New hemoglobin disorders atlas one for the books
A new Color Atlas of Hemoglobin Disorders, available soon from the CAP,
may replace a dog-eared textbook more than 20 years old upon which
many laboratories still rely.
“The standards [on hemoglobin disorders and diagnosis] were
old books out of print for years,” says Steven H. Kroft, MD,
associate professor of pathology, Division of Hematopathology, University
of Texas Southwestern Medical Center, Dallas. In fact, he says,
many labs depend on photocopies of an out-of-print 1980 publication
by Virgil F. Fairbanks, MD, called Hemoglobinopathies and Thalassemias,
Laboratory Methods and Clinical Cases.
It was Dr. Fairbanks himself, retired from the Mayo Clinic, who
urged the CAP Hematology and Clinical Microscopy Resource Committee
to create a new reference on hemoglobin disorders. Dr. Fairbanks
also initiated the CAP Hemoglobinopathy Survey.
“This whole process [to publish the atlas] started out about
five years ago at Dr. Fairbanks’ suggestion,” says James
D. Hoyer, MD, a hematopathology consultant at the Mayo Clinic and
an advisor to the CAP’s hematology committee. Dr. Hoyer is
co-editor of the atlas.
The same committee produced an earlier book, the Color Atlas
of Hematology, in 1998. That atlas was so well received that
committee members decided to undertake another, this one on hemoglobin
disorders. This atlas was largely compiled and edited over the past
two years, says Dr. Kroft, another co-editor. It is similar in style
and format to the hematology atlas, with full-color electrophoretic
scans, illustrations, diagrams, peripheral blood smears, and numerous
The lack of up-to-date material on hemoglobinopathies supported
the need for a hemoglobin atlas. “The idea was an educational
and practical reference that would cover everything you’re
likely to see in practice,” Dr. Kroft says. The CAP had a
wealth of information in its Surveys to meet the need, he notes.
The CAP Surveys identify the cases laboratories may have difficulty
with, so the atlas addresses those in depth, says Linda M. Sandhaus,
MD, associate professor of pathology, Case Western Reserve University
School of Medicine and University Hospitals of Cleveland. “The
Surveys are intended to be a teaching tool,” she adds. “The
atlas is intended to capture that same purpose.” Dr. Sandhaus,
a member of the hematology committee, helped edit the atlas.
The atlas presents various disorders as they would appear on electrophoresis
and, in some cases, on high-performance liquid chromatography, or
HPLC. The atlas also contains photomicrographs and isoelectric focusing
images. And it presents a case-study discussion of the results,
including issues such as how to diagnose, what to rule out, and
what the differential diagnoses might be. The discussion also covers
“You can use this with students to present an unknown case,”
says Dr. Sandhaus. “They can approach it as they would a real
clinical situation and turn the page over to see what the results
The 315-page atlas encompasses wet lab and dry lab results for disorders
ranging from common to rare. It uses a format similar to that of
the Survey. The discussion includes a report of how labs fared on
identifying the disorder in the CAP Surveys.
“This is not meant to say that labs aren’t doing a good
job,” says Dr. Hoyer. “A lot of these [disorders] were
very challenging, and we expected labs to have a difficult time
identifying them, especially small labs.” The atlas helps
laboratories recognize some of the rare, complex disorders so, if
necessary, the lab can send them out for additional testing.
Many of the electrophoresis and HPLC illustrations came from the
Mayo Clinic and, as such, present a wide variety of cases. “There
are almost 70 examples of different hemoglobin disorders,”
says Dr. Hoyer. “If there’s something you don’t
recognize, you can probably find it here.” He singles out
the focuses on groups of disorders, such as alpha and beta thalassemias
and Hb E, as particularly useful in compiling information. “A
lot of this is fairly standard stuff, but it’s just not put
into book form very often,” he adds.
The case-study format was chosen because the CAP’s Surveys
lent themselves to that and because “what people liked about
Dr. Fairbanks’ book were the illustrative cases of abnormal
hemoglobin,” says Dr. Kroft. “Our idea was to produce
a new version of illustrative cases, an update of Dr. Fairbanks’
in a sense.”
The CAP’s atlas, however, is unique because the information
from the Surveys “isn’t available anywhere else,”
Dr. Kroft adds. “We were able to update information and incorporate
the results of newer studies and methods to diagnose hemoglobin
disorders,” including HPLC.
Many labs are moving to HPLC from routine electrophoresis and “are
using HPLC as a primary screening modality,” he says. The
CAP atlas is valuable because it contains extensive examples of
the newer technology.
Dr. Sandhaus’ laboratory at the University Hospitals of Cleveland
moved to HPLC about two years ago. “It’s faster, it’s
cheaper, and it requires much less technologist time,” she
says. Committee members “felt it was very important to include
HPLC diagrams in the atlas, even though we didn’t have that
data to send out for proficiency testing.”
Dr. Sandhaus has already used an early version of the atlas in clinical
practice at Case Western. “I saw an abnormality on an HPLC
result from a newborn infant that might have been hemoglobin-Bart’s,”
she says. She turned to the relevant section in the atlas and found
an HPLC tracing for the condition.
The atlas is geared toward medical technologists and technicians,
pathologists, residents, and clinicians interested in hemoglobin
disorders. Dr. Kroft expects the hematologists at his medical center
to quickly snag a couple of the atlases for themselves.
“The atlas will be a great reference for labs that do hemoglobin
identification,” says Dr. Sandhaus. “It presents a very
comprehensive collection of cases,” all of which are cross-referenced.
The committee’s next project is an atlas on body fluids that,
too, will incorporate CAP Surveys data. After that may come a second
edition of the hematology atlas and an atlas of urine sediment.
At CAP TODAY press time, the Color Atlas of Hemoglobin
Disorders was slated for release in May. Sample pages will
be available on the CAP web site. The atlas is $125 for CAP members
and $150 for non-members. To order, call the CAP at 800-323-4040
and press option 1#.
Karen Southwick is a writer in San Francisco.