Screening for abnormal hemoglobins: who, when, and how.

Sickle cell and abnormal hemoglobin screening programs should not be undertaken lightly but rather should have a specific purpose or purposes. If the aim is to detect only sickle hemoglobin, a certain strategy is necessary. If the goal is to detect all abnormal hemoglobins and genetic counseling is planned, another approach should be used. A simple solubility test detects sickle hemoglobin with high reliability, but deals with no other abnormal hemoglobins. Hemoglobin electrophoresis, followed by other tests as indicated, is then necessary to ascertain other abnormal hemoglobins in addition to hemoglobin S.