Detection of α-thalassaemia in neonates on cord blood and dried blood spot samples by capillary electrophoresis

Introduction: Haemoglobin Bart's (Hb Bart's) level is associated with alpha-thalassaemia traits in neonates, enabling early diagnosis of alpha-thalassaemia. The study aimed to detect and quantify the Hb Bart's using Cord Blood (CB) and CE Neonat Fast Hb (NF) progammes on fresh and dried blood spot (DBS) specimen respectively by capillary electrophoresis (CE). Methods: Capillarys Hemoglobin (E) Kit (for CB) and Capillarys Neonat Hb Kit (for NF) were used to detect and quantify Hb Bart's by CE in fresh cord blood and dried blood spot (DBS) specimens respectively. High performance liquid chromatography (HPLC) using the beta-Thal Short Programme was also performed concurrently with CE analysis. Confirmation was obtained by multiplex ARMS Gap PCR. Results: This study was performed on 600 neonates. 32/600 (5.3%) samples showed presence of Hb Bart's peak using the NF programme while 33/600 (5.5%) were positive with CB programme and HPLC methods. The range of Hb Bart's using NF programme and CB programme were (0.5-4.1%) and (0.5-7.1%), respectively. Molecular analysis confirmed all positive samples possessed alpha-thalassaemia genetic mutations, with 23/33 cases being alpha/--(SEA), four -alpha(3.7)/-alpha(3.7), two alpha alpha/-alpha(3.7) and three alpha alpha/alpha alpha(CS). Fifty Hb Bart's negative samples were randomly tested for a-genotypes, three were also found to be positive for alpha-globin gene mutations. Thus, resulting in sensitivity of 91.7% and 88.9% and specificity of 100% for the Capillarys Cord Blood programme and Capillarys Neonat Fast programme respectively. Conclusion: Both CE programmes using fresh or dried cord blood were useful as a screening tool for alpha-thalassaemia in newborns. All methods show the same specificity (100%) with variable, but acceptable sensitivities in the detection of Hb Bart.