Yes, newborn screening tests for sickle cell disease and trait using a heel-prick blood spot in the first 1–2 days after birth.
Newborn screening is a routine heel-prick blood test done shortly after birth to check for conditions that benefit from early care. In the United States, every state screens babies for sickle cell disease (SCD) and also detects sickle cell trait. The lab tests a few dried blood drops from your baby’s heel and reports a hemoglobin pattern, which tells the care team whether results look typical, show trait, or suggest a form of SCD. If the screen isn’t typical, your baby will get a follow-up test to confirm the finding and set up care.
Newborn Screening Test For Sickle Cell: What Parents Should Know
Sickle cell screening on the newborn blood spot looks for hemoglobin types made in the first days of life. Patterns such as FA, FAS, FS, or FSC point to different possibilities. A pattern with only F and A (FA) is the usual finding. Patterns that include S alongside F (and sometimes A or C) may indicate a trait or a form of SCD that needs prompt follow-up. Screening doesn’t make a final diagnosis; it flags babies who need confirmatory testing so care can start without delay.
| Hemoglobin Pattern | What It Likely Means | What Usually Happens Next |
|---|---|---|
| FA | Typical pattern; no S present | No further testing unless your clinician advises |
| FAS | Sickle cell trait | Trait confirmation; offer parent testing and education |
| FS | Possible SCD (often HbSS or HbSβ0) | Confirm promptly; start preventive care after diagnosis |
| FSC | Possible HbSC disease | Confirm promptly; plan hematology follow-up |
| FSA | Possible HbSβ+ thalassemia | Confirm promptly; plan hematology follow-up |
| FSD/FSE | Possible S with D or E variant | Confirm promptly; plan hematology follow-up |
Early testing helps babies with SCD begin penicillin, stay current with vaccines, and connect with a pediatric sickle cell team. You can read the national Recommended Uniform Screening Panel to see how hemoglobin disorders appear on the standard newborn list. For a walk-through of the heel-prick process, see HRSA’s short guide to the newborn screening process.
How The Heel-Prick Screen Works
The nurse warms your baby’s heel, cleans a small area, and collects several drops of blood onto a filter card. The card dries and goes to the state lab. There, technicians run protein-based methods such as isoelectric focusing or high-performance liquid chromatography to separate the hemoglobins. These methods are accurate for detecting patterns that include S. Programs use quality checks, and abnormal screens also trigger confirmatory testing.
Timing And Transfusions
Most programs collect the blood spot at 24–48 hours of age. A specimen drawn too early can give unclear results. If a baby received a red-blood-cell transfusion before collection, donor cells can mask the baby’s pattern. In that case, a repeat screen or DNA-based testing is arranged, often about four months after the last transfusion.
What Happens After A Positive Screen
A positive or out-of-range screen is a start, not the last word. Your baby will have a confirmatory test with a fresh blood sample. Programs aim to finish by two months so care can begin quickly if SCD is present. Families are linked with a pediatric hematology clinic by three months. After a confirmed diagnosis, babies start daily penicillin, keep the routine immunization schedule on time, and receive a clear plan for fever or illness.
| When | Action | Why It Matters |
|---|---|---|
| Days to weeks | Confirmatory hemoglobin testing | Clarifies the exact type and avoids mislabeling |
| By 2 months | Finish confirmation; share the care plan | Sets up early antibiotics and family education |
| By 3 months | First visit with a pediatric sickle cell team | Builds the care relationship and reviews safety steps |
| 2–5 months | Start penicillin if SCD is confirmed | Lowers the risk of severe infections in early childhood |
| Ongoing | Timely vaccines; emergency plan for fever | Prepares the family for common situations |
What About Sickle Cell Trait?
Sickle cell trait means a baby has one usual hemoglobin gene and one S gene. Babies with trait are healthy and don’t need treatment, yet trait knowledge helps with later pregnancies and may matter for certain sports or military settings. Many programs confirm trait with a second sample. Parents often choose to get tested themselves, since two trait carriers have a one-in-four chance of having a child with SCD in each pregnancy.
Reading The Report You Receive
Newborn screening reports list a pattern rather than a full diagnosis. That’s because newborns still make mostly fetal hemoglobin, so the lab needs a second test to name the exact type. Here’s how to read the basics:
Pattern Order
Letters are shown in order of amount. F (fetal) comes first in newborns, then A (adult) or S, C, D, or E variants. An FA pattern is the common finding; adding S (FAS) indicates trait; patterns that start with FS usually point to an SCD type that needs prompt follow-up.
Notes And Flags
Reports often include flags about early collection, possible transfusion, or a request for a repeat sample. If you see a note about transfusion, expect a repeat at three to four months or a DNA-based test sooner. If you see “repeat needed,” it’s about getting a clean, reliable sample.
How A Confirmed Sickle Cell Diagnosis Changes Care
Once SCD is confirmed, the care team sets up a simple daily routine and a safety plan. Daily penicillin in the first years reduces life-threatening infections. Families learn to check temperatures and seek care for fever. The pediatric team keeps vaccines on schedule and talks through nutrition, hydration, and pain comfort. As children grow, the team adds screening tests and helps with school and activity plans. Starting early keeps children thriving and helps families feel prepared.
Questions To Ask Before You Leave The Hospital
- When will the heel-prick sample be collected, and how will I get results?
- Will my baby need a second sample because of timing, prematurity, or a transfusion?
- Who should I call if the report says “repeat needed” or “out-of-range”?
- If trait or SCD is reported, where will confirmatory testing take place?
- How soon can we meet a pediatric sickle cell team if SCD is confirmed?
My Baby’s Result Mentions A Different Variant
Some screens show S with another letter such as C, D, or E. These patterns can indicate HbSC disease, S-D, or S-E forms. Severity varies by type, which is why the exact diagnosis comes from confirmatory testing. A team visit helps you learn the plan that fits your child’s type, from fever care to travel tips.
Accuracy, Limits, And Repeat Samples
Screening separates hemoglobin proteins with great precision, yet it still functions as a risk check. A few results need repeating because the first sample was too early, the circles didn’t fully soak through the card, or a transfusion occurred. Premature or extra-low-birth-weight infants often get a scheduled repeat because some values shift across the first weeks. When a repeat is requested, it doesn’t mean something is wrong; it simply ensures that the final answer rests on a clean sample.
How Results Are Shared And What To Expect
Hospitals send cards to the state lab daily, and results return to your baby’s clinician and the hospital or birth center. Many programs call only if a repeat or follow-up test is needed, so ask how you’ll receive routine results. If the screen shows a trait or suggests SCD, you’ll hear from your clinician or the newborn screening office with clear next steps and a timeline. State teams are used to guiding families through confirmatory testing and the first appointments. Ask for a copy of the report for your records and bring it to the first clinic visit.
Sickle Cell Types At A Glance
Different patterns point to different SCD types. HbSS (often the result behind an FS pattern) is one of the most common. HbSC disease (FSC on a screen) and HbSβ0 thalassemia can resemble HbSS in early childhood. HbSβ+ thalassemia (often FSA) tends to have some HbA present, which can soften certain features; only the confirmatory test can sort out the exact type. No matter the type, early care includes infection prevention, growth, and pain comfort, matched to the child.
Tips To Make The Heel-Prick Easier
- Hold your baby or do skin-to-skin during the collection if staff say it’s safe.
- Offer feeding or a pacifier during the quick poke.
- Keep the heel warm with a blanket or a gentle rub so the drops flow smoothly.
Want to see the official policy basis for screening? The CDC confirms that universal newborn screening for SCD is in place across the country; see this MMWR report. For a plain-language walkthrough of the dried blood spot process, visit HRSA’s page on the newborn screening process.
Quick Takeaways
- Every U.S. state screens newborns for sickle cell, and the heel-prick blood spot also detects trait.
- Screening flags babies who need a second test; diagnosis comes from confirmatory testing.
- Early confirmation lets families start penicillin, keep vaccines on time, and set an action plan for fever.
- Trait is common, doesn’t cause illness, and is useful to know for family planning and later activities.
- Transfusion before collection can hide a baby’s own pattern, so many programs repeat the test months later.