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Updated: Jul 25, 2026
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Routine hemoglobin electrophoresis for pediatric surgery day case in at-risk populations: Suggested algorithm for
A O Ademuyiwa1, C O Bode, O O Adekola
1Department of Surgery, Paediatric Surgery Unit, College of Medicine, Lagos University Teaching Hospital, University of Lagos, Lagos, Nigeria.
Insights
This study identified key risk factors for hemoglobinopathies in pediatric patients undergoing day surgery. Proposed guidelines aim to optimize preoperative screening for hemoglobin electrophoresis (HBE).
Area of Science:
- Pediatric Surgery
- Hematology
- Clinical Genetics
Background:
- Hemoglobin electrophoresis (HBE) is a standard preoperative test, but hemoglobinopathy prevalence is low.
- Current screening practices may lead to unnecessary testing in pediatric day surgery patients.
- Identifying clinical risk factors can refine HBE screening protocols.
Purpose of the Study:
- To determine clinical risk factors for hemoglobinopathies in pediatric patients undergoing day surgery.
- To propose evidence-based clinical guidelines for preoperative HBE screening.
Main Methods:
- Prospective study over 12 months including pediatric patients (≥6 months) undergoing day surgery.
- Collection and statistical analysis of biodata and clinical information.
- Evaluation of patient history, physical examination findings, and laboratory results.
Main Results:
- 124 pediatric patients (median age 3 years) were included; 71.7% underwent scrotal lesion repair.
- Prevalence of hemoglobin variants: HbAA (78%), HbAS (15.3%), HbAC (4.8%), HbSC/HbSS (0.8%).
- Significant predictors of hemoglobinopathy included history of jaundice, hand-foot syndrome, frontal bossing, and low packed cell volume (anemia).
Conclusions:
- Clinical indicators like jaundice, hand-foot syndrome, frontal bossing, and anemia are significant risk factors for hemoglobinopathies.
- Recommended screening guidelines: HBE if one parent has sickle cell trait and the other's genotype is unknown, or if any identified risk factors are present.
- No mortality was observed in the study cohort.
Background:
Hemoglobin electrophoresis (HBE) is a part of the preoperative routine requested by anesthetists. However, the prevalence of hemoglobinopathy in the population is low. This study aims to determine the clinical risk factors for hemoglobinopathies and propose clinical guidelines for preoperative screening of patients for pediatric day care surgery.
Patients And Methods:
A prospective study carried out over 12 months. Consecutive patients aged 6 months and older who had day case surgery were recruited to the study. Biodata and relevant clinical data were collated and documented in a proforma and analyzed using a statistical package for social sciences version 17.
Results:
There were 124 patients106 boys and 18 girls. The median age was 3 years. Scrotal lesions were the most common conditions managed (71.7%). Seventy-eight percent of patients had HbAA, 15.3% had HbAS, and 4.8% had HbAC while 0.8% each had both HbSC and HbSS. At least one parent of 78.2% knew their Hb phenotype, of which, 79% were HbAA. A history of jaundice (P = 0.0001), hand and foot syndrome (P = 0.0001), frontal bossing (P = 0.0001), and low packed cell volume at surgery (P = 0.001) were found significant in predicting hemoglobinopathies. There was no mortality.
Conclusion:
Risk factors for hemoglobinopathies from this study included a positive history of jaundice, hand and foot syndrome, frontal bossing, and anemia. Proposed guidelines for HBE screening include the presence of hemoglobinopathy in one parent if one parent has sickle cell trait, and the other parent's genotype is unknown or if any of the risk factors is present.
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