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Smitirupa Mishra: Normal Hemoglobin Does Not Always Mean Normal Genes
Smitirupa Mishra/LinkedIn
Jun 10, 2026, 18:00

Smitirupa Mishra: Normal Hemoglobin Does Not Always Mean Normal Genes

Smitirupa Mishra, Consultant Pathologist at Sparsh Hospitals and Lab Head at Pathkind Labs, shared a post on LinkedIn:

“After reporting daily HPLCs, and seeing so many carrier states that look completely normal on a CBC…
that’s when it really struck me:

‘Normal hemoglobin does not always mean normal genes.’

Many people walk into the lab with normal hemoglobin and no symptoms – yet they silently carry hemoglobinopathies.

These ‘silent carriers’ are often detected only through HPLC/electrophoresis.

Early detection can prevent a lifetime of complications for the next generation.

Hemoglobinopathies that may have normal or near-normal hemoglobin:

  • β-thalassemia trait
  • α-thalassemia trait (including silent carriers)
  • Sickle cell trait (HbAS)
  • HbE trait
  • HbD trait
  • HbC trait
  • δβ-thalassemia trait
  • Hereditary persistence of fetal hemoglobin (HPFH)
  • Mild/compound heterozygous states (e.g., HbE/β plus thal, HbS/β plus thal)

The real goal:

Detect early.

Counsel early.

Prevent severe hemoglobinopathies.

Screening principles to follow:

  • Do not rely on hemoglobin alone.
  • Look for clues: low MCV/MCH, high RBC count, target cells, family/ethnic history.
  • Use HPLC/electrophoresis as a screening tool.
  • Screen both partners (premarital/antenatal).
  • Counsel and guide at-risk couples.
  • Consider molecular testing when needed (especially for α-thalassemia).
  • Universal and community screening can save generations.

Every HPLC report is more than numbers – it is an opportunity to change a family’s future.

Let’s keep raising awareness, strengthening screening, and working together to reduce the burden of hemoglobin disorders.”

Smitirupa Mishra

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