Newborn screening for sickle cell disease: 4 years of experience from California's newborn screening program.
OBJECTIVE
In this article we describe the success of a unique newborn screening program for sickle cell disease and other hemoglobinopathies. We will present and discuss 4 years of experience from the California Newborn Hemoglobinopathy Screening Program.


METHODS
Several aspects that ensure the success of the program will be reviewed. These aspects include (a) the use of high-pressure liquid chromatography as the initial screening technique, (b) a confirmatory testing laboratory that incorporates DNA technology and innovative protein analysis using electrospray mass spectrometry, and (c) a complex follow-up strategy that employs regional nurses to track positive results and ensure timely enrollment of infants into treatment systems.


RESULTS
Of these 2 million infants screened, 492 were diagnosed with some form of sickle cell disease; 290 (58.9%) were diagnosed with hemoglobin SS, 143 (29.0%) were diagnosed with hemoglobin SC, and 47 (9.5%) were diagnosed with S beta+thalassemia.


CONCLUSIONS
The prevalence and ethnicity data presented here demonstrate the ineffectiveness of targeted screening and justify universal screening. Had targeted screening been performed in California during the past 4 years, 58 nonblack infants with sickle cell disease would have gone undiagnosed, and 6,921 nonblack infants with sickle cell trait would not have been identified.
Shafer
F E
FE
Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
Lorey
F
F
Cunningham
G C
GC
Klumpp
C
C
Vichinsky
E
E
Lubin
B
B
D000755:Anemia, Sickle Cell / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D002140:California / Q000453:epidemiology; D002851:Chromatography, High Pressure Liquid; D006453:Hemoglobinopathies / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control; D006455:Hemoglobins, Abnormal / Q000032:analysis; D006801:Humans; D007231:Infant, Newborn; D007525:Isoelectric Focusing; D008403:Mass Screening / Q000592:standards; D009359:Neonatology / Q000592:standards; D015995:Prevalence; D015397:Program Evaluation
D006455:Hemoglobins, Abnormal