular cases: Analysis of samples without any Hb A or Hb A2 (these samples are perfectly quantified but not identified by zones). 

To identify hemoglobin fractions of a sample without any hemoglobin A or hemoglobin A2, it is recommended to prepare this sample according to one 

of the two following procedures: 

Automatic dilution: 

- In a microtube, mix one volume (80 µL) of red blood cells from the sample to analyze with one volume of Normal Hb A2 Control (80 µL). 

- Vortex for 5 seconds. 


- Place the microtube, on a new hemolysing tube used as a support-tube, on a sample rack of the CAPILLARYS system. 

- Perform the analysis of this sample according to the standard procedure like a usual blood sample. 

Manual dilution: 

- Apply, directly in the wells of a new green dilution segment, 9 µL of reconstituted Normal Hb A2 Control with 9 µL of blood sample to analyze and 

90 µL of CAPILLARYS HEMOGLOBIN(E) hemolyzing solution. 

- Mix by repeated pipettings. 

- Place this dilution segment on the sample rack No. 0 of CAPILLARYS. 

- Slide the sample rack into the CAPILLARYS system, select "Sample" with "manual dilution" in the window which appears on the screen and validate. 


IMPORTANT: For a sample without any Hb A or Hb A2 prepared according to one of these two procedures, the result obtained with the mixed sample 

will enable presumptive variant identification due to the positioning of the hemoglobins fractions in the appropriate identification zones. Do not report 

the relative quantification from the mixed sample result. 

The relative quantification of hemoglobins should be reported utilizing the initial, unmixed sample result (without any dilution in the blood control). 

Samples to avoid 

• Do not use unsedimented blood samples. 

• Avoid aged, improperly stored blood samples ; the automated hemolysis of samples may be disturbed by viscous aggregates in red blood cells. 

Then, degradation products (as artefacts) may affect the electrophoretic pattern. 

PROCEDURE 

The CAPILLARYS system is a multiparameter instrument for hemoglobins analysis on parallel capillaries. The hemoglobins assay uses 7 of the total 

8 instrument capillaries to run the samples. 

The sequence of automated steps is as follows: 

• Bar code reading of sample tubes (for up to 7 tubes) and samples-racks ; 

• Sample hemolysis and dilution from primary tubes (without any plasma) into dilution segments ; 

• Capillary washing ; 

• Injection of hemolyzed samples ; 

• Hemoglobin separation and direct detection of the separated hemoglobins on capillaries. 

- 38 -


The manual steps include: 

• Placement of opened sample tubes in sample-racks in positions 1 to 7 ; 

• Placement of hemolysing solution tube in sample-racks in position 8 ; 

• Placement of new dilution segments in sample-racks ; 

• Placement of racks on the CAPILLARYS instrument ; 

• Removal of sample-racks after analysis. 

PLEASE CAREFULLY READ THE CAPILLARYS INSTRUCTION MANUAL. 

I. PREPARATION OF CAPILLARYS ANALYSIS 

1. Switch on CAPILLARYS instrument and computer. 

2. Set up the software, enter and the instrument automatically starts. 

3. The CAPILLARYS HEMOGLOBIN(E) kit is intended to run with "HEMOGLOBIN(E)" analysis program from the CAPILLARYS instrument. To 

select "HEMOGLOBIN(E)" analysis program and place the CAPILLARYS HEMOGLOBIN(E) buffer vial in the instrument, please read carefully 

the CAPILLARYS instruction manual. 

4. The sample rack contains eight positions for sample tubes. Place seven opened sample tubes without any plasma on each sample rack; the 

bar code of each tube must be visible in the openings of the sample rack. 

IMPORTANT: If the number of tubes to analyze is less than 7, complete the sample rack with tubes containing distilled or deionized water. 

5. Pour 4 mL CAPILLARYS HEMOGLOBIN(E) hemolysing solution in a tube without introducing air bubbles and place it in position No. 8 on the 

sample rack. 


6. Position a new dilution segment on each sample rack. A message will be displayed if the segment is missing. 

7. Slide the complete sample carrier(s) into the CAPILLARYS system through the opening in the middle of the instrument. Up to 13 sample racks 

can be introduced successively and continuously into the system. It is advised to use the sample rack No. 0 intended for control blood sample. 

8. Remove analyzed sample racks from the plate on the left side of the instrument. 

9. Take off carefully used dilution segments from the sample rack and discard them. 


DILUTION - MIGRATION - DESCRIPTION OF THE AUTOMATED STEPS 

1. Bar codes are read on both sample tubes and sample racks. 

2. Samples are diluted in hemolysing solution and the sample probe is rinsed after each sample. 

3. Capillaries are washed. 

4. Diluted samples are injected into capillaries. 

5. Migration is carried out under constant voltage for about 8 minutes and the temperature is controlled by Peltier effect. 

6. Hemoglobins are detected directly by scanning at 415 nm and an electrophoretic profile appears on the screen of the system. 

NOTE: These automated steps described above are applied to the first introduced sample rack. The electrophoretic patterns appear after about 

20 minutes from the start of the analysis. For the following sample rack, the first two steps (bar code reading and sample dilution) are performed during 

analysis of the previous sample rack. 

II. RESULT ANALYSIS 

At the end of the analysis, relative quantification of individual hemoglobin fractions is performed automatically and profiles can be analyzed ; the 

hemoglobin fractions, Hb A, Hb F and Hb A2 are automatically identified ; the Hb A fraction is adjusted in the middle of the review window. The resulting 

electrophoregrams are evaluated visually for pattern abnormalities. 

The potential positions of the different hemoglobin variants (identified in zones called Z1 to Z15) are shown on the screen of the system and indicated 

on the result ticket. The table in paragraph "Interpretation" shows known variants which may be present in each corresponding zone. 

When the software identifies a hemoglobin fraction in a defined zone, the name of this zone is framed. 

Patterns are automatically adjusted with regard to Hb A fraction to facilitate their interpretation: 

- when Hb A and / or Hb A2 fractions are not detected on an electrophoretic pattern, a yellow warning signal appears, the adjustment is performed 

using the position of the Hb A fraction on the two previous patterns obtained with the same capillary ; then, there is no fraction identified (except 

when Hb C is detected: in this case, Hb A2 and Hb C fractions are identified) ; 

- when Hb F is detected on an electrophoretic pattern, without any detection of Hb A, the yellow warning signal does not appear, the adjustment is 

then performed using the position of the Hb F fraction, and Hb F and / or Hb A and / or Hb A2 fractions are identified ; 

- when the adjustment is not possible, a red warning signal appears, Hb F and Hb A2 fractions are then not identified (Call SEBIA). 

In those three cases, the different variant zones (Z1 to Z15) do not appear neither on the screen of the system, nor on the ticket result. 

On the electrophoretic pattern, the curves of Hb A2 and Hb C fractions, are calculated and redrawn by fitting with adjustment (or fitted) and are overlaid 

with the native curve. This display allows the Hb A2 fraction quantification if Hb C is present in the sample. 

WARNING: In some cases of hemoglobin C (homozygous) or after a technical problem, the hemoglobins A2 and C are not fitted ; these 

fractions are then under-quantified. It is then recommended to quantify the Hb A2 fraction by using another technique. 


III. END OF ANALYSIS SEQUENCE 

At the end of each analysis sequence, the operator must initiate the "stand by" or "shut down" procedure of the CAPILLARYS system in order to store 

capillaries in optimal conditions. 

IV. FILLING OF REAGENT CONTAINERS 

The CAPILLARYS system has a reagent automatic control. 

IMPORTANT: Please refer to the instructions for replacement of reagent containers respecting color code for vials and connectors. 

A message will be displayed when it is necessary to perform one of the following tasks: 

• Place a new buffer container and / or ; 

• Fill the container with working wash solution and / or ; 

• Fill the container with filtered distilled or deionized water for rinsing capillaries and / or ; 

• Empty the waste container. 

- 39 -


WARNING: Do not use marketed deionized water, such as water for ironing for example (risk of important capillaries damage). Use only 




QUALITY CONTROL 

After having changed the analysis buffer lot number or the technique, or after a capillary cleaning sequence with CAPICLEAN, and before starting 

a new analysis sequence, it is necessary to run two analysis sequences with the Normal Hb A2 Control, SEBIA, PN 4478, and the sample rack No. 0 

intended for control blood sample (see paragraph REAGENTS REQUIRED BUT NOT SUPPLIED). 

It is also advised to include into each run of samples, an assayed control blood (for example, a blood sample containing hemoglobins A, F, C and S, 

such as Hb AFSC Control, SEBIA, PN 4792, or a normal blood sample, the Normal Hb A2 Control, SEBIA, PN 4778 or the Pathological Hb A2 Control, 

SEBIA, PN 4779). 

* US customers : Follow federal, state and local guidelines for quality control. 

RESULTS 

Values 

Direct detection at 415 nm in capillaries yields relative concentrations (percentages) of individual hemoglobin zones. 

Normal values for individual major electrophoretic hemoglobin zones in the CAPILLARYS system have been established from a healthy population of 

113 adults (men and women) with normal hemoglobin values using HPLC technique: 

Hemoglobin A : comprised between 96.8 and 97.8 % 

Hemoglobin F : < 0.5 % (*) 

Hemoglobin A2 : comprised between 2.2 and 3.2 % 

(*) See Interference and limitations. 

It is recommended that each laboratory establish its own threshold values. 

NOTE: Normal values have been established using the standard parameters of the CAPILLARYS software (smoothing 0 and hemoglobin fractions 

automatic quantification with HEMOGLOBIN(E) analysis program). 

WARNING: Normal (reference) values must be considered only when hemoglobin variants are absent. 

Interpretation 

See ELECTROPHORETIC PATTERNS, figures 1 - 15. 

The different migration zones of hemoglobin variants (called Z1 to Z15) are shown on the screen of the system and on the result ticket. Passing the 

mouse cursor over a zone name displays icon information containing possible hemoglobin variants that could be seen in this zone. 

For each fraction, the maximum position defines the migration zone. 

See the table showing the potential variants located in each zone. 

WARNING: The graduation of the horizontal axis does not allow, in any case, the identification of an hemoglobin variant. 

1. Qualitative abnormalities: Hemoglobinopathies 

Most hemoglobinopathies are due to substitution by mutation of a single amino acid in one of the four types of polypeptide chains (1, 2, 4, 9, 12) . The clinical 

significance of such a change depends on the type of amino acid and the site involved (13) . In clinically significant disease, either the α-chain or the 

ß-chain is affected. 

More than 900 variants of adult hemoglobin have been described (6, 14) . The first abnormal hemoglobins studied and the most frequently occuring have 

an altered net electric charge, leading to an easy detection by electrophoresis. 

There are five main abnormal hemoglobins which present a particular clinical interest: S, C, E, O-Arab and D. 

The CAPILLARYS HEMOGLOBIN(E) kit is intended for the identification of hemoglobinopathies and thalassemias. 

Hemoglobin S 

Hemoglobin S is the most frequent. It is due to the replacement of one glutamic acid (an acidic amino acid No. 6) of the ß-chain by valine (a neutral 

amino acid): when compared to Hb A, its isoelectric point is elevated and its total negative charge decreased with the analysis pH. Its electrophoretic 

mobility is therefore increased in the capillary and this hemoglobin is faster than A fraction. 

With alkaline buffered CAPILLARYS HEMOGLOBIN(E) procedure, hemoglobin S migrates between A and A2 fractions, next to Hb A2. 

Hemoglobin C 

One glutamic acid of the ß-chain is replaced by lysine (a basic amino acid No. 6): its mobility is strongly reduced. When compared to Hb A, its 

isoelectric point is highly elevated and its total negative charge decreased with the analysis pH. Its electrophoretic mobility is therefore increased in 

the capillary and this hemoglobin is faster than A fraction which allows its differenciation. Hemoglobins C, E and O-Arab are not superimposed on the 

electrophoretic pattern and are easily identified. 

Hemoglobin E 

One glutamic acid of the ß-chain (No. 26) is replaced by lysine. With CAPILLARYS HEMOGLOBIN(E) procedure, hemoglobin E migrates just 

anodically behind hemoglobin A2 and is totally separated from it. Then, when hemoglobin E is present, A2 fraction can be measured to detect ß 

thalassemia. 

- 40 -


Hemoglobin O-Arab 

One glutamic acid of the ß-chain (No. 121) is replaced by lysine. With CAPILLARYS HEMOGLOBIN(E) procedure, hemoglobin O-Arab migrates 

exactly like hemoglobin A2. In such a case, hemoglobin A2 can not be quantified. When this fraction is > 9 %, hemoglobin O-Arab must be suspected. 

Note that Hb O-Arab migrates separately from hemoglobins C and E. 

Hemoglobin D (-Los Angeles) 

One glutamic acid of the ß-chain (No. 121) is replaced by glutamine. With CAPILLARYS HEMOGLOBIN(E) procedure, hemoglobin D (called D-Punjab, 

D-Los Angeles, D-Chicago or D-Portugal) migrates behind hemoglobin S, this property allows to differenciate S and D hemoglobins. 

2. Quantitative abnormalities: Thalassemias 

Thalassemias constitute a quite heterogeneous group of genetic disorders characterized by decreased synthesis of one type of the polypeptide chains. 

The molecular mechanism of this decrease has not been fully described. 

There are two types of thalassemia syndromes: 

Alpha-thalassemias 

They are characterized by the decrease of synthesis of the α-chains, consequently affecting the synthesis of all normal hemoglobins. 

The excess of synthesis of the ß- and γ-chains in relation to α-chains induces the formation of tetrameres without any α-chain: 

• hemoglobin Bart = γ 4, 

• hemoglobin H = ß 4. 

Hemoglobin H presents a low isoelectric point ; with CAPILLARYS HEMOGLOBIN(E) procedure, it migrates more anodic than hemoglobin A (and may 

appear as one or several fractions). 

Beta-thalassemias 

They are characterized by the decrease of synthesis of the ß-chains. Only hemoglobin A synthesis is affected. 

Therefore hemoglobin F and hemoglobin A2 percentages are increased with respect to hemoglobin A. 

With CAPILLARYS HEMOGLOBIN(E) procedure, values obtained for different normal hemoglobin fractions allow the detection of beta thalassemias. 

3. Particular cases 

• When there is no hemoglobin A in the sample, a small fraction may be observed in its migration zone ; this fraction may be acetylated hemoglobin 

F which represents about 15 to 25 % of hemoglobin F. The CAPILLARYS system can identify this acetylated hemoglobin separately from the 

hemoglobin A without any confusion. 

• When a small fraction (about 0.5 to 3 %) migrates between hemoglobins F and δA’2 (A2 variant), a hemoglobin A2 variant may be suspected. 

• When a hemoglobin A2 variant is detected (δA’2 or any other A2 variant), it is recommended to add its percentage to hemoglobin A2 for a better 

beta-thalassemia diagnostic. 

• Some hemoglobin variants (such as Hb Camperdown and Hb Okayama) migrate close to Hb A and may not be separated from this hemoglobin. 

• Some hemoglobin variants (such as Hb Porto-Alegre and degraded Hb S) migrate close to Hb F and may not be separated from it. 

• Weak hemoglobin fractions which migrate in zone Z12 are sometimes quantified with imprecision (too asymmetric Hb Bart’s, for example). It is thus 

necessary to delete automatic quantification and then to quantify them manually. 

• When analysing blood samples from newborn babies, Hb A from samples containing Hb F at high concentrations may be disturbed, especially due 

to the presence of degraded Hb F in its migration zone. The Hb A percentage indicated by the software may be overvalued. In addition, when 

hemoglobin variants (> 4 %, such as Hb S, Hb C, Hb E or Hb D-Punjab) are present in blood samples containing high Hb F levels (> 60 %), it is 

necessary to perform complementary analyses in order to confirm the presence of Hb A. 

• For newborn babies until 6 - 9 months old, it is recommended to analyze many blood samples (collected monthly, for example) in order to check the 

Hb F concentration. It will allow to verify the decrease of Hb F concentration and the potential presence of a variant. 

In case of uncertainty, it is advised to confirm by using complementary studies and to analyze parents’ blood samples. 

• Examples with increased hemoglobin F (Hb F) (except for newborn babies): 

- pregnancy ; 

- patients with sickle cell disease, more than 2 years old, with a Hydrea® (hydroxyurea) treatment and / or transfused and / or producing 

naturally Hb F increased by compensation ; 

- patients, aged more than 2 years old, with HPFH trouble (hereditary persistence of foetal hemoglobin exhibiting 20 to 40 % Hb F for 

heterozygous patients) ; 

- patients, more than 2 years old, with leukaemia (with any type), hereditary haemolytic anemia, diabetes, thyroid disease, hyperactivity of 

bone marrow, multiple myeloma, cancer with metastases. 

For further informations, please refer to: http://www.answers.com/topic/fetal-hemoglobin-test. 

• When analysing blood samples from transfused patients with sickle cell disease, with low Hb A level (< 10 %), Hb S fraction may appear shifted 

from Z5 zone to Z6 zone. It is necessary to analyze the hematologic state and to perform complementary studies in order to confirm the presence 

of Hb S. 

Interference and Limitations 

• See SAMPLES FOR ANALYSIS. 


• Avoid aged, improperly stored blood samples ; degradation products (or artefacts) may affect the electrophoretic pattern after 7 days storage. 

• After 10 days storage, viscous aggregates composed in red blood cells may appear, they must be discarded before analysis. 

• When an abnormal hemoglobin is detected, use other means of identification (e.g., globin chain electrophoresis), or consult or send sample to a 

specialized laboratory. 

IMPORTANT: It is also necessary to analyze the hematologic state, as complementary results. 

• The migration of a hemoglobin variant close to Hb A involves an underestimation of Hb A fraction and that of the variant and consequently, an 

overestimation of Hb A2 fraction. In order to quantify Hb A2 with precision, it is necessary to delete the separate integration of both variants and 

Hb A, and to quantify these fractions together. 

• Some homozygous "S" subjects receive a "Hydrea®" (hydroxyurea) treatment that can induce synthesis of foetal hemoglobin. With CAPILLARYS 

HEMOGLOBIN(E) procedure, the mobility of the induced hemoglobin F is not different from the physiological hemoglobin F. 

• Due to the resolution and sensitivity limits of zone electrophoresis, it is possible that some hemoglobin variants may not be detected with this 

method. 

Troubleshooting 

Call SEBIA Technical Service of the supplier when the test fails to perform while the instruction for the preparation and storage of materials, and for 

the procedure were carefully followed. 

Kit reagent Safety Data Sheets and information on waste products elimination are available from the Technical Service of the supplier. 

- 41 -


PERFORMANCE DATA 

Results obtained using the CAPILLARYS HEMOGLOBIN(E) procedure indicate a very good reproducibility for quantitative analysis with a mean CV % 

of about 1.7 % for each hemoglobin component. All electrophoregrams were also interpreted visually. 

Results presented below have been obtained using the standard parameters of the CAPILLARYS software (smoothing 0 and hemoglobin fractions 


Reproducibility within run 

Five (5) different blood samples (normal blood A ; blood B with increased Hb A2 ; bloods C and E with Hb F ; blood F with increased Hb A2 and Hb F 

and S components) were run in 7 capillaries using the CAPILLARYS HEMOGLOBIN(E) procedure with 2 lots of analysis buffer. 

The mean, SD and CV (n = 7) were calculated for each sample, each hemoglobin component and each lot. 

The table shows the values for the 5 tested samples for each hemoglobin component and with the 2 lots of buffer. 

Hemoglobin component Hb A Hb A2 Hb F Hb S 

Blood sample A : lot No. 1 / lot No. 2 

MEAN (%) 97.3 / 97.3 2.7 / 2.7 / / 

SD 0.05 / 0.05 0.05 / 0.05 / / 

CV (%) 0.1 / 0.1 1.8 / 1.8 / / 

Blood sample B : lot No. 1 / lot No. 2 

MEAN (%) 94.3 / 94.5 5.7 / 5.5 / / 

SD 0.06 / 0.08 0.06 / 0.08 / / 

CV (%) 0.1 / 0.1 1.1 / 1.5 / / 

Blood sample C : lot No. 1 / lot No. 2 

MEAN (%) 80.5 / 80.4 2.3 / 2.3 17.2 / 17.3 / 

SD 0.14 / 0.12 0.00 / 0.05 0.14 / 0.08 / 

CV (%) 0.2 / 0.1 0.0 / 2.0 0.8 / 0.5 / 

Blood sample E : lot No. 1 / lot No. 2 

MEAN (%) 96.8 / 96.9 2.4 / 2.3 0.8 / 0.8 / 

SD 0.09 / 0.11 0.05 / 0.03 0.05 / 0.08 / 

CV (%) 0.1 / 0.1 1.9 / 1.5 6.7 / 10.2 / 

Blood sample F : lot No. 1 / lot No. 2 

MEAN (%) 53.4 / 53.7 5.0 / 4.9 9.0 / 8.8 32.6 / 32.6 

SD 0.17 / 0.24 0.05 / 0.07 0.05 / 0.07 0.17 / 0.20 

CV (%) 0.3 / 0.4 1.1 / 1.4 0.6 / 0.8 0.5 / 0.6 

In addition, none of the repeats showed false positive or false negative values. 

Reproducibility between runs 

Eight (8) different blood samples were run 10 times using the CAPILLARYS HEMOGLOBIN(E) procedure with three lots of analysis buffer. The 

samples analyzed included four samples with normal Hb A2 level, and four samples with an abnormal hemoglobin (Hb F or Hb S) and one elevated 

Hb A2. 

The mean, SD and CV (n = 10) of different hemoglobin components were calculated for each sample and each lot. 

The table shows the ranges of hemoglobins values for the 8 tested samples with the three lots of buffer and a mean CV calculated from the pooled 

CV's for all samples (n = 24). 

Hb COMPONENT MEAN (%) SD CV (%) MEAN CV (%) 

Hb A 53.1 - 97.3 0.00 - 0.65 0.0 - 1.1 0.3 

Hb A2 2.4 - 5.0 0.00 - 0.10 0.0 - 2.7 1.5 

Hb F 0.7 - 8.7 0.04 - 0.07 0.7 - 8.8 4.5 

Hb S 30.8 - 42.7 0.19 - 0.63 0.5 - 1.6 0.9 

Reproducibility between lots 

Eight (8) different blood samples (identical as those used for "Reproducibility between runs" study) were run 10 times using the CAPILLARYS 

HEMOGLOBIN(E) procedure with three lots of analysis buffer. The mean, SD and CV (n = 30) of different hemoglobin components were calculated 

for each sample and each lot. 

The table shows the ranges of hemoglobins values for the 8 samples tested with the three lots of buffer and a mean CV calculated from the pooled 

CV's for all samples (n = 3). 


Hb A 53.2 - 97.3 0.04 - 0.77 0.04 - 1.4 0.5 

Hb A2 2.4 - 5.0 0.03 - 0.09 1.0 - 2.2 1.8 

Hb F 0.7 - 8.6 0.06 - 0.08 0.9 - 8.5 4.9 

Hb S 31.1 - 42.0 0.29 - 0.71 0.9 - 1.7 1.3 

In addition, none of the repeats (reproducibility between runs and lots) showed false positive or false negative values. 

Linearity 

Two blood samples were mixed within different proportions and the dilutions were electrophoresed with CAPILLARYS HEMOGLOBIN(E) procedure. 

The test was determined to be linear within the entire range studied. 

In addition, two blood samples from anaemic patients were serially diluted in saline and electrophoresed with CAPILLARYS HEMOGLOBIN(E). The 

test was determined to be linear within the entire range studied from 2.1 to 12.6 g/dL hemoglobin and hemoglobin fractions percentages were not 

affected by the hemoglobin concentration of the samples. 

- 42 -

Linearity (study No. 2 with Hb F) 

Two different umbilical cord blood samples (one containing 15.9 g/dL hemoglobin with 88.2 % Hb F and another containing 25.4 g/dL with 81.6 % 

Hb F) were mixed with a normal control blood sample within different proportions and the dilutions were electrophoresed with CAPILLARYS 

HEMOGLOBIN(E) procedure. The 2 tests gave a good linearity for Hb A, Hb A2 and Hb F within the entire range studied, with a maximum of about 

20.7 g/dL for Hb F (between 0 and 88 % of Hb F). 

Linearity (study No. 3 with Hb A2) 

Two different blood samples (one sample containing 14.3 g/dL hemoglobin with 0.1 % Hb A2 and another containing 13.7 g/dL with 9.5 % Hb A2) were 

mixed within different proportions and the dilutions were electrophoresed with the CAPILLARYS HEMOGLOBIN(E) procedure. The tests gave a good 

linearity for Hb A and Hb A2 within the entire range studied, with a maximum of about 1.3 g/dL for Hb A2 (between 0.1 and 9.5 % of Hb A2). 

Accuracy 

NOTE: The blood samples and their diagnostic assessment, used in the three accuracy studies presented below, were provided by hospitals in Europe. 

The diagnosis was based on HPLC and/or on a routine alkaline gel and acid gel electrophoresis. 

Quantitative Determination of Hb A2 

The levels of Hb A2 were measured in sixty six (66) blood samples with normal and elevated levels of Hb A2 both by electrophoretic separations 

obtained with CAPILLARYS HEMOGLOBIN(E) procedure and a commercially available HPLC system for Hb A2 quantification. 

The measured values of Hb A2 from both procedures were analyzed by a linear regression statistical procedure. The results of linear regression 

analysis are tabulated below (y = CAPILLARYS HEMOGLOBIN(E)) : 

Fraction Correlation coefficient y-Intercept Slope 


Range of % values 


Hb A2 0.947 0.146 0.908 1.6 - 6.0 

Quantitative Determination of Hb F 

The levels of Hb F were measured in seventy four (74) blood samples with normal and elevated levels of Hb F both by electrophoretic separations 

obtained with CAPILLARYS HEMOGLOBIN(E) procedure and a commercially available HPLC system for Hb F quantification. 

The measured values of Hb F from both procedures were analyzed by a linear regression statistical procedure. The results of linear regression analysis 

are tabulated below (y = CAPILLARYS HEMOGLOBIN(E)) : 




Hb F 0.995 -0.339 0.968 0.0 - 44.9 

Quantitative Determination of Hb S 

The levels of Hb S were measured in forty three (43) blood samples with Hb S both by electrophoretic separations obtained with CAPILLARYS 

HEMOGLOBIN(E) procedure and a commercially available HPLC system for Hb S quantification. 

The measured values of Hb S from both procedures were analyzed by a linear regression statistical procedure. The results of linear regression analysis 

are tabulated below (y = CAPILLARYS HEMOGLOBIN(E) ) : 




Hb S 0.994 1.769 1.005 9.1 - 92.7 

Detection of Hemoglobin Abnormalities 

Seventy five (75) different blood samples with hemoglobin variants, such as hemoglobins S, C and E, were analyzed with CAPILLARYS 

HEMOGLOBIN(E) procedure and a commercially available HPLC system for hemoglobins analysis. 

All abnormal hemoglobins or abnormal levels of normal hemoglobins detected with CAPILLARYS HEMOGLOBIN(E) procedure were in agreement 

with the comparative HPLC system, hospital results and clinical diagnosis. There were no case observed of false positive, i.e., detection of an abnormal 

band or abnormal level of a normal band where no such abnormality existed. 

- 43 -

CAPILLARYS HEMOGLOBIN(E) PROCEDURE WITH THE CAPILLARYS 2 FLEX PIERCING SYSTEM 

INTENDED USE 

The CAPILLARYS HEMOGLOBIN(E) kit is designed for the detection and the characterization of hemoglobins in human blood with the SEBIA 

CAPILLARYS 2 FLEX PIERCING system, for capillary electrophoresis. The CAPILLARYS HEMOGLOBIN(E) kit is designed for laboratory use. 

The CAPILLARYS 2 FLEX PIERCING system performs all procedural sequences automatically to obtain a hemoglobin profile. The system 

automatically mixes the blood samples collected in tubes containing EDTA as anticoagulant with hemolysing solution. The hemoglobins, separated in 

silica capillaries, are directly detected by their absorbance at 415 nm. The electrophoregrams are evaluated visually for the pattern abnormalities. 

Direct detection of the hemoglobins provides relative quantification of individual hemoglobin fraction of the normal hemoglobin fractions A, A2, F and 

for the detection of major hemoglobin variants as S, C, E and D using capillary electrophoresis. 


This procedure must be performed with the components of the CAPILLARYS HEMOGLOBIN(E) kit. 


PRINCIPLE OF THE TEST 



part called globin. Polypeptide chains α, ß, δ and γ constitute the normal human hemoglobins: 

• hemoglobin A .............................................. = α2 ß2 

• hemoglobin A2 ............................................ = α2 δ2 

• fetal hemoglobin F ...................................... = α2 γ2 






to quantitative (or regulation) abnormalities, called thalassemias. 


abnormalities (1, 2, 3, 4, 12) . The CAPILLARYS 2 FLEX PIERCING System has been developed to provide complete automation of this testing with fast 

separation and good resolution. In many respects, the methodology can be considered as an intermediary type of technique between classical zone 

electrophoresis and liquid chromatography (8, 11) . 

The CAPILLARYS 2 FLEX PIERCING System uses the principle of capillary electrophoresis in free solution. With this technique, charged molecules 

are separated by their electrophoretic mobility in an alkaline buffer with a specific pH. Separation also occurs according to the electrolyte pH and 

electroosmotic flow (5) . 

The CAPILLARYS 2 FLEX PIERCING System has capillaries functioning in parallel allowing 8 simultaneous analyses for hemoglobin quantification 

from whole blood sample. A sample dilution with hemolysing solution is prepared and injected by aspiration at the anodic end of the capillary. A high 

voltage protein separation is then performed and direct detection of the hemoglobins is made at 415 nm at the cathodic end of the capillary. Before 

each run, the capillaries are washed with a Wash Solution and prepared for the next analysis with buffer. 


hemoglobins. The resulting electrophoregrams are evaluated visually for pattern abnormalities. 

Direct detection provides accurate relative quantification of individual hemoglobin fraction, with particular interest, such as A2 hemoglobin for 

ß thalassemia diagnostic. In addition, the high resolution of this procedure should allow the identification of hemoglobin variants, in particular, to 

differentiate hemoglobins S from D, and E from C. 

The hemoglobin A2 quantification can also be performed when hemoglobin E is present. 

By using alkaline pH buffer, normal and abnormal (or variant) hemoglobins are detected in the following order, from cathode to anode: δA’2 (A2 

variant), C, A2/O-Arab, E, S, D, G-Philadelphia, F, A, Hope, Bart, J, N-Baltimore and H. 

The carbonic anhydrase is not visualized on the hemoglobin electrophoretic patterns, this permits to identify hemoglobin A2 variants in this migration 

zone. 


See the previous part "CAPILLARYS HEMOGLOBIN(E) PROCEDURE WITH THE CAPILLARYS SYSTEM". 


1. NORMAL Hb A2 CONTROL 

Composition 

The Normal Hb A2 Control (SEBIA, PN 4778) is obtained from a pool of normal human blood samples. The Normal Hb A2 Control is in a stabilized 

lyophilised form. 

Intended use 

The Normal Hb A2 Control is designed for the migration control before starting a new analysis sequence, after the analyses of 10 successive 

sample racks and at the end of an analysis sequence, and for the quality control of human hemoglobin A2 quantification with CAPILLARYS 

HEMOGLOBIN(E) electrophoresis procedure performed with the CAPILLARYS 2 FLEX PIERCING system. 

Reconstitute each Normal Hb A2 Control vial with the exact volume of distilled or deionized water, as indicated in the package insert of the Normal 

Hb A2 Control. Allow to stand for 30 minutes and mix gently (avoid formation of foam). 

- 44 -


Migration control: 

IMPORTANT: For optimal use of the Normal Hb A2 Control with the CAPILLARYS 2 FLEX PIERCING system, it is necessary to use one specific tube 

designed for blood controls and its corresponding cap (see "EQUIPMENT AND ACCESSORIES REQUIRED", Tubes and caps for Controls) and to 

identify this tube with one Normal Hb A2 Control bar code label. 

The Normal Hb A2 Control should be used as follows: 

- Apply the reconstituted Normal Hb A2 Control in a tube designed for blood control. 

- Close the tube with its cap. 

- Place a wedge adapter for the blood control tube in position No. 1 on the CAPILLARYS 2 FLEX PIERCING sample rack No. 0 intended for control 

blood sample, containing a new green dilution segment. 

- Place the tube with Normal Hb A2 Control (identified with the Normal Hb A2 Control bar code label) on the wedge adapter on the sample rack No. 0. 

- Start the analysis: Slide the sample rack No. 0 into the CAPILLARYS 2 FLEX PIERCING system, select "Automatic dilution" in the window which 

appears on the screen and validate. 

- After having changed the analysis buffer vial (even if the lot number is identical) or the technique, after a capillary cleaning sequence with 

CAPICLEAN, after a software upgrade or after capillaries activation, perform a second series of analyses with the control, by sliding in again 

immediately the same sample rack No. 0 with the same dilution segment containing the Normal Hb A2 Control, previously diluted during the first 

series and an empty tube for control identified with the Normal Hb A2 Control bar code in position No. 1. In the window called "Hb A2 Normal Control" 

which appears on the screen, select "Manual dilution" and validate. 


IMPORTANT: The hemoglobin A fraction of the Normal Hb A2 Control must show a minimal optical density (OD) of 0.12. Under this value, the 

recentering of the electrophoretic pattern will not occur correctly. When analysing samples, the identification of hemoglobin fractions, Hb A, Hb F, Hb A2 

and Hb C and also the determination of the migration zone of other variants, may be impossible or wrong (see the paragraph RESULT ANALYSIS). 

IMPORTANT: For optimal use of the Normal Hb A2 Control, it is necessary to use one bar code label intended to identify the tube for control which 

contains the Hb A2 Control (close the tube with its specific cap before using it). 

NOTES: For the first use of the "HEMOGLOBIN(E)" analysis program with the CAPILLARYS 2 FLEX PIERCING instrument, it is recommended to 

perform 3 successive series of analyses with the Normal Hb A2 Control. 

After the installation of CAPILLARYS 2 FLEX PIERCING instrument, during the first sequence of blood sample analysis, a red warning signal will 

appear if hemoglobin A is absent in one sample (and the recentering of the electrophoretic pattern will not be possible, see paragraph «Result 

analysis»). 

It is then recommended to analyze a blood sample with hemoglobin A on the concerned capillary and to analyze again the sample without hemoglobin 

A by placing it in a position corresponding to a capillary which has already detected hemoglobin A. 

Quality control: The Normal Hb A2 Control should be used as a normal human blood. After reconstitution, use directly the Normal Hb A2 Control as 

a blood sample to analyze or as a migration control (applied in a tube for control with its cap, identified with one bar code label, and analyzed with the 

sample rack No. 0 using the wedge adapter, see paragraph before). It will be automatically diluted with hemolysing solution. It is recommended to 

include one analysis of Normal Hb A2 Control into each run of samples. The values obtained must fall within the range provided with each batch of 

Hb A2 Control. 

IMPORTANT: For optimal use of the Normal Hb A2 Control placed on a sample rack, it is necessary to use one bar code label intended to identify the 

tube for control which contains the Hb A2 Control (close the tube with its specific cap before using it and place it on a wedge adapter on the sample 

rack). 

Utilization of a wedge adapter for conical tubes intended for controls : 

This yellow wedge adapter is intended to support the conical tubes for blood controls on a sample rack No. 0 or on a rack for samples of the 

CAPILLARYS 2 FLEX PIERCING system. It presents 2 markers which allow estimating of the volume of blood control available to perform the analysis: 

- when the tube is supported by the wedge adapter, the upper marker is located at the top of the wedge adapter and corresponds to a volume of 

about 250 µL of blood control in the tube. When the volume of blood control reaches this level or is higher, it is sufficient to perform the complete 

analysis of this blood control with the sample rack No. 0. 

- when the tube is supported by the wedge adapter, the lower level is located at the bottom of the crenellations and corresponds to a volume of about 

100 µL of blood control in the tube. When the volume of blood control reaches this level or is comprised between the 2 markers of the wedge adapter, 

it is sufficient to perform one analysis of this blood control on a sample rack. 


Before reconstitution, store the lyophilised Normal Hb A2 Control refrigerated (2 to 8 °C). It is stable until the expiration date indicated on the box or 

vial labels. 

Store the reconstituted Normal Hb A2 Control at 2 – 8 °C. Due to the risk of microbial contamination and denaturation, use it within one week. 


IMPORTANT: After storage at 2 – 8 °C or at - 20 °C, homogenize the reconstituted Normal Hb A2 Control before the analysis with the CAPILLARYS 

2 FLEX PIERCING system. 

NOTE: For optimal use with the CAPILLARYS 2 FLEX PIERCING system, it is recommended to split the Control into 4 aliquots of 400 µL in microtubes 

before freezing. 

Before use, store the thawed Normal Hb A2 Control at 2 – 8 °C and use it within the day. Do not freeze and thaw the Control more than 15 times. 

The hemolysed Normal Hb A2 Control should be stored at 2 – 8 °C and used within one day. 

The dilution segment containing the hemolysed Normal Hb A2 Control may be frozen and stored at – 20 °C. Do not freeze and thaw the dilution 

segment with hemolysed Control more than twice. 


NOTE: During transportation, the lyophilized Normal Hb A2 Control can be kept without refrigeration (15 to 30 °C) for 15 days without any adverse 

effects on performance. 

- 45 -


No test method can provide an absolute assurance of the absence of HIV, hepatitis B and C or other infectious agents. Therefore, handle the Normal 

Hb A2 Control as a hazardous biological material. 

This lot of control blood was found negative on assays approved by FDA or EU equivalent regulatory agency: 





Use 

For rinsing capillaries in automated system CAPILLARYS 2 FLEX PIERCING, SEBIA, for capillary electrophoresis. 




3. CAPICLEAN 

Composition 




Use 

For sample probe cleaning in automated system CAPILLARYS 2 FLEX PIERCING, SEBIA, for capillary electrophoresis, during the CAPICLEAN 

cleaning sequence. 






Store CAPICLEAN refrigerated (2 – 8 °C). It is stable until the expiration date indicated on the vial label. DO NOT FREEZE. 



Preparation 



Use 

For the sample probe cleaning in the CAPILLARYS 2 FLEX PIERCING System (weekly maintenance in order to eliminate adsorbed proteins from the 

probe). 

See the instruction sheets of CAPILLARYS 2 FLEX PIERCING, SEBIA. 



• Slide the sample rack No. 100 for maintenance in the CAPILLARYS 2 FLEX PIERCING System. 


validate. 





Preparation 



Use 

For washing the capillaries of CAPILLARYS 2 FLEX PIERCING. This additional reagent is needed when the number of tests in series is below 40. 






Working wash solution is stable for 3 months. Discard working wash solution if it changes its appearance, e.g., becomes cloudy due to microbial 

contamination. 

6. SALINE 

Preparation 


Use 

To wash red blood cells before storage at – 80 °C, if necessary. 




- 46 -



1. CAPILLARYS 2 FLEX PIERCING System SEBIA, PN 1227. 

2. Sample racks supplied with CAPILLARYS 2 FLEX PIERCING. 

3. Container Kit supplied with CAPILLARYS 2 FLEX PIERCING: Rinse (to fill with distilled or deionized water), wash solution and waste container. 

4. Collection tubes with 75 mm length and 13 mm diameter with corresponding caps (maximal length of tube with cap : 82 mm, maximal diameter of 

cap : 17 mm) : BD Vacutainer 13 x 75 mm, Terumo Venosafe 5 mL, Greiner Bio-one Vacuette 1, 2, 3 or 4 mL 13 x 75 mm or collection tubes with 

equivalent dimensions approved for clinical assays. 

5. Tubes and caps for Controls, SEBIA, PN 9202 : 20 conical tubes and their caps to analyze blood controls with the CAPILLARYS 2 FLEX 

PIERCING system. 

6. Wedge adapters for tubes for controls (yellow) SEBIA, PN 9203, 10 units (or supplied with CAPILLARYS 2 FLEX PIERCING). 



Fresh anticoagulated whole blood samples collected in tubes containing EDTA as anticoagulant are recommended for analysis. Avoid anticoagulants 

containing iodoacetate. Blood must be collected according to established procedures used in clinical laboratory testing. 


NOTE: Samples should not be stored at room temperature! Do not store them at – 80 °C without any preparation. 


When the blood sample is stored for more than 7 days at 2 – 8 °C: 

• a weak fraction, corresponding to methemoglobin, appears in the Hb S migration zone, 

• when Hb C is present, a fraction corresponding to degraded Hb C appears more anodic than Hb A2 which does not interfere with it (Z4 zone, see 

the table in paragraph "Interpretation"), 

• when Hb O-Arab is present, a fraction corresponding to degraded Hb O-Arab appears in the Hb S migration zone (Z5 zone, see the table in 

paragraph "Interpretation"), 

• when Hb E is present, a fraction corresponding to degraded Hb E appears in the Z6 zone (see the table in paragraph "Interpretation"), 

• when Hb S is present, a fraction corresponding to degraded Hb S appears in the Hb F migration zone (Z7 zone, see the table in paragraph 

"Interpretation"), 

• when Hb A is present, a fraction corresponding to degraded Hb A ("aging fraction" of Hb A) appears more anodic (Z11 zone, see the table in 

paragraph "Interpretation"). 

When Hb F is present (in blood samples from newborn babies), a fraction appears in the Hb A migration zone (Z9 zone, see the table in paragraph 

"Interpretation") due to the sample degradation. 

When stored for more than 10 days, viscous aggregates in red blood cells are observed ; it is necessary to discard them before the analysis. 

For longer storage, samples can be frozen at – 80 °C within 8 hours of collection after having washed the red blood cells according to the following 

procedure: Centrifuge anticoagulated blood at 5 000 rpm for 5 minutes ; discard the plasma ; wash the red blood cells (RBC) 2 times with 10 volumes 

of saline (centrifuge after each washing step) ; discard the excess of saline over the red blood cells pellet and vortex them before freezing. 


IMPORTANT: For optimal storage of blood samples, store them at – 80 °C. Do not store at – 20 °C (see BIBLIOGRAPHY, J. Bardakdjian-Michau et 

al, 2003). 


• Use directly whole blood samples. 

• Check that all the tubes contain 1 mL minimum of blood and are perfectly closed. 

• Vortex for 5 seconds blood samples stored at 2 – 8 °C for one week. 

WARNING: The tubes must be closed with their corresponding caps designed for the CAPILLARYS HEMOGLOBIN(E) procedure with the 

CAPILLARYS 2 FLEX PIERCING system (see EQUIPMENT AND ACCESSORIES REQUIRED). 

Particular cases: 

Analysis of samples without any Hb A or Hb A2 (these samples are perfectly quantified but not identified by zones): 

To identify hemoglobin fractions in a sample without any hemoglobin A or hemoglobin A2, it is recommended to prepare this sample according to the 

following procedure : 

- Vortex for 5 seconds the whole blood sample. 

- In a conical tube for control, mix one volume (50 µL) of whole blood to analyze with one volume (50 µL) of Normal Hb A2 Control and cap the tube. 


- Place the tube with a wedge adapter on a sample rack of the CAPILLARYS 2 FLEX PIERCING system. 

- Slide the sample rack into the CAPILLARYS 2 FLEX PIERCING system. 



IMPORTANT: For a sample without any Hb A or Hb A2 prepared according to this procedure, the result obtained with the mixed sample will enable 

presumptive variant identification due to the positioning of the hemoglobins fractions in the appropriate identification zones. Do not report the relative 

quantification from the mixed sample result. 

The relative quantification of hemoglobins should be reported utilizing the initial, unmixed sample result (without any dilution in the blood control). 

- 47 -

Analysis of a sample with an additional fraction in Z2 migration zone (Hb C migration zone) or Z3 migration zone (Hb A2 migration zone): 

The presence of a Hb Constant Spring variant may be suspected when a hemoglobin fraction is observed in Z2 or Z3 migration zones. This fraction 

may also be due to plasmatic proteins from the sample (from a patient with anaemia for example, with a decreased [red blood cells] / [plasma] ratio). 

The analysis of red blood cells from the same sample, without plasmatic proteins, will confirm the presence of this variant. 

Prepare the sample according to the following procedure : 

- Centrifuge the whole blood sample at 5 000 rpm for 5 minutes, discard plasma. 

- In a microtube, mix one volume (50 µL) of red blood cells from the sample to analyze with 8 volumes (400 µL) of CAPILLARYS HEMOGLOBIN(E) 

hemolysing solution. 


- Apply 100 µL of prepared hemolysate in the wells of a new green dilution segment. 

- Place this dilution segment on the sample rack No. 0 of CAPILLARYS 2 FLEX PIERCING. 

- Slide the sample rack into the CAPILLARYS 2 FLEX PIERCING system, select "Sample" with "manual dilution" in the window which appears on the 

screen and validate. 


Analysis of samples stored at – 80 °C: 

To analyze a sample stored at – 80 °C, prepare this sample according to the following procedure : 

- Vortex for 5 seconds the tube with thawed red blood cells. 

- In a microtube, mix one volume (50 µL) of red blood cells with 8 volumes (400 µL) of CAPILLARYS HEMOGLOBIN(E) hemolysing solution. 


- Apply 100 µL of prepared hemolysate in the wells of a new green dilution segment. 

- Place this dilution segment on the sample rack No. 0 of CAPILLARYS 2 FLEX PIERCING. 

- Slide the sample rack into the CAPILLARYS 2 FLEX PIERCING system, select "Sample" with "manual dilution" in the window which appears on the 

screen and validate. 


Analysis of samples with volume below 1 mL: 

- Vortex for 5 seconds the whole blood sample. 

- Apply in a conical tube for control 100 µL of whole blood to analyze and cap the tube. 

- Place the tube with a wedge adapter on a sample rack of the CAPILLARYS 2 FLEX PIERCING system. 

- Slide the sample rack into the CAPILLARYS 2 FLEX PIERCING system. 


NOTE : Without any bar code label on the conical tube, the sample cannot be identified. 



• Avoid coagulated blood samples. 

• Avoid aged, improperly stored blood samples ; the automated hemolysis of samples may be disturbed by viscous aggregates in red blood cells. 

Then, degradation products (as artefacts) may affect the electrophoretic pattern. 

In these 2 previous cases, aggregates in red blood cells may affect the collection of the sample by the probe. 

• Do not analyze directly tubes containing less than 1 mL of blood sample, the analysis should be affected (see particular cases). 

PROCEDURE 

The CAPILLARYS 2 FLEX PIERCING system is a multiparameter instrument for hemoglobins analysis on parallel capillaries. The hemoglobins assay 

uses 8 capillaries to run the samples. 


• Bar code reading of sample tubes (for up to 8 tubes) and samples-racks ; 

• Mixing of blood samples before analysis. 

• Sample hemolysis and dilution from primary tubes into dilution segments ; 

• Capillary washing ; 

• Injection of hemolyzed samples ; 



• Placement of sample tubes (with caps) in sample-racks in positions 1 to 8 ; 

• Placement of new dilution segments in sample-racks ; 

• Placement of racks on the CAPILLARYS 2 FLEX PIERCING instrument ; 


PLEASE CAREFULLY READ THE CAPILLARYS 2 FLEX PIERCING INSTRUCTION MANUAL. 


1. Switch on CAPILLARYS 2 FLEX PIERCING instrument and computer. 


3. The CAPILLARYS HEMOGLOBIN(E) kit is intended to run with "HEMOGLOBIN(E)" analysis program from the CAPILLARYS 2 FLEX 

PIERCING instrument. To select "HEMOGLOBIN(E)" analysis program and place the CAPILLARYS HEMOGLOBIN(E) buffer and hemolyzing 

solution vials in the instrument, please read carefully the CAPILLARYS 2 FLEX PIERCING instruction manual. 

4. The sample rack contains 8 positions for sample tubes. Place up to 8 capped sample tubes with whole blood on each sample rack (positions 1 

to 8) ; the bar code of each tube must be visible in the openings of the sample rack. 

IMPORTANT: If the number of tubes to analyze is less than 8, complete the sample rack with capped tubes containing distilled or deionized 

water. 

- 48 -



6. Slide the complete sample carrier(s) into the CAPILLARYS 2 FLEX PIERCING system through the opening in the middle of the instrument. 

Up to 13 sample racks can be introduced successively and continuously into the system. When analyzing a control blood sample, it is 

advised to use the sample rack No. 0 intended for control blood sample with specific tubes, caps and the wedge adapter for tubes 

for controls. 






2. Mixing of tubes. 







20 minutes from the start of the analysis. For the following sample rack, the first three steps (bar code reading, mixing and sample dilution) are 

performed during analysis of the previous sample rack. 


At the end of the analysis, relative quantification of individual hemoglobin fractions is performed automatically and profiles can be analyzed ; the 

hemoglobin fractions, Hb A, Hb F and Hb A2 are automatically identified ; the Hb A fraction is adjusted in the middle of the review window. The resulting 

electrophoregrams are evaluated visually for pattern abnormalities. 

The potential positions of the different hemoglobin variants (identified in zones called Z1 to Z15) are shown on the screen of the system and indicated 

on the result ticket. The table in paragraph "Interpretation" shows known variants which may be present in each corresponding zone. 

When the software identifies a hemoglobin fraction in a defined zone, the name of this zone is framed. 

Patterns are automatically adjusted with regard to Hb A and Hb A2 fractions to facilitate their interpretation: 

- when Hb A and/or Hb A2 fractions are not detected on an electrophoretic pattern, a yellow warning signal appears, the adjustment is performed 

using the position of the Hb A fraction on the two previous patterns obtained with the same capillary ; then, there is no fraction identified (except 

when Hb C is detected : in this case, Hb A2 and Hb C fractions are identified) ; 

- when Hb F is detected on an electrophoretic pattern, without any detection of Hb A, the yellow warning signal does not appear, the adjustment is 

then performed using the position of the Hb F fraction, and Hb F and/or Hb A and/or Hb A2 fractions are identified ; 

- when the adjustment is not possible, a red warning signal appears, Hb F and Hb A2 fractions are then not identified (Call SEBIA). 

In those three cases, the different variant zones (Z1 to Z15) do not appear neither on the screen of the system, nor on the ticket result. 

On the electrophoretic pattern, the curves of Hb A2 and Hb C fractions, are calculated and redrawn by fitting with adjustment (or fitted) and are overlaid 

with the native curve. This display allows the Hb A2 fraction quantification if Hb C is present in the sample. 

WARNING: In some cases of hemoglobin C (homozygous) or after a technical problem, the hemoglobins A2 and C are not fitted ; these 

fractions are then under-quantified. It is then recommended to quantify the Hb A2 fraction by using another technique. 



At the end of each analysis sequence, the operator must initiate the "shut down" procedure of the CAPILLARYS 2 FLEX PIERCING system in order 

to store capillaries in optimal conditions. 


The CAPILLARYS 2 FLEX PIERCING system has a reagent automatic control. 



• Place a new buffer container and / or ; 

• Place a new hemolysing solution container and / or ; 

• Fill the container with working wash solution and / or ; 

• Fill the container with filtered distilled or deionized water for rinsing capillaries and / or ; 






- 49 -



After having changed the analysis buffer lot number or the technique, or after a cleaning sequence with CAPICLEAN, and before starting a new 

analysis sequence, it is necessary to run two analysis sequences with the Normal Hb A2 Control, SEBIA, PN 4778, and the sample rack No. 0 

intended for control blood sample (see paragraph REAGENTS REQUIRED BUT NOT SUPPLIED). 


such as Hb AFSC Control, SEBIA, PN 4792, or a normal blood sample, the Normal Hb A2 Control, SEBIA, PN 4778 or the Pathological Hb A2 Control, 

SEBIA, PN 4779). 

IMPORTANT: For optimal use of the blood controls analyzed with the CAPILLARYS 2 FLEX PIERCING system, it is necessary to use the specific 

conical tubes for controls and their corresponding caps, the wedge adapters for tubes for controls (see EQUIPMENT AND ACCESSORIES 

REQUIRED) and the bar code labels intended to identify the tubes for controls that contain the blood control to analyze (see the paragraph "Normal 

Hb A2 Control" for the utilization of a wedge adapter for tubes for controls). 

* US customers : Follow federal, state and local guidelines for quality control. 

RESULTS 

Values 


Reference values for individual major electrophoretic hemoglobin zones in the CAPILLARYS 2 FLEX PIERCING system have been established from 

a healthy population of 113 adults (men and women) with normal hemoglobin values using HPLC technique: 

Hemoglobin A : comprised between 96.8 and 97.8 % 

Hemoglobin F : < 0.5 % (*) 

Hemoglobin A2 : comprised between 2.2 and 3.2 % 

(*) See Interference and limitations 

It is recommended that each laboratory establish its own threshold values. 

NOTE: Reference values have been established using the standard parameters of the CAPILLARYS software (smoothing 0 and hemoglobin fractions 


WARNING: Reference values must be considered only when hemoglobin variants are absent. 


See ELECTROPHORETIC PATTERNS, figures 1 – 17. 

The different migration zones of hemoglobin variants (called Z1 to Z15) are shown on the screen of the system and on the result ticket. Passing the 









More than 900 variants of adult hemoglobin have been described (6, 14) . The first abnormal hemoglobins studied and the most frequently occuring have 

an altered net electric charge, leading to an easy detection by electrophoresis. 


The CAPILLARYS HEMOGLOBIN(E) kit is intended for the identification of hemoglobinopathies and thalassemias. 

Hemoglobin S 

Hemoglobin S is the most frequent. It is due to the replacement of one glutamic acid (an acidic amino acid No. 6) of the ß-chain by valine (a neutral 

amino acid): when compared to Hb A, its isoelectric point is elevated and its total negative charge decreased with the analysis pH. Its electrophoretic 

mobility is therefore increased in the capillary and this hemoglobin is faster than A fraction. With alkaline buffered CAPILLARYS HEMOGLOBIN(E) 

procedure, hemoglobin S migrates between A and A2 fractions, next to Hb A2. 

Hemoglobin C 

One glutamic acid of the ß-chain is replaced by lysine (a basic amino acid No. 6): its mobility is strongly reduced. When compared to Hb A, its 


the capillary and this hemoglobin is faster than A fraction which allows its differenciation. Hemoglobins C, E and O-Arab are not superimposed on the 

electrophoretic pattern and are easily identified. 

Hemoglobin E 

One glutamic acid of the ß-chain (No. 26) is replaced by lysine. With CAPILLARYS HEMOGLOBIN(E) procedure, hemoglobin E migrates just 

anodically behind hemoglobin A2 and is totally separated from it. Then, when hemoglobin E is present, A2 fraction can be measured to detect 

ß thalassemia. 

- 50 -



One glutamic acid of the ß-chain (No. 121) is replaced by lysine. With CAPILLARYS HEMOGLOBIN(E) procedure, hemoglobin O-Arab migrates 

exactly like hemoglobin A2. In such a case, hemoglobin A2 can not be quantified. When this fraction is > 9 %, hemoglobin O-Arab must be suspected. 

Note that Hb O-Arab migrates separately from hemoglobins C and E. 


One glutamic acid of the ß-chain (No. 121) is replaced by glutamine. With CAPILLARYS HEMOGLOBIN(E) procedure, hemoglobin D (called D-Punjab, 

D-Los Angeles, D-Chicago or D-Portugal) migrates behind hemoglobin S, this property allows to differenciate S and D hemoglobins. 






They are characterized by the decrease of synthesis of the α-chains, consequently affecting the synthesis of all normal hemoglobins. The excess of 

synthesis of the ß- and γ-chains in relation to α-chains induces the formation of tetrameres without any α-chain: 

• hemoglobin Bart = γ4, 

• hemoglobin H = ß4. 

Hemoglobin H presents a low isoelectric point ; with CAPILLARYS HEMOGLOBIN(E) procedure, it migrates more anodic than hemoglobin A (and may 

appear as one or several fractions). 


They are characterized by the decrease of synthesis of the ß-chains. Only hemoglobin A synthesis is affected. 

Therefore hemoglobin F and hemoglobin A2 percentages are increased with respect to hemoglobin A. 

With CAPILLARYS HEMOGLOBIN(E) procedure, values obtained for different normal hemoglobin fractions allow the detection of beta thalassemias. 


• When there is no hemoglobin A in the sample, a small fraction may be observed in its migration zone ; this fraction may be acetylated hemoglobin 

F which represents about 15 to 25 % of hemoglobin F. The CAPILLARYS 2 FLEX PIERCING system can identify this acetylated hemoglobin 

separately from the hemoglobin A without any confusion. 

• When a small fraction (about 0.5 to 3 %) migrates between hemoglobins F and δA’2 (A2 variant), a hemoglobin A2 variant may be suspected. 

• When a hemoglobin A2 variant is detected (δA’2 or any other A2 variant), it is recommended to add its percentage to hemoglobin A2 for a better 

beta-thalassemia diagnostic. 

• Some hemoglobin variants (such as Hb Camperdown and Hb Okayama) migrate close to Hb A and may not be separated from this hemoglobin. 

• Some hemoglobin variants (such as Hb Porto-Alegre and degraded Hb S) migrate close to Hb F and may not be separated from it. 

• Weak hemoglobin fractions which migrate in zone Z12 are sometimes quantified with imprecision (too asymmetric Hb Bart’s, for example). It is thus 

necessary to delete automatic quantification and then to quantify them manually. 

• Weak fractions may be observed in Z14 and Z15 migration zones. It is then necessary to analyze the hematologic state of the patient and to perform 

complementary analyses in order to characterize these fractions (artefact or hemoglobin abnormality). 





• For newborn babies until 6 – 9 months old, it is recommended to analyze many blood samples (collected monthly, for example) in order to check 

the Hb F concentration. It will allow to verify the decrease of Hb F concentration and the potential presence of a variant. In case of uncertainty, it is 

advised to confirm by using complementary studies and to analyze parents’ blood samples. 

• Examples with increased hemoglobin F (Hb F) (except for newborn babies): 

- pregnancy ; 

- patients with sickle cell disease, more than 2 years old, with a Hydrea® (hydroxyurea) treatment and/or transfused and/or producing naturally Hb F 

increased by compensation ; 

- patients, aged more than 2 years old, with HPFH trouble (hereditary persistence of foetal hemoglobin exhibiting 20 to 40 % Hb F for heterozygous 

patients) ; 

- patients, more than 2 years old, with leukaemia (with any type), hereditary haemolytic anemia, diabetes, thyroid disease, hyperactivity of bone 

marrow, multiple myeloma, cancer with metastases. 

For further informations, please refer to: http://www.answers.com/topic/fetal-hemoglobin-test 

• When analysing blood samples from transfused patients with sickle cell disease, with low Hb A level (< 10 %), Hb S fraction may appear shifted 

from Z5 zone to Z6 zone. It is necessary to analyze the hematologic state and to perform complementary studies in order to confirm the presence 

of Hb S. 



• Analyze only blood samples contained in collection tubes indicated in the paragraph "EQUIPMENT AND ACCESSORIES REQUIRED" or tubes with 

equivalent dimensions approved for clinical assays. Call SEBIA technical service for further information on these devices. 

• Do not analyze directly tubes containing less than 1 mL of blood sample. 

• Avoid aged, improperly stored blood samples ; degradation products (or artefacts) may affect the electrophoretic pattern after 7 days storage. 


• When analysing blood samples with a decreased [red blood cells] / [plasma] ratio (from patients with anaemia), a hemoglobin Constant Spring 

variant may be suspected when a fraction is observed in Z2 or Z3 migration zones. This fraction may be due to plasmatic proteins present in the 

sample (see § Sample preparation, Particular cases). 

- 51 -





• The migration of a hemoglobin variant close to Hb A involves an underestimation of Hb A fraction and that of the variant and consequently, an 

overestimation of Hb A2 fraction. In order to quantify Hb A2 with precision, it is necessary to delete the separate integration of both variants and 

Hb A, and to quantify these fractions together. 

• Some homozygous "S" subjects receive a "Hydrea"® (hydroxyurea) treatment that can induce synthesis of foetal hemoglobin. With CAPILLARYS 

HEMOGLOBIN(E) procedure, the mobility of the induced hemoglobin F is not different from the physiological hemoglobin F. 


method. 





PERFORMANCE DATA 

Results obtained using the CAPILLARYS HEMOGLOBIN(E) procedure with the CAPILLARYS 2 FLEX PIERCING system indicate a very good 

reproducibility for quantitative analysis with a mean CV % of about 0.9 % for each hemoglobin component. All electrophoregrams were also interpreted 

visually. 

Results presented below have been obtained using the standard parameters of the CAPILLARYS software (smoothing 0 and hemoglobin fractions 


Reproducibility within run 

Six (6) different blood samples (normal bloods A and E, blood F with increased Hb A2, blood B with Hb S, blood C with increased Hb F and blood G 

with Hb F, S and C components) were run using the CAPILLARYS HEMOGLOBIN(E) procedure in 8 capillaries of 3 CAPILLARYS 2 FLEX PIERCING 

systems and with 3 lots of CAPILLARYS HEMOGLOBIN(E) kits. 

The mean, SD and CV (n = 8) were calculated for each hemoglobin component, each sample, each lot of kit and each system. 

The table shows the values for the 6 tested samples for each hemoglobin component calculated with the 3 lots of kit and the 3 CAPILLARYS 2 FLEX 

PIERCING systems. 

Hemoglobin component Hb A Hb A2 Hb F Hb S Hb C 

Blood sample A : lot No. 1 & system No. 1 - lot No. 2 & system No. 2 - lot No. 3 & system No. 3 

MEAN (%) 97.4 - 97.35 - 97.4 2.6 - 2.65 - 2.6 / / / 

SD 0.03 - 0.05 - 0.05 0.03 - 0.05 - 0.05 / / / 

CV (%) 0.03 - 0.1 - 0.05 1.3 - 1.9 - 1.8 / / / 

Blood sample B : lot No. 1 & system No. 1 - lot No. 2 & system No. 2 - lot No. 3 & system No. 3 

MEAN (%) 58.1 - 58.1 - 58.0 3.0 - 3.0 - 3.0 / 38.9 - 38.9 - 39.0 / 

SD 0.10 - 0.16 - 0.06 0.05 - 0.03 - 0.03 / 0.12 - 0.17 - 0.05 / 

CV (%) 0.2 - 0.3 - 0.1 1.7 - 1.1 - 1.1 / 0.3 - 0.4 - 0.1 / 

Blood sample C : lot No. 1 & system No. 1 - lot No. 2 & system No. 2 - lot No. 3 & system No. 3 

MEAN (%) 83.0 - 83.0 - 83.14 2.3 - 2.3 - 2.32 14.7 - 14.7 - 14.54 / / 

SD 0.08 - 0.13 - 0.10 0.03 - 0.03 - 0.04 0.05 - 0.10 - 0.10 / / 

CV (%) 0.1 - 0.2 - 0.1 1.4 - 1.4 - 1.9 0.3 - 0.7 - 0.7 / / 

Blood sample E : lot No. 1 & system No. 1 - lot No. 2 & system No. 2 - lot No. 3 & system No. 3 

MEAN (%) 97.5 - 97.4 - 97.3 2.5 - 2.6 - 2.7 / / / 

SD 0.04 - 0.04 - 0.07 0.04 - 0.04 - 0.07 / / / 

CV (%) 0.04 - 0.04 - 0.1 1.7 - 1.7 - 2.5 / / / 

Blood sample F : lot No. 1 & system No. 1 - lot No. 2 & system No. 2 - lot No. 3 & system No. 3 

MEAN (%) 93.6 - 93.6 - 93.25 6.4 - 6.4 - 6.75 / / / 

SD 0.07 - 0.16 - 0.11 0.07 - 0.16 - 0.11 / / / 

CV (%) 0.1 - 0.2 - 0.1 1.1 - 2.5 - 1.7 / / / 

Blood sample G : lot No. 1 & system No. 1 - lot No. 2 & system No. 2 - lot No. 3 & system No. 3 

MEAN (%) 50.1 - 50.05 - 48.85 2.2 - 2.25 - 2.45 24.5 - 24.57 - 24.26 18.7 - 18.59 - 19.66 4.5 - 4.54 - 4.78 

SD 0.25 - 0.19 - 0.21 0.04 - 0.05 - 0.09 0.08 - 0.11 - 0.10 0.19 - 0.11 - 0.11 0.08 - 0.05 - 0.04 

CV (%) 0.5 - 0.4 - 0.4 1.9 - 2.2 - 3.5 0.3 - 0.4 - 0.4 1.0 - 0.6 - 0.6 1.8 - 1.1 - 0.9 

In addition, none of the repeats showed false positive or false negative values. 

- 52 -


Reproducibility between runs 

Eight (8) different blood samples were run 10 times using the CAPILLARYS HEMOGLOBIN(E) procedure on 3 CAPILLARYS 2 FLEX PIERCING 

systems and with 3 lots of CAPILLARYS HEMOGLOBIN(E) kits (1 lot per system). The analyzed samples included 3 samples with normal Hb A2 level, 

1 sample with elevated Hb A2 level, 1 sample with elevated Hb F level and 3 samples with abnormal hemoglobins (Hb S or Hb C or Hb E). The mean, 

SD and CV (n = 10) were calculated for each sample, each hemoglobin component, each lot of kit and each system. 

The table shows the ranges of hemoglobins values for the 8 tested blood samples on the 3 CAPILLARYS 2 FLEX PIERCING systems with the 3 lots 

of kits and a mean CV calculated from the pooled CV's for each hemoglobin component (n = 24 for Hb A and Hb A2, n = 6 for Hb F and Hb S, n = 3 

for Hb C and Hb E). 


Hb A 49.0 - 97.5 0.03 - 0.22 0.03 - 0.3 0.1% 

Hb A2 2.2 - 6.6 0.00 - 0.22 0.0 - 3.4 1.7% 

Hb F 7.5 - 24.5 0.05 - 0.11 0.3 - 1.2 0.6% 

Hb S 18.4 - 37.0 0.05 - 0.14 0.2 - 0.6 0.3% 

Hb C 4.5 - 4.7 0.03 - 0.05 0.7 - 1.1 0.9% 

Hb E 26.1 - 26.4 0.08 - 0.13 0.3 - 0.5 0.4% 

Reproducibility between lots and between systems 

Eight (8) different blood samples (identical as those assayed for the "Reproducibility between runs" study) were run 10 times using the CAPILLARYS 

HEMOGLOBIN(E) procedure on 3 CAPILLARYS 2 FLEX PIERCING systems and with 3 lots of CAPILLARYS HEMOGLOBIN(E) kits (1 lot per 

system). The mean, SD and CV (n = 30) were calculated for each sample, for each hemoglobin component with the 3 lots of kits and the 

3 CAPILLARYS 2 FLEX PIERCING systems. 

The table shows the ranges of hemoglobins values for the 8 samples tested on the 3 CAPILLARYS 2 FLEX PIERCING systems and with the 3 lots 

and a mean CV calculated from the pooled CV's for all samples (n = 8 for Hb A and Hb A2, n = 2 for Hb F and Hb S, n = 1 for Hb C and Hb E). 


Hb A 49.7 - 97.4 0.05 - 0.57 0.1 - 1.1 0.3% 

Hb A2 2.3 - 6.5 0.03 - 0.18 1.2 - 4.9 2.5% 

Hb F 7.7 - 24.5 0.12 - 0.13 0.5 - 1.5 1.0% 

Hb S 18.9 - 36.7 0.26 - 0.46 0.7 - 2.4 1.6% 

Hb C 4.6 0.10 2.2 2.2% 

Hb E 26.2 0.15 0.6 0.6% 

In addition, none of the repeats (reproducibility between runs, systems and lots) showed false positive or false negative values. 

Linearity 

Different characteristic blood samples were mixed by pairs within different proportions and the dilutions were electrophoresed with the CAPILLARYS 

HEMOGLOBIN(E) procedure. The tests were determined to be linear within the entire ranges studied for each of the hemoglobin fraction (Hb A, Hb F, 

Hb S and Hb A2). 

In addition, three different characteristic blood samples were also serially diluted in saline and electrophoresed with the CAPILLARYS 

HEMOGLOBIN(E) procedure. The tests were determined to be linear within the entire ranges studied from 1.1 to 36.0 g/dL total hemoglobin and 

hemoglobin fractions percentages were not affected by the hemoglobin concentration of the samples. 

Hb A2 linearity 

Two different blood samples (one sample containing 13.4 g/dL hemoglobin with 0.0 % Hb A2 and another containing 13.2 g/dL with 9.8 % Hb A2) were 

mixed within different proportions and the dilutions were electrophoresed with the CAPILLARYS HEMOGLOBIN(E) procedure. The tests gave a good 

linearity for Hb A and Hb A2 hemoglobin fractions within the entire range studied, with a maximum of about 1.3 g/dL for Hb A2 (between 0.0 and 9.8 % 

of Hb A2). 

In addition, a normal blood sample (containing 13.3 g/dL hemoglobin with 2.7 % Hb A2) was concentrated twice and serially diluted in saline and 

electrophoresed with the CAPILLARYS HEMOGLOBIN(E) procedure. The tests were determined to be linear within the entire range studied from 26.6 

to 1.3 g/dL total hemoglobin and Hb A2 fraction percentages were not affected by the hemoglobin concentration of the samples. 

Hb F linearity 

One umbilical cord blood sample (containing 18.0 g/dL hemoglobin with 86.0 % Hb F) was mixed with a normal blood sample (containing 13.4 g/dL 

hemoglobin with 0.0 % Hb F) within different proportions and the dilutions were electrophoresed with the CAPILLARYS HEMOGLOBIN(E) procedure. 

The tests gave a good linearity for Hb A, Hb A2 and Hb F hemoglobin fractions within the entire range studied. 

The CAPILLARYS HEMOGLOBIN(E) tests gave a good linearity for Hb F hemoglobin fraction within the entire range studied, with a maximum of about 

15.5 g/dL for Hb F (between 0.0 and 86.0 % of Hb F). 

In addition, this same umbilical cord blood sample (containing 18.0 g/dL hemoglobin with 86.0 % Hb F) was concentrated twice and serially diluted in 

saline and electrophoresed with the CAPILLARYS HEMOGLOBIN(E) procedure. The tests were determined to be linear within the entire range studied 

from 36.0 to 1.8 g/dL total hemoglobin and Hb F fraction percentages were not affected by the hemoglobin concentration of the samples. 

Hb S linearity 

One blood sample with Hb S (containing 11.5 g/dL hemoglobin with 39.8 % Hb S) was mixed with a normal blood sample without Hb S (containing 

13.4 g/dL hemoglobin) within different proportions and the dilutions were electrophoresed with the CAPILLARYS HEMOGLOBIN(E) procedure. The 

tests gave a good linearity for Hb A, Hb S and Hb A2 hemoglobin fractions within the entire range studied, with a maximum of about 4.6 g/dL for Hb S 

(between 0.0 and 39.8 % of Hb S). 

- 53 -


In addition, this same blood sample with Hb S (containing 11.5 g/dL hemoglobin with 39.8 % Hb S) was concentrated twice and serially diluted in saline 

and electrophoresed with the CAPILLARYS HEMOGLOBIN(E) procedure. The tests were determined to be linear within the entire range studied from 

23.0 to 1.1 g/dL total hemoglobin and Hb S fraction percentages were not affected by the hemoglobin concentration of the samples. 

Accuracy – Internal correlation No. 1 

NOTE : The blood samples and their diagnostic assessment, used in the five accuracy studies presented below, were provided by 5 hospital 

laboratories in France. The diagnosis was based on a routine HPLC procedure. 


The levels of Hb A2 were measured in two hundred and forty three (243) blood samples with normal and elevated levels of Hb A2 both by 

electrophoretic separations obtained with the CAPILLARYS HEMOGLOBIN(E) procedure with the CAPILLARYS 2 FLEX PIERCING system and a 

commercially available capillary electrophoresis system for Hb A2 quantification. 






Hb A2 0.993 0.024 1.012 0.0 - 6.5 


The levels of Hb F were measured in one hundred and ten (110) blood samples with normal and elevated levels of Hb F both by electrophoretic 

separations obtained with the CAPILLARYS HEMOGLOBIN(E) procedure with the CAPILLARYS 2 FLEX PIERCING system and a commercially 

available capillary electrophoresis system for Hb F quantification. 






Hb F 0.999 0.184 0.997 0.2 - 62.5 


The levels of Hb S were measured in seventy four (74) blood samples with Hb S both by electrophoretic separations obtained with the CAPILLARYS 

HEMOGLOBIN(E) procedure with the CAPILLARYS 2 FLEX PIERCING system and a commercially available capillary electrophoresis system for 

Hb S quantification. 






Hb S 0.999 -0.173 0.998 1.8 - 92.6 

Quantitative Determination of Hb C and Hb E 

The levels of Hb C and Hb E were measured in, respectively, 14 and 9 blood samples both by electrophoretic separations obtained with the 

CAPILLARYS HEMOGLOBIN(E) procedure with the CAPILLARYS 2 FLEX PIERCING system and a commercially available capillary electrophoresis 

system for Hb C and Hb E quantification. 

The measured values of Hb C and Hb E from both procedures were analyzed by a linear regression statistical procedure. The results of linear 

regression analysis are tabulated below (y = CAPILLARYS HEMOGLOBIN(E)) : 




Hb C 0.999 -0.134 0.995 4.6 – 40.9 

Hb E 0.999 0.754 0.983 11.4 – 92.9 


Two hundred and forty three (243) different blood samples, including 106 samples with hemoglobin variants, such as hemoglobins S, C, D and E, were 

analyzed with the CAPILLARYS HEMOGLOBIN(E) procedure with the CAPILLARYS 2 FLEX PIERCING system and a commercially available capillary 

electrophoresis system for hemoglobins analysis. 

All abnormal hemoglobins or abnormal levels of normal hemoglobins detected with the CAPILLARYS HEMOGLOBIN(E) procedure were in agreement 

with the comparative capillary electrophoresis system, hospital results and clinical diagnosis. There was no case observed of false positive, i.e., 

detection of an abnormal band or abnormal level of a normal band where no such abnormality existed. 

Accuracy – Internal correlation No. 2 

NOTE : The blood samples and their diagnostic assessment, used in the five accuracy studies presented below, were provided by 1 hospital laboratory 

in France. The diagnosis was based on a routine HPLC procedure. 

- 54 -



The levels of Hb A2 were measured in seventy two (72) blood samples with normal and elevated levels of Hb A2 both by electrophoretic separations 

obtained with the CAPILLARYS HEMOGLOBIN(E) procedure with the CAPILLARYS 2 FLEX PIERCING system and a commercially available HPLC 

system for Hb A2 quantification. 






Hb A2 0.971 0.398 0.852 0.6 – 4.6 


The levels of Hb F were measured in sixty (60) blood samples with normal and elevated levels of Hb F both by electrophoretic separations obtained 

with the CAPILLARYS HEMOGLOBIN(E) procedure with the CAPILLARYS 2 FLEX PIERCING system and a commercially available HPLC system 

for Hb F quantification. 






Hb F 0.990 -0.471 1.229 0.0 – 13.1 


The levels of Hb S were measured in nine (9) blood samples with Hb S both by electrophoretic separations obtained with the CAPILLARYS 

HEMOGLOBIN(E) procedure with the CAPILLARYS 2 FLEX PIERCING system and a commercially available HPLC system for Hb S quantification. 






Hb S 0.999 -1.594 1.089 26.7 – 91.5 

Quantitative Determination of Hb C 

The levels of Hb C were measured in four (4) blood samples with Hb C both by electrophoretic separations obtained with the CAPILLARYS 

HEMOGLOBIN(E) procedure with the CAPILLARYS 2 FLEX PIERCING system and a commercially available HPLC system for Hb C quantification. 

The measured values of Hb C from both procedures were analyzed by a linear regression statistical procedure. The results of linear regression 





Hb C 0.997 4.965 0.788 25.9 – 35.6 


Seventy two (72) different blood samples, including 15 samples with hemoglobin variants such as hemoglobins S and C, were analyzed with the 

CAPILLARYS HEMOGLOBIN(E) procedure with the CAPILLARYS 2 FLEX PIERCING system and a commercially available HPLC system for 

hemoglobins analysis. 


with the comparative HPLC system, hospital results and clinical diagnosis. There was no case observed of false positive, i.e., detection of an abnormal 

band or abnormal level of a normal band where no such abnormality existed. 

Accuracy – External correlations 

NOTE: The results presented below have been obtained from 2 external accuracy studies that have been performed in 1 laboratory located in France 

and in 1 laboratory located in the USA. The diagnosis was based on a routine HPLC. 

In France, the levels of hemoglobin fractions were measured in 307 blood samples, including 34 samples with hemoglobin variants such as 

hemoglobins S and C, both by electrophoretic separations obtained with the CAPILLARYS HEMOGLOBIN(E) procedure with the CAPILLARYS 

2 FLEX PIERCING system and a commercially available HPLC system for hemoglobins analysis. 

The measured values of hemoglobin fractions from both procedures were analyzed by a linear regression statistical procedure. The results of linear 

regression analysis for Hb A2, Hb F, Hb S and Hb C are tabulated below (y = CAPILLARYS HEMOGLOBIN(E)) : 

Hb fraction 

Number of samples 

Correlation 

coefficient 

y-Intercept 

Slope 

Range of Hb % values 


Hb A2 307 0.990 0.228 0.917 0.9 – 6.6 

Hb F 124 0.993 -0.150 1.036 0.2 – 21.9 

Hb S 26 0.997 1.077 0.992 18.5 – 64.1 

Hb C 8 0.985 -4.732 1.041 30.4 – 36.7 

- 55 -



with the comparative HPLC system and clinical diagnosis. There was no case observed of false positive, i.e., detection of an abnormal band or 

abnormal level of a normal band where no such abnormality existed. 

In USA, the levels of hemoglobin fractions were measured in 59 blood samples, including 19 samples with hemoglobin variants such as hemoglobins 

S, C and other variants, by electrophoretic separations obtained with the CAPILLARYS HEMOGLOBIN(E) procedure with the CAPILLARYS 2 FLEX 

PIERCING system and 2 commercially available systems for hemoglobins analysis by capillary electrophoresis (CE) and HPLC. 

The measured values of hemoglobin fractions from all 3 procedures were analyzed by a linear regression statistical procedure. The results of linear 

regression analysis for Hb A, Hb A2, Hb F and Hb S are tabulated below (y = CAPILLARYS HEMOGLOBIN(E)) : 

Correlation coefficient y-Intercept Slope Range of Hb % values 

Hb fraction Number of samples 

CAPILLARYS 

CE HPLC CE HPLC CE HPLC HEMOGLOBIN(E) 

Hb A 59 0.999 0.996 -0.340 3.145 1.003 0.965 43.7 – 98.7 

Hb A2 57 0.990 0.880 -0.087 0.515 1.026 0.773 1.3 – 5.6 

Hb F 22 0.999 0.999 0.033 0.304 1.009 1.019 0.0 – 31.8 

Hb S 13 0.996 0.995 1.087 -0.546 0.983 1.047 14.3 – 49.0 

All abnormal hemoglobins (S, C and other variants) or abnormal levels of normal hemoglobins detected with the CAPILLARYS HEMOGLOBIN(E) 

procedure were in agreement with the 2 comparative capillary electrophoresis and HPLC systems and clinical diagnosis. There was no case observed 

of false positive, i.e., detection of an abnormal band or abnormal level of a normal band where no such abnormality existed. 

- 56 -


CAPILLARYS CORD BLOOD PROCEDURE WITH THE CAPILLARYS SYSTEM 

INTENDED USE 

The CAPILLARYS CORD BLOOD procedure is designed for the separation of the normal hemoglobins (F and A) in umbilical cord blood samples from 

human new-borns, and for the detection of the major hemoglobin variants (especially S, C, E, D and Bart’s), by electrophoresis in alkaline buffer 

(pH 9.4) with the CAPILLARYS System. 

The CAPILLARYS performs all sequences automatically to obtain a complete hemoglobin profile for the qualitative or quantitative analysis of 

hemoglobins. The assay is performed on sedimented, centrifuged or washed red blood cells; washing red blood cells is not essential to perform the 

analysis. 

This procedure must be performed with the components of the CAPILLARYS HEMOGLOBIN(E) kit. 


hemoglobins. 

The resulting electrophoregrams are evaluated automatically for pattern abnormalities with identification of normal and pathological patterns. Direct 

detection provides accurate relative quantification of individual hemoglobin fraction. The sickle cell disease diagnosis is improved due to the separation 

of the different hemoglobin fractions which enables the differentiation of hemoglobin S from other hemoglobin variants. 


PRINCIPLE OF THE TEST (1-19) 



part called globin. Polypeptide chains α, ß, δ and γ constitute the normal human hemoglobins : 

• hemoglobin A............................................... = α2 ß2 

• hemoglobin A2............................................. = α2 δ2 

• fetal hemoglobin F....................................... = α2 γ2 






to quantitative (or regulation) abnormalities, called thalassemias (5, 16) . 


abnormalities (1, 2, 3, 4, 12) . The CAPILLARYS System has been developed to provide complete automation of this testing with fast separation and good 

resolution. In many respects, the methodology can be considered as an intermediary type of technique between classical zone electrophoresis and 

liquid chromatography (6, 9) . 

The CAPILLARYS System uses the principle of capillary electrophoresis in free solution. With this technique, charged molecules are separated by 

their electrophoretic mobility in an alkaline buffer with a specific pH. Separation also occurs according to the electrolyte pH and electroosmotic flow (5) . 

The CAPILLARYS System has capillaries functioning in parallel allowing 7 simultaneous analyses for hemoglobin quantification. A sample dilution with 

hemolyzing solution is prepared and injected by aspiration at the anodic end of the capillary. A high voltage protein separation is then performed and 

direct detection of the hemoglobins is made at 415 nm at the cathodic end of the capillary. Before each run, the capillaries are washed with a Wash 

Solution and prepared for the next analysis with buffer. The hemoglobins, separated in silica capillaries, are directly and specifically detected at an 

absorbance wave length of 415 nm which is specific to hemoglobins. The resulting electrophoregrams are evaluated visually for pattern abnormalities. 

By using alkaline pH buffer, normal and abnormal (or variant) hemoglobins are detected in the following order, from cathode to anode : C, A2/O-Arab, 

F-Ouled Rabah, E, S, D, G-Philadelphia, Korle-Bu, F, degraded F, A, degraded A and Bart’s. Variants generated by the mutation of the gamma chain 

may appear in different zones of the electrophoretic pattern. 

The carbonic anhydrase is not visualized on the hemoglobin electrophoretic patterns with capillary electrophoresis. 


See the previous part "CAPILLARYS HEMOGLOBIN(E) PROCEDURE WITH THE CAPILLARYS SYSTEM". 


1. Hb AF CONTROL 

Composition 

The Hb AF Control (SEBIA, PN 4777) is obtained from a pool of normal blood samples from human adults and from new-borns umbilical cord blood 

samples. The Hb AF Control is in a stabilized lyophilized form. 

Intended use 

The Hb AF Control is designed for the migration control before starting a new analysis sequence, and for the quality control of the human 

hemoglobin F detection by electrophoresis with the CAPILLARYS CORD BLOOD procedure. 

Reconstitute the Hb AF Control vial with the exact volume of distilled or deionized water, as indicated in the package insert of the Hb AF Control. Allow 

to stand for 30 minutes and mix gently (avoid formation of foam). 

- 57 -


Migration control: The Hb AF Control should be used as follows : 

- Apply the reconstituted Hb AF Control in a microtube. 


- Place the microtube, located on a new hemolyzing tube used as a support tube (and identified with the bar code label specific to the Hb AF Control), 

in position No. 1 on the CAPILLARYS sample rack No. 0 intended for control blood sample, and a new dilution segment. 

- Pour 4 mL of CAPILLARYS HEMOGLOBIN(E) hemolyzing solution in a hemolyzing tube without introducing air bubbles and place it in position No. 8 



- Start the analysis: Slide the sample rack No. 0 into the CAPILLARYS system, select "automatic dilution" in the window which appears on the screen 

and validate. 

- After having changed the analysis buffer vial (even if the lot number is unchanged) or the technique, after a capillary cleaning sequence 

with CAPICLEAN or after capillaries activation, perform a second series of analyses with the control, by sliding in again immediately the sample 

rack No. 0 with the same dilution segment containing the Hb AF Control, previously diluted during the first series (remove the microtube containing 

the Hb AF Control and let the support tube identified with the bar code label on the sample rack). 

- In the window called "Hb AF Control" which appears on the screen, select "manual dilution" and validate. 


IMPORTANT: For optimal use of the Hb AF Control with the CAPILLARYS System, it is necessary to use one bar code label intended to identify the 

hemolyzing tube holding the microtube which contains the Hb AF Control (cut the cap of the microtube before using it). 

NOTE: For the first use of the "CORD BLOOD" analysis program with the CAPILLARYS instrument, it is recommended to perform 3 successive series 

of analyses with the Hb AF Control. 

Quality control: The Hb AF Control should be used as a normal human blood. After reconstitution, use directly the Hb AF Control as a blood sample 

to analyze or as a migration control (with the sample rack No. 0, see the paragraph before). It will be automatically diluted with hemolyzing solution. 

It is recommended to include the Hb AF Control into each series of analysis. 

IMPORTANT: For optimal use of the Hb AF Control with the CAPILLARYS System, it is necessary to use one bar code label intended to identify the 

hemolyzing tube holding the microtube which contains the Hb AF Control (cut the cap of the microtube before using it). 


Before reconstitution, store the lyophilized Hb AF Control refrigerated (2 to 8 °C). It is stable until the expiration date indicated on the box or vial labels. 

Store the reconstituted Hb AF Control at 2 - 8 °C. Due to the risk of microbial contamination and denaturation, use it within one week. 


IMPORTANT: After storage at 2 - 8 °C or at - 20 °C, homogenize the reconstituted Hb AF Control before the analysis with the CAPILLARYS system. 

Before use, store the thawed Hb AF Control at 2 - 8 °C and use it within the day, after homogeneization. Do not freeze and thaw the Control more 

than 7 times. 

The hemolyzed Hb AF Control should be stored at 2 - 8 °C and used within 2 hours after dilution with the CAPILLARYS system. 

The dilution segment containing the hemolysed Hb AF Control may be frozen and stored at - 20 °C. Do not freeze and thaw the dilution segment with 

hemolysed Control more than three times. 


No test method can provide an absolute assurance of the absence of HIV, hepatitis B and C or other infectious agents. Therefore, handle the Hb AF 

Control as a hazardous biological material. 

This control was found negative on assays approved by FDA or EU equivalent regulatory agency : 




NOTE: During transportation, the lyophilized Hb AF Control can be kept without refrigeration (15 to 30 °C) for 15 days without any adverse effects on 

performance. 


Use 

For rinsing capillaries in automated system CAPILLARYS, SEBIA, for capillary electrophoresis. 




3. CAPICLEAN 

Composition 




Use 

For sample probe cleaning in automated system CAPILLARYS, SEBIA, for capillary electrophoresis, during the CAPICLEAN cleaning sequence. 





- 58 -



Store CAPICLEAN refrigerated (2 - 8 °C). It is stable until the expiration date indicated on the vial label. DO NOT FREEZE. 



Preparation 



Use 

For the sample probe cleaning in the CAPILLARYS System (weekly maintenance in order to eliminate adsorbed proteins from the probe). 

See the instruction sheets of CAPILLARYS, SEBIA. 



• Slide the sample rack No. 100 for maintenance in the CAPILLARYS System. 


validate. 





Preparation 



Use 

For washing the capillaries of CAPILLARYS. This additional reagent is needed when the number of tests in series is below 40. 






Working wash solution is stable for 3 months. 

Discard working wash solution if it changes its appearance, e.g., becomes cloudy due to microbial contamination. 

6. SALINE 

Preparation 


Use 

To wash red blood cells before storage at - 80 °C, if necessary. 




OPTIONAL REAGENT (SOLD SEPARATELY) 

Hb AFSC CONTROL 

Composition 

The Hb AFSC Control (SEBIA, PN 4792) is obtained from a pool of human blood samples with normal hemoglobins A and F and abnormal hemoglobins 

S and C. The Hb AFSC Control is in a stabilized lyophilized form. 

Intended use 

The Hb AFSC Control is designed for the quality control of electrophoretic separations of human hemoglobins with the CAPILLARYS CORD BLOOD 

procedure. It should be used as normal human blood. 

It is recommended to include the Hb AFSC Control into each series of analysis. 

Reconstitute the Hb AFSC Control vial with the exact volume of distilled or deionized water, as indicated in the package insert of the Hb AFSC Control. 

Allow to stand for 30 minutes and mix gently (avoid formation of foam). 

Quality control using the sample rack No. 0 : The Hb AFSC Control should be used as follows : 

- Apply the reconstituted Hb AFSC Control in a microtube. 


- Place the microtube, located on a new hemolyzing tube used as a support, in position No. 1 on the CAPILLARYS sample rack No. 0 intended for 

control blood sample, and a new dilution segment. 

IMPORTANT: For optimal use of the Hb AFSC Control, it is necessary to use one bar code label intended to identify the hemolyzing tube holding 

the microtube which contains the Hb AFSC Control (cut the cap of the microtube before using it). 

- Pour 4 mL of CAPILLARYS HEMOGLOBIN(E) hemolyzing solution in a hemolyzing tube without introducing air bubbles and place it in position No. 8 



- Start the analysis : Slide the sample rack No. 0 into the CAPILLARYS system, select "automatic dilution" in the window which appears on the screen 

and validate. 


- 59 -


Quality control among a series of samples to analyze : 

The Hb AFSC Control should be used as a normal human blood. After reconstitution, use directly the Hb AFSC Control as a blood sample to analyze 

or as a migration control (with the sample rack No. 0, see the paragraph before). It will be automatically diluted with hemolyzing solution. It is 

recommended to include the Hb AFSC Control into each series of analysis. 

IMPORTANT: For optimal use of the Hb AFSC Control with the CAPILLARYS System, it is necessary to use one bar code label intended to identify 

the hemolyzing tube holding the microtube which contains the Hb AFSC Control (cut the cap of the microtube before using it). 


Before reconstitution, store the lyophilized Hb AFSC Control refrigerated (2 to 8 °C). It is stable until the expiration date indicated on the box or vial 

labels. 

Store the reconstituted Hb AFSC Control at 2 - 8 °C. Due to the risk of microbial contamination and denaturation, use it within one week. 


IMPORTANT: After storage at 2 - 8 °C or at - 20 °C, homogenize the reconstituted Hb AFSC Control before the analysis with the CAPILLARYS system. 

NOTE: For optimal use with the CAPILLARYS system, it is recommended to split the Control into aliquots in microtubes before freezing. 

Before use, store the thawed Hb AFSC Control at 2 - 8 °C and use it within the day, after homogeneization. Do not freeze and thaw the Control more 

than 10 times. 

No test method can provide an absolute assurance of the absence of HIV, hepatitis B and C or other infectious agents. Therefore, handle the Hb AFSC 

Control as a hazardous biological material. 

This control was found negative on assays approved by FDA or EU equivalent regulatory agency : 




NOTE: During transportation, the lyophilized Hb AFSC Control can be kept without refrigeration (15 to 30 °C) for 15 days without any adverse effects 

on performance. 


1. CAPILLARYS System SEBIA, PN 1222. 

2. Sample racks supplied with CAPILLARYS. 

3. Container Kit supplied with CAPILLARYS: Rinse (to fill with distilled or deionized water), wash solution and waste container. 



Fresh umbilical cord blood samples from new-borns, anticoagulated with EDTA, are recommended for analysis. Avoid anticoagulants containing 

iodoacetate. Blood must be collected according to established procedures used in clinical laboratory testing. 

IMPORTANT: The volume of collected blood sample must not exceed the recommended volume of the collection tube. In the opposite case, if the 

volume of anticoagulant is insufficient for the collected blood sample, viscous aggregates in red blood cells may be observed. It is necessary to discard 

them before the analysis. 


For longer storage, samples can be frozen at - 80 °C within 8 hours of collection after having washed the red blood cells according to the following 

procedure: Centrifuge anticoagulated blood at 5 000 rpm for 5 minutes; discard the plasma; wash the red blood cells (RBC) 2 times with 10 volumes 

of saline (centrifuge after each washing step); discard the excess of saline over the red blood cells pellet and vortex them before freezing. 


IMPORTANT: For optimal storage of blood samples, store them at - 80 °C. Do not store at - 20 °C (see BIBLIOGRAPHY, J. Bardakdjian-Michau et al, 

2003). 

NOTE: Samples should not be stored at room temperature! 


When the blood sample is stored for more than 7 days at 2 - 8 °C: 

• Degraded Hb F becomes more visible and appears as a shoulder on the cathodic side of the Hb A (C9 zone, see the table in paragraph 

"Interpretation") due to the sample degradation. The Hb A percentage is then overvalued. 

• When Hb A is present, a spread fraction corresponding to degraded Hb A ("aging fraction" of Hb A) appears more anodic (C11 zone, see the table 

in paragraph "Interpretation"). 

• Due to the sample degradation, a weak fraction, corresponding to methemoglobin, may appear in the Hb E migration zone (C3 zone, see the table 

in paragraph "Interpretation"). 

When stored for more than 10 days, viscous aggregates in red blood cells are observed; it is necessary to discard them before the analysis. 


• Let red blood cells precipitate for several hours at 2 - 8 °C or centrifuge the blood sample at 5 000 rpm for 5 minutes. 

• Discard carefully the maximum volume of plasma. 

• Vortex for 5 seconds. 

IMPORTANT: Do not use blood samples containing 3 mm maximum residual plasma over red blood cells; when more than 3 mm plasma is present 

in the tube, the analysis should be affected. 

- 60 -




• Avoid aged, improperly stored blood samples; the automated hemolysis of samples may be disturbed by viscous aggregates in red blood cells. Then, 

degradation products (as artefacts) may affect the electrophoretic pattern. 

PROCEDURE 

The CAPILLARYS system is a multiparameter instrument for hemoglobins analysis on parallel capillaries. The hemoglobins assay uses 7 of the total 

8 instrument capillaries to run the samples. 


• Bar code reading of sample tubes (for up to 7 tubes) and samples-racks; 

• Sample hemolysis and dilution from primary tubes (without any plasma) into dilution segments; 

• Capillary washing; 

• Injection of hemolyzed samples; 



• Placement of opened sample tubes in sample-racks in positions 1 to 7; 

• Placement of hemolysing solution tube in sample-racks in position 8; 

• Placement of new dilution segments in sample-racks; 

• Placement of racks on the CAPILLARYS instrument; 




1. Switch on CAPILLARYS instrument and computer. 


3. For the CAPILLARYS CORD BLOOD procedure, the CAPILLARYS HEMOGLOBIN(E) kit is used with the "CORD BLOOD" analysis program 

from the CAPILLARYS instrument. To select "CORD BLOOD" analysis program and place the CAPILLARYS HEMOGLOBIN(E) buffer vial in 

the instrument, please read carefully the CAPILLARYS instruction manual. 

4. The sample rack contains eight positions for sample tubes. Place seven opened sample tubes without any plasma on each sample rack 

(positions 1 to 7) ; the bar code of each tube must be visible in the openings of the sample rack. 

IMPORTANT: If the number of tubes to analyze is less than 7, complete the sample rack with tubes containing distilled or deionized water. 

5. Pour 4 mL CAPILLARYS HEMOGLOBIN(E) hemolysing solution in a tube without introducing air bubbles and place it in position No. 8 on the 

sample rack. 



7. Slide a sample rack No. 0 with the Hb AF Control: See the previous paragraph "Hb AF Control" when using it with the CAPILLARYS CORD 

BLOOD procedure, part "Migration control". 

8. Slide the complete sample carrier(s) into the CAPILLARYS system through the opening in the middle of the instrument. Up to 13 sample racks 

(including the sample rack No. 0 intended for the control blood sample) can be introduced successively and continuously into the system. 












20 minutes from the start of the analysis. For the following sample rack, the first two steps (bar code reading and sample dilution) are performed during 

analysis of the previous sample rack. 


At the end of the analysis, relative quantification of individual hemoglobin fractions is performed automatically and profiles can be analyzed. The 

hemoglobin fractions, Hb A, Hb F and Hb A2 are automatically identified and the Hb F hemoglobin fraction is adjusted at a well-defined position. The 

resulting electrophoregrams are evaluated visually for pattern abnormalities. 

The potential positions of the different hemoglobin variants (identified in zones called C1 to C12) are shown on the screen of the system and indicated 

on the result ticket. The table in paragraph "Interpretation" shows known variants which may be present in each corresponding zone. When the 

software identifies a hemoglobin fraction in a defined zone, the name of this zone is framed. 

The identification of normal blood samples and of pathological blood samples are automatically performed and the profiles can be distinguished in the 

curve review window of patterns by a blue color for normal samples and a red color for pathological samples. This identification is based on the 

detection of abnormal fractions of hemoglobin on a pattern or on the absence of Hb F or Hb A hemoglobin fractions. 

The software is optimized to limit the interferences due to degraded hemoglobins on the analysis. Moreover, the software allows for the detection of 

low Bart’s hemoglobin concentrations which may alert the user on a probable alpha-thalassemia diagnostic. 

- 61 -


Patterns are automatically adjusted with regard to Hb F fraction to facilitate their interpretation: 

- when Hb F fraction is not detected on an electrophoretic pattern, a yellow warning signal appears, the adjustment is then performed using the 

position of the Hb F fraction on the two previous patterns obtained with the same capillary ; 

- when the adjustment is not possible, a red warning signal appears, Hb A, Hb F and Hb A2 fractions are then not identified (Call SEBIA). 

In those two cases, the different variant zones (C1 to C12) do not appear neither on the screen of the system, nor on the ticket result. 



At the end of each analysis sequence, the operator must initiate the "stand by" or "shut down" procedure of the CAPILLARYS system in order to store 

capillaries in optimal conditions. 


The CAPILLARYS system has a reagent automatic control. 



• Place a new buffer container and / or; 

• Fill the container with working wash solution and / or; 

• Fill the container with filtered distilled or deionized water for rinsing capillaries and / or; 







After having changed the analysis buffer vial (even if the lot number is unchanged) or the technique, after a capillary cleaning sequence 

with CAPICLEAN or after capillaries activation and before starting a new analysis sequence, it is necessary to run two analysis sequences with 

the Hb AF Control, SEBIA, PN 4777, and the sample rack No. 0 intended for control blood sample (see paragraph REAGENTS REQUIRED BUT NOT 

SUPPLIED). 


such as Hb AFSC Control, SEBIA, PN 4792, or the Hb AF Control, SEBIA, PN 4777). 

* US customers: Follow federal, state and local guidelines for quality control. 

RESULTS 

Values 



See ELECTROPHORETIC PATTERNS, figures 1 - 8. 

The different migration zones of hemoglobin variants (called C1 to C12) are shown on the screen of the system and on the result ticket. Passing the 









More than 900 variants of adult hemoglobin have been described (6, 14) . The first abnormal hemoglobins studied and the most frequent have an altered 

net electric charge, leading to an easy detection by electrophoresis. 


The CAPILLARYS CORD BLOOD procedure is intended for the identification of hemoglobinopathies and alpha-thalassemias. 

Hemoglobin S 

Hemoglobin S is the most frequent. It is due to the substitution of one glutamic acid (an acidic amino acid No. 6) of the ß-chain by a valine (a neutral 

amino acid): when compared to Hb A, its isoelectric point is elevated and its total negative charge decreased with the analysis pH. 

Its electrophoretic mobility is therefore increased in the capillary and this hemoglobin is faster than A and F fractions. With the alkaline buffered 

CAPILLARYS CORD BLOOD procedure, hemoglobin S migrates before A and F fractions. 

- 62 -


Hemoglobin C 

One glutamic acid of the ß-chain is substituted by a lysine (a basic amino acid No. 6): its mobility is strongly reduced. When compared to Hb A, its 


the capillary and this hemoglobin is faster than A, F and S fractions. 

Hemoglobins C, E and O-Arab are not superimposed on the electrophoretic pattern and can easily be identified. 

Hemoglobin E 

One glutamic acid of the ß-chain (No. 26) is substituted by a lysine. With the CAPILLARYS CORD BLOOD procedure, hemoglobin E migrates 

anodically behind hemoglobin C and is totally separated from it. Then, it is possible to diagnose a heterozygous C / E patient. 


One glutamic acid of the ß-chain (No. 121) is substituted by a lysine. With the CAPILLARYS CORD BLOOD procedure, hemoglobin O-Arab migrates 

separately between E and C fractions. When the blood sample contains Hb A2, Hb O-Arab migrates exactly like this hemoglobin. The analysis being 

performed on new-borns blood samples, with very low Hb A2 concentration, in such a case, Hb A2 does not interfere on Hb O-Arab detection. 


One glutamic acid of the ß-chain (No. 121) is substituted by a glutamine. With the CAPILLARYS CORD BLOOD procedure, hemoglobin D (called 

D-Punjab, D-Los Angeles, D-Chicago or D-Portugal) migrates behind hemoglobin S, this property allows for the differentiation of S and D hemoglobins. 






They are characterized by the decrease of synthesis of the α-chains, consequently affecting the synthesis of all normal hemoglobins. The excess of 

synthesis of the ß- and γ-chains in relation to α-chains induces the formation of tetramers without any α-chain: 

• hemoglobin Bart’s = γ4, 

• hemoglobin H = ß4. 

Hemoglobin Bart’s, which presents a low isoelectric point, is in blood samples from new-borns but also, less frequently, in blood samples from adults. 

Hemoglobin H is not detected in blood sample from new-borns. With the CAPILLARYS CORD BLOOD procedure, hemoglobin Bart’s migrates more 

anodic than hemoglobin F (and may appear as a wide fraction not focused). 


They are characterized by the decrease of synthesis of the ß-chains. Only hemoglobin A synthesis is affected. Since the analysis is made on umbilical 

cord blood samples from new-borns, the amount of hemoglobin A2 in the sample does not allow the diagnostic of beta-thalassemias. 

The CAPILLARYS CORD BLOOD procedure is not intended to the diagnostic of beta-thalassemias in new-borns. 


• Hemoglobin A2 is generally absent or in low concentration in umbilical cord blood samples from new-borns, according to the term of pregnancy. In 

a normal new-born blood sample, hemoglobin F is the major fraction, hemoglobin A is the minor one and hemoglobin A2 is generally absent or in 

low concentration. When a larger fraction appears in the Hb A2 migration zone, a variant may be suspected. 

In this case, the fraction appeared in the Hb A2 migration zone will be detected by the CAPILLARYS system but it is necessary to perform 

complementary analyses in order to confirm the variant. 

• When there is no hemoglobin A in the sample or present at a low level (blood sample from premature baby, beta chain deficiency, etc), or in aged 

samples, a fraction may be observed in the C9 migration zone before the C10 migration zone of Hb A. This fraction is acetylated F hemoglobin and 

degraded F hemoglobin. The CAPILLARYS system can identify this acetylated hemoglobin separately from the hemoglobin A without any confusion. 





IMPORTANT: When analyzing blood samples without hemoglobin A but with one or many abnormal X variants, it is possible to consider the level 

of abnormal X fractions and that of the hemoglobin fraction located in the degraded Hb F migration zone to analyze the electrophoretic pattern: a 

low fraction located in C9 and C10 migration zones can not be considered as Hb A if abnormal fractions are in large proportion. In most cases, A /X 

heterozygous samples have Hb A and variants X fractions at the same intensity, sometimes with Hb A fraction higher than variant X. 

• Some hemoglobin variants (such as Hb Porto-Alegre and Hb Q-Thailand, for example) migrate close to Hb F and may be partially separated from 

it. The CAPILLARYS system can identify Hb F without any confusion due to the large proportion of Hb F in new-born blood sample. 

• Alpha-thalassemia (deletion of one to three α chains) may be detected on the electrophoretic pattern due to the presence of Hb Bart’s. The deletion 

of only one chain induces silent alpha-thalassemia because it is asymptomatic. The deletion of 2 or 3 α chains induces quantities of Hb Bart’s on 

the electrophoretic pattern. 

• When analysing cord blood samples from transfused new-borns with high Hb A level, the electrophoretic pattern may appear disturbed. Sickle cell 

disease may be hidden and confused with A / S heterozygous diagnosis. It is necessary to analyze the hematologic state and to perform 

complementary studies in order to confirm the diagnosis. 

• Gamma chain mutations may lead to abnormal hemoglobins which appear in different zones of the electrophoretic pattern. These hemoglobins have 

been less studied than hemoglobins due to mutations of other chains. 




• Avoid aged, improperly stored blood samples; degradation products (or artefacts) may affect the electrophoretic pattern after 7 days storage. 

- 63 -






• No interference with the CAPILLARYS CORD BLOOD procedure was detected due to the blood sample’s high concentration of triglycerids 

(≤ 32 mmol/L) and bilirubin (≤ 16.1 mg/dL). 


method. 





- 64 -


BIBLIOGRAPHIE / BIBLIOGRAPHY 

1. J. Bardakdjian-Michau, J.-L. Dhondt, R. Ducrocq, F. Galactéros, A. Guyard, F.-X. Huchet, A. Lahary, D. Lena-Russo, P. Maboudou, M.-L. North, 

C. Prehu, A.-M. Soummer, M. Verschelde, H. Wajcman (2003) Bonnes pratiques de l’étude de l’hémoglobine. Ann. Biol. Clin., 61, 401-409. 

2. V.F. Fairbanks, ed. (1980) Hemoglobinopathies and thalassemia: Laboratory methods and case studies. Brian C. Decker, New York. 

3. F. Galacteros (1986) Thalassémie, drépanocytose et autres hémoglobinopathies. Techniques et Biologie, 3, 174-178. 

4. JM Hempe, JN Granger and RD Craver (1997) Capillary isoelectric focusing of hemoglobin variants. Electrophoresis, 18, 1785-1795. 

5. T.H.J. Huisman and J.H.P. Jonxis (1977) The hemoglobinopathies: techniques of identification. Marcel Dekker, New York. 

6. Jellum E et al. Diagnostic applications of chromatography and capillary electrophoresis. J. Chromatogr. B, 689, 155-164 (1997). 

7. Joutovsky A, Hadzi-Nesic J and Nardi MA (2004) HPLC retention time as a diagnostic tool for hemoglobin variants and hemoglobinopathies : a 

study of 60 000 samples in a clinical diagnostic laboratories. Clin. Chem., 50, 10, 1736-1747. 

8. J.S. Krauss, P.A. Drew, M.H. Jonah, M. Trinh, S. Shell, L. Black and C.R. Baisden (1986) Densitometry and microchromatography compared for 

determination of the hemoglobin C and A2 proportions in hemoglobin C and hemoglobin SC disease and in hemoglobin C trait. Clin. Chem. 32, 

5, 860-863. 

9. Landers JP. Clinical Capillary Electrophoresis. Clin. Chem., 41, 495-509 (1995). 

10. C. Livingstone (1986) The hemoglobinopathies. Edit. London.- 

11. M. Maier-Redelsberger, R. Girot (1989) Diagnostic biologique des maladies de l’hémoglobine. Feuillets de biologie, 170. 

12. Oda RP et al. Capillary electrophoresis as a clinical tool for the analysis of protein in serum and other body fluids. Electrophoresis, 18, 1715- 

1723 (1997). 

13. R.G. Schneider (1978) Methods for detection of hemoglobin variants and hemoglobinopathies in the routine clinical laboratory. CRC Crit. Rev. 

Clin. Lab. Sci. 9, 243-271. 

14. L. Vovan, D. Lara-Russo, A. Orsini (1985) Diagnostic biologique des hémoglobinoses. Ann. Pédiat. 32, 9, 780-789. 

15. http://globin.cse.psu.edu/hbvar/menu.html : Hbvar : A Database of Human Hemoglobin Variants and Thalassemias. 

16. http://www.isns-neoscreening.org/agenda.htm. 

17. F Boemer, O Ketelslegers, JM Minon, V Bours, R Schoops (2008) Newborn screening for sickle cell disease using tandem mass spectrometry. 

Clin. Chem., 54, 12, 2036-2041. 

18. Lubin BH, Witkowska HE, Kleman K (1991) Laboratory diagnosis of hemoglobinopathies. Clin. Biochem., 24, 363-374. 

19. B Gulbis, B Fontaine, F Vertongen, F Cotton (2003) The place of capillary electrophoresis techniques in screening for haemoglobinopathies. 

Ann. Clin. Biochem., 40, 659-662. 

20. Aguilar-Martinez P et al (2010) Arbres décisionnels pour le diagnostic et la caractérisation moléculaire des hémoglobinopathies. Ann. Biol. Clin., 

68 (4) : 455-464. 

21. Wendling A. Procédures de diagnostic ou de dépistage : Justification et validité d’un test de diagnostic ou de dépistage-sensibilité-spécificité. 

Impact-Internat, 1986 ; Sept : 93-97. 

- 289 -


TABLEAU / TABLE 

CAPILLARYS HEMOGLOBIN(E) : 

VARIANTS POTENTIELS PRÉSENTS DANS CHAQUE ZONE 

POTENTIAL VARIANTS LOCATED IN EACH ZONE 

Zone 

Z1 

Z2 

Z3 

Z4 

Z5 

Z6 

Z7 

Z8 

Z9 

Z10 

Hémoglobines / Hemoglobins (Hb) 

Hb Santa Ana (chaîne libre alpha), Hb Mizuho (pic mineur), Hb δA’2, Hb αA2, Hb F-Hull, Hb T-Cambodia, variants de Hb A2 "Arya", de 

Hb A2 "Hasharon", de Hb A2 "Fort de France", de Hb A2 "Ottawa", de Hb A2 "Chad", de Hb A2 "G-Norfolk", de Hb A2 "Matsue-Oki", 

de Hb A2 "Stanleyville II", de Hb A2 "Montgomery", de Hb A2 "Winnipeg", de Hb A2 "Q-India", de Hb A2 « G-Pest", de Hb A2 

"Memphis", de Hb A2 "Inkster", de Hb A2 "Chapel Hill" et de Hb A2 "Q-Thailand" 

Hb Santa Ana (free alpha chain), Hb Mizuho (minor peak), Hb δA’2, Hb αA2, Hb F-Hull, Hb T-Cambodia, "Arya" Hb A2 variant, 

"Hasharon" Hb A2 variant, "Fort de France" Hb A2 variant, "Ottawa" Hb A2 variant, "Chad" Hb A2 variant, "G-Norfolk" Hb A2 variant, 

"Matsue-Oki" Hb A2 variant, "Stanleyville II" Hb A2 variant, "Montgomery" Hb A2 variant, "Winnipeg" Hb A2 variant, "Q-India" Hb A2 

variant, "G-Pest" Hb A2 variant, "Memphis" Hb A2 variant, "Inkster" Hb A2 variant, "Chapel Hill" Hb A2 variant, "Q-Thailand" Hb A2 

variant 

Hb C, Hb F-Texas, Hb Constant Spring, Hb C-Harlem (C-Georgetown), variant de Hb A2 "Setif", variant de Hb A2 "Bassett", variant de 

Hb A2 "Swan River", variant de Hb A2 "Manitoba I", variant de Hb A2 "Manitoba II" 

Hb C, Hb F-Texas, Hb Constant Spring, Hb C-Harlem (C-Georgetown), "Setif" Hb A2 variant, "Bassett" Hb A2 variant, "Swan River" 

Hb A2 variant, "Manitoba I" Hb A2 variant, "Manitoba II" Hb A2 variant 

Hb A2, Hb O-Arab, Hb Chad (E-Keelung), Hb E-Saskatoon 

Hb A2, Hb O-Arab, Hb Chad (E-Keelung), Hb E-Saskatoon 

Hb E, Hb Köln (Ube-1), Hb Buenos Aires (pic mineur), Hb Agenogi, Hb G-Siriraj, Hb Santa Ana, Hb A2-Babinga, Hb M-Saskatoon (pic 

mineur), variant de Hb A2 "M-Iwate", Hb C dégradée 

Hb E, Hb Köln (Ube-1), Hb Buenos Aires (minor peak), Hb Agenogi, Hb G-Siriraj, Hb Santa Ana, Hb A2-Babinga, Hb M-Saskatoon 

(minor peak), "M-Iwate" Hb A2 variant, denatured Hb C 

Hb S, Hb Dhofar (Yukuhashi), Hb Arya, Hb Hasharon (Sinai), Hb Handsworth, Hb Ottawa (Siam), Hb S-Antilles, Hb Fort de France, 

Hb Hamadan, Hb Montgomery, variant de Hb A2 "Lombard", variant de Hb A2 "Cemenelum", variant de Hb A2 "Jackson", Hb O-Arab 

dégradée 

Hb S, Hb Dhofar (Yukuhashi), Hb Arya, Hb Hasharon (Sinai), Hb Handsworth, Hb Ottawa (Siam), Hb S-Antilles, Hb Fort de France, 

Hb Hamadan, Hb Montgomery, "Lombard" Hb A2 variant, "Cemenelum" Hb A2 variant, "Jackson" Hb A2 variant, denatured Hb O-Arab 

Hb D-Punjab (D-Los Angeles), Hb Stanleyville II, Hb Osu Christiansborg, Hb Leiden, Hb G-Philadelphie, Hb Muravera, Hb D-Bushman, 

Hb G-Norfolk, Hb Matsue-Oki, Hb D-Ouled Rabah, Hb Lepore (Lepore-BW), Hb Muskegen, Hb D-Ibadan, Hb Buenos Aires (pic 

mineur), Hb Summer Hill, Hb Q-India, Hb Q-Iran, Hb Korle-Bu (G-Accra), Hb Köln, Hb Fort Worth, Hb G-Taipei, Hb Winnipeg, 

Hb G-Siriraj, Hb G-Pest, Hb D-Iran, Hb G-Coushatta (G-Saskatoon), Hb Inkster, Hb Setif, Hb Memphis, Hb P-Nilotic, Hb Willamette, 

variant de Hb A2 "J-Rajappen", variant de Hb A2 "J-Anatolia", variant de Hb A2 "J-Oxford", variant de Hb A2 "J-Broussais", variant de 

Hb A2 "J-Toronto", variant de Hb A2 "Mexico", variant de Hb A2 "J-Habana", variant de Hb A2 "J-Rovigo", Hb E dégradée 

Hb D-Punjab (D-Los Angeles), Hb Stanleyville II, Hb Osu Christiansborg, Hb Leiden, Hb G-Philadelphia, Hb Muravera, Hb D-Bushman, 

Hb G-Norfolk, Hb Matsue-Oki, Hb D-Ouled Rabah, Hb Lepore (Lepore-BW), Hb Muskegen, Hb D-Ibadan, Hb Buenos Aires (minor 

peak), Hb Summer Hill, Hb Q-India, Hb Q-Iran, Hb Korle-Bu (G-Accra), Hb Köln, Hb Fort Worth, Hb G-Taipei, Hb Winnipeg, 

Hb G-Siriraj, Hb G-Pest, Hb D-Iran, Hb G-Coushatta (G-Saskatoon), Hb Inkster, Hb Setif, Hb Memphis, Hb P-Nilotic, Hb Willamette, 

"J-Rajappen" Hb A2 variant, "J-Anatolia" Hb A2 variant, "J-Oxford" Hb A2 variant, "J-Broussais" Hb A2 variant, "J-Toronto" Hb A2 

variant, "Mexico" Hb A2 variant, "J-Habana" Hb A2 variant, "J-Rovigo" Hb A2 variant, denatured Hb E 

Hb F, Hb Q-Thailand (G-Taichung), Hb Alabama, Hb Chapel Hill, Hb Bassett, Hb G-San José, Hb Richmond, Hb Barcelona, 

Hb Geldrop Santa Anna, Hb Porto Alegre, Hb Swan River, Hb Presbyterian, Hb Burke, Hb Manitoba I, Hb Manitoba II, variant de 

Hb A2 "J-Paris-I", Hb S dégradée 

Hb F, Hb Q-Thailand (G-Taichung), Hb Alabama, Hb Chapel Hill, Hb Bassett, Hb G-San Jose, Hb Richmond, Hb Barcelona, 

Hb Geldrop Santa Anna, Hb Porto Alegre, Hb Swan River, Hb Presbyterian, Hb Burke, Hb Manitoba I, Hb Manitoba II, "J-Paris-I" 

Hb A2 variant, denatured Hb S 

Hb F acétylée, Hb Hinsdale, Hb Alberta, Hb Kempsey, Hb Atlanta, Hb Athens-GA (Waco) 

Acetylated Hb F, Hb Hinsdale, Hb Alberta, Hb Kempsey, Hb Atlanta, Hb Athens-GA (Waco) 

Hb A, Hb Gorwihl (Hinchingbrooke), Hb Phnom Penh, Hb Silver Springs, Hb La Coruna, Hb Bougardirey-Mali, Hb Austin, Hb Buenos 

Aires (pic majeur), Hb Chicago, Hb Toulon, Hb Okayama, Hb Fontainebleau, Hb Raleigh, Hb Hekinan, Hb Mosella, Hb Dallas, 

Hb Aztec, Hb Little Rock, Hb Frankfurt, Hb Bethesda, Hb M-Boston (M-Osaka), Hb Brisbane (Great Lakes), Hb Mizuho, Hb Grange 

Blanche, Hb San Diego, Hb M-Saskatoon (pic majeur), Hb Malmö, Hb Minneapolis Laos, Hb Syracuse, Hb Camperdown 

Hb A, Hb Gorwihl (Hinchingbrooke), Hb Phnom Penh, Hb Silver Springs, Hb La Coruna, Hb Bougardirey-Mali, Hb Austin, Hb Buenos 

Aires (major peak), Hb Chicago, Hb Toulon, Hb Okayama, Hb Fontainebleau, Hb Raleigh, Hb Hekinan, Hb Mosella, Hb Dallas, 

Hb Aztec, Hb Little Rock, Hb Frankfurt, Hb Bethesda, Hb M-Boston (M-Osaka), Hb Brisbane (Great Lakes), Hb Mizuho, Hb Grange 

Blanche, Hb San Diego, Hb M-Saskatoon (major peak), Hb Malmö, Hb Minneapolis Laos, Hb Syracuse, Hb Camperdown 

Hb Hope, Hb M-Iwate (M-Kankakee), Hb Camden (Tokuchi) 

Hb Hope, Hb M-Iwate (M-Kankakee), Hb Camden (Tokuchi) 

- 290 -



CAPILLARYS HEMOGLOBIN(E) : 

VARIANTS POTENTIELS PRÉSENTS DANS CHAQUE ZONE 

POTENTIAL VARIANTS LOCATED IN EACH ZONE 

Zone 

Z11 

Z12 

Z13 

Z14 

Z15 


Hb A dégradée, Hb Providence (pic X-Asn), Hb K-Woolwich, Hb Lombard, Hb Kaohsiung (New York), Hb Fannin Lubbock, Hb Andrew 

Minneapolis, Hb Jackson, Hb Himeji, variant de Hb A2 "I (I-Texas)" 

Denatured Hb A, Hb Providence (X-Asn peak), Hb K-Woolwich, Hb Lombard, Hb Kaohsiung (New York), Hb Fannin Lubbock, 

Hb Andrew Minneapolis, Hb Jackson, Hb Himeji, "I (I-Texas)" Hb A2 variant 

Hb Bart, Hb Cemenelum, Hb J-Calabria (J-Bari), Hb Providence (pic X-Asp), Hb J-Rajappen, Hb Grady, Hb J-Anatolia, Hb J-Broussais 

(Tagawa-I), Hb J-Chicago, Hb J-Oxford (I-Interlaken), Hb J-Toronto, Hb J-Meinung (J-Bangkok), Hb Ube-2, Hb Mexico (J-Paris-II), 

Hb J-Habana, Hb J-Baltimore (N-New Haven), Hb J-Paris-I (J-Aljezur) 

Hb Bart's, Hb Cemenelum, Hb J-Calabria (J-Bari), Hb Providence (X-Asp peak), Hb J-Rajappen, Hb Grady, Hb J-Anatolia, 

Hb J-Broussais (Tagawa-I), Hb J-Chicago, Hb J-Oxford (I-Interlaken), Hb J-Toronto, Hb J-Meinung (J-Bangkok), Hb Ube-2, Hb Mexico 

(J-Paris-II), Hb J-Habana, Hb J-Baltimore (N-New Haven), Hb J-Paris-I (J-Aljezur) 

Hb J-Rovigo, Hb N-Baltimore (Hopkins-I), Hb J-Norfolk (Kagoshima), Hb J-Kaohsiung (J-Honolulu) 

Hb J-Rovigo, Hb N-Baltimore (Hopkins-I), Hb J-Norfolk (Kagoshima), Hb J-Kaohsiung (J-Honolulu) 

Hb N-Seattle 

Hb N-Seattle 

Hb H, Hb I (I-Texas) 

Hb H, Hb I (I-Texas) 

- 291 -


SCHÉMAS / FIGURES 


PROFILS ÉLECTROPHORÉTIQUES - ELECTROPHORETIC PATTERNS 

Figure 1 

Figure 2 

Z15 Z14 Z13 Z12 Z11 Z10 Z9 Z8 Z7 Z6 Z5 Z4 Z3 Z2 Z1 


Hb A 

Hb A 

Hb A2 

Hb A2 

Sang normal 

Normal blood sample 

Sang bêta-thalassémique 

Blood sample with beta-thalassemia 

Figure 3 

Figure 4 



Hb A 

Hb C 

Hb A 

Hb S 

Hb A2 

Hb F 

Hb A2 

Sang avec variant Hb C 

Blood sample with Hb C variant 

Sang avec variant hétérozygote Hb S 

Blood sample with Hb S heterozygote variant 

- 292 -





Figure 5 

Figure 6 



Hb F 

Hb F 

Hb A 

Hb A 

Hb A2 

Hb Bart's 

Sang de bébé (agé de 3 semaines) 

Baby blood sample (3 weeks old) 

Sang de bébé avec Hb Bart's 

Baby blood sample with Hb Bart's 

Figure 7 

Figure 8 



Hb A 

Hb A 

Hb F 

Hb A2 

Hb H 

Hb A2 

Sang avec Hb F (jeune enfant) 

Blood sample with Hb F (young child) 

Sang avec Hb H 

Blood sample with Hb H 

- 293 -





Figure 9 

Figure 10 



Hb A 

Hb D-Punjab 

Hb A 

Hb A2 

Hb A2 

Hb 

delta A'2 

Sang avec variant Hb D-Punjab 

Blood sample with Hb D-Punjab variant 

Sang avec variant delta Hb A'2 

Blood sample with delta Hb A'2 variant 

Figure 11 

Figure 12 

Hb E 

Hb C 

Hb S 

Hb F 

Hb A2 

Hb F 

Hb A2 

Sang avec variant homozygote Hb E et fraction Hb F élevée 

Blood sample with homozygote Hb E variant and elevated Hb F 

Sang avec variants hétérozygotes Hb S et Hb C 

Blood sample with Hb S & Hb C heterozygote variants 

- 294 -





Figure 13 

Figure 14 


Hb S 

Hb A 

Hb F 

Hb A2 

Hb A 

dégradée 

degradated 

Hb F 

Hb A2 

Sang avec variant homozygote Hb S (et Hb F) 

Blood sample with Hb S homozygote variant (and Hb F) 

Sang avec Hb A dégradée (Hb A3) et Hb F faible 

Blood sample with degradated Hb A (Hb A3) and faint Hb F 

Figure 15 


Hb A 

Hb Lepore 

Hb F 

Hb A2 

Sang avec variant Hb Lepore 

Bood sample with Hb Lepore variant 

- 295 -



CAPILLARYS HEMOGLOBIN(E) - CAPILLARYS 2 FLEX PIERCING 


Figure 16 

Fraction supplémentaire en zone de migration Z2 (protéines plasmatiques) 

Additional fraction in Z2 migration zone (plasmatic proteins) 

Z15 

Z14 

Z13 

Z12 

Z11 Z10 Z9 Z8 

Hb A 

Z7 

Z6 

Z5 

Z4 

Z3 

Z2 

Z1 

Z15 

Z14 

Z13 

Z12 

Z11 Z10 Z9 Z8 

Hb A 

Z7 

Z6 

Z5 

Z4 

Z3 

Z2 

Z1 

0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 

Hb A2 

3 

0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 

Hb A2 

Analyse du sang total 

Whole blood analysis 

Analyse des globules rouges correspondants 

Analysis of corresponding red blood cells 

Figure 17 

Fraction supplémentaire en zone de migration Z2 (Hb Constant spring) 

Additional fraction in Z2 migration zone (Hb Constant spring) 

Z15 

Z14 

Z13 

Z12 

Z11 Z10 Z9 

Z8 

Z7 

Z6 

Z5 

Z4 

Z3 

Z2 

Z1 

Z15 

Z14 

Z13 

Z12 

Z11 Z10 Z9 

Z8 

Z7 

Z6 

Z5 

Z4 

Z3 

Z2 

Z1 

Hb A 

Hb A 

0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 

Hb A2 

3 

0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 

Hb A2 

3 

Analyse du sang total 

Whole blood analysis 

Analyse des globules rouges correspondants 

Analysis of corresponding red blood cells 

Hb Constant Spring 

- 296 -



CAPILLARYS HEMOGLOBIN(E) - CAPILLARYS 2 FLEX PIERCING 


Figure 18 

Fraction supplémentaire en zone de migration Z15 

Additional fraction in Z15 migration zone 

Z15 

Z14 

Z13 

Z12 

Z11 

Z10 Z9 

Z8 

Z7 

Z6 

Z5 

Z4 

Z3 

Z2 

Z1 

Hb A 

Hb H 

Hb Bart’s 

Hb A2 

Hb Constant Spring 

- 297 -



CAPILLARYS SANGS DE CORDONS : VARIANTS POTENTIELS PRÉSENTS DANS CHAQUE ZONE 

CAPILLARYS CORD BLOOD : POTENTIAL VARIANTS LOCATED IN EACH ZONE 

Zone 

C1 

C2 

C3 

C4 

C5 

C6 

C7 

C9 

C10 

C11 

C12 


Hb C 

Hb C 

Hb A2, Hb O-Arab 

Hb A2, Hb O-Arab 

Hb E, methémogobine, Hb C dégradée 

Hb E, methemoglobin, denatured Hb C 

Hb S 

Hb S 

Hb D-Punjab (D-Los Angeles), Hb G-Philadelphie, Hb Korle-Bu (G-Accra), Hb E dégradée 

Hb D-Punjab (D-Los Angeles), Hb G-Philadelphia, Hb Korle-Bu (G-Accra), denatured Hb E 

Hb S dégradée 

Denatured Hb S 

Hb F 

Hb F 

Hb F dégradée 

Denatured Hb F 

Hb A 

Hb A 

Hb A dégradée, Hb Hope 

Denatured Hb A, Hb Hope 

Hb Bart 

Hb Bart’s 

- 298 -



CAPILLARYS SANGS DE CORDONS / CAPILLARYS CORD BLOOD 


Figure 1 

Figure 2 

C12 

C11 

C10 

C9 C8 C7 C6 

Hb F 

C5 

C4 

C3 

C2 

C1 

C12 

C11 

C10 

C9 C8 C7 C6 

Hb F 

C5 

C4 

C3 

C2 

C1 

Hb A 

Hb A 

Hb A2 

0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 

0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 

Sang de cordon normal 

Normal cord blood sample 

Sang de cordon normal avec Hb A2 

Normal cord blood sample with Hb A2 

Figure 3 

Figure 4 

C12 

C11 

C10 

C9 C8 C7 C6 

Hb F 

C5 

C4 

C3 

C2 

C1 

C12 

C11 

C10 

C9 C8 C7 C6 

Hb F 

C5 

C4 

C3 

C2 

C1 

Hb A 

Hb A 

Hb S 

0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 

0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 

Sang de cordon avec Hb A faible 

Cord blood sample with faint Hb A 

Sang de cordon avec variant Hb S 

Cord blood sample with Hb S variant 

- 299 -



CAPILLARYS SANGS DE CORDONS / CAPILLARYS CORD BLOOD 


Figure 5 

Figure 6 

C12 

C11 

C10 

C9 C8 C7 C6 

Hb F 

C5 

C4 

C3 

C2 

C1 

C12 

C11 

C10 

C9 C8 C7 C6 

Hb F 

C5 

C4 

C3 

C2 

C1 

Hb A 

Hb A 

Hb C 

Hb Bart 

0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 

0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 

Sang de cordon avec variant Hb Bart 

Cord blood sample with Hb Bart’s variant 

Sang de cordon avec variant Hb C 

Cord blood sample with Hb C variant 

Figure 7 

Figure 8 

C12 

C11 

C10 

C9 C8 C7 C6 

Hb F 

C5 

C4 

C3 

C2 

C1 

C12 

C11 

C10 

C9 C8 C7 C6 

Hb F 

C5 

C4 

C3 

C2 

C1 

Hb A 

Hb A 

Hb E 

Hb A dégradée 

0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 

0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 

Sang de cordon avec variant Hb E 

Cord blood sample with Hb E variant 

Sang de cordon avec Hb F dégradée (en zone C9) et 

Hb A dégradée (en zone C11) 

Cord blood sample with degraded Hb F (C9 zone) and 

degraded Hb A (C11 zone) 

- 300 -

CAPILLARYS HEMOGLOBIN(E)

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?