Hematological Correlates of Hemoglobinopathies in Women of Reproductive Age With Anemia: A High-Performance Liquid Chromatography (HPLC)-Based Cross-Sectional Study

Background: Anemia continues to pose a significant public health challenge, particularly among women of reproductive age. Despite ongoing nutritional intervention programs and iron supplementation strategies, the burden of anemia remains persistently high. In addition to iron deficiency anemia (IDA), inherited hemoglobin disorders such as β-thalassemia and sickle cell disease are important contributors to anemia. High-performance liquid chromatography (HPLC) has emerged as a reliable and widely used method for the identification of hemoglobin variants and the quantification of hemoglobin A₂ (HbA₂) and hemoglobin F (HbF). The objective of our study was to investigate the range of hemoglobinopathies identified by HPLC and to compare them with routine hematological parameters. Methods: Our study was conducted in the Department of Pathology, Rajendra Institute of Medical Sciences, Ranchi, over 18 months from August 2024 to January 2026. A total of 277 anemic females aged 19-49 years with hemoglobin levels below 11 g/dL were enrolled. Hematological parameters were analyzed using an automated hematology analyzer, while hemoglobin fraction analysis was performed using cation-exchange HPLC. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 27 (Released 2019; IBM Corp., Armonk, New York, United States). Results: The mean age of participants was 33.2 ± 9.07 years, and the mean hemoglobin level was 9.7 ± 0.95 g/dL. Microcytic hypochromic anemia was the predominant pattern with elevated red cell distribution width (RDW) values indicating anisocytosis. HPLC analysis revealed abnormal hemoglobin patterns in 44% of participants. Sickle cell trait was the most common abnormality (26%), followed by sickle cell disease (11%) and β-thalassemia trait (7%). RDW showed significantly superior discriminative ability for predicting hemoglobinopathies compared to mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). Conclusion: Hemoglobinopathies were common among anemic women of reproductive age, with sickle cell trait being the predominant abnormality detected on HPLC analysis. Routine hematological parameters showed considerable overlap, whereas RDW demonstrated better discriminatory ability but was insufficient alone. HPLC improved the detection and characterization of hemoglobin variants and may be useful in the targeted evaluation of high-risk populations.