Imbalances of globin chains cause hemolysis and impair erythropoiesis. Hemoglobin F or Fetal hemoglobin- It is found in newborn kids and foetuses. A serum ferritin (to exclude iron deficiency anemia) should be performed simultaneously. Then, they put the strip with the sample into a machine called an electrophoresis chamber. Chui DHK SM. Hemoglobin electrophoresis (pronounced he-ma-glow-bin elek-tro-fo-re-sus) is one process that healthcare providers use to analyze hemoglobin in your red blood cells. You don't need any special preparations for a hemoglobin electrophoresis test. Copyright 2023 American Academy of Family Physicians. The Hb Electrophoresis Test, or the Hemoglobin electrophoresis, is a laboratory test that separates the different types of hemoglobin in a blood sample. HbC is an abnormal form of hemoglobin associated with hemolytic anemia. Hemoglobin type levels that are too high or too low may be signs of a blood disorder. Hemoglobin electrophoresis has been superseded by more rapid, sensitive, and quantitative methods of hemoglobin separation. Description This test is limited to qualitative identification of hemoglobins without interpretation. In the laboratory, a process called electrophoresis passes an electrical current through the hemoglobin in your blood sample. Hemoglobin electrophoresis analyzes the different types of hemoglobin in your red blood cells. The adequacy of the oxygen transport system depends on the affinity of hemoglobin for oxygen In adults, HbA is the major hemoglobin (97%), composed of 2 subunits and 2 subunits () with minor amount of HbA 2 (approximately 1.5 - 3.5%; 2 2) and HbF (approximately 1%; 2 2) ; Two -globin genes are located on each chromosome 16, resulting in 4 -gene loci (/) High hemoglobin usually occurs when there is an underlying issue present. There are two options for how the blood sample is tested: Hemoglobin electrophoresisThis is a test that looks at the different types of hemoglobin in your blood. [3], Capillary electrophoresis (CE) is comparable to CA electrophoresis for reliable measurement of Hb fractions. Carrier screening for hemoglobinopathies is done with a blood test. What is a hemoglobin electrophoresis test? Critical values: low/high which indicate life threatening state, triggers phone call to physician. Multivitamin supplements in pregnancy: an expense too much? For example, if your hemoglobin Type F level is higher than normal, it could be a sign you have a form of thalassemia. The two-gene deletion causes alpha thalassemia trait (minor) with microcytosis and usually no anemia. Approximate ranges given below. However, studies focusing on Hb levels and pregnancy outcomes are scarce. Performed in a private laboratory, this test costs between 20 and 30 euros. (Hb H is a tetramer of beta globin chains.) He or she can help you understand the disorder and your risk of passing it along to your child. Hemoglobin electrophoresis helps diagnose serious conditions like sickle cell anemia. Using these references, as well as publications by other researchers in which normal values were determined across pregnancy for a number of analytes, we compiled a table of the most common, and some not so common, laboratory test . The only other hemoglobin band that is visible on alkaline gel electrophoresis in normal adults and children (not neonates) is Hb A2 (22) which is present at low concentrations, < 3.5% of total hemoglobin. This website uses cookies to improve your experience while you navigate through the website. Oct 2011;31(4):238-243.: Caruso D, Crestani M, Mitro N, et al. Hemoglobin electrophoresis (pronounced he-ma-glow-bin elek-tro-fo-re-sus) is one process that healthcare providers use to analyze hemoglobin in your red blood cells. laboratory tests, reference ranges, and understanding results, https://www.hematology.org/Patients/Anemia/Sickle-Cell.aspx, https://my.clevelandclinic.org/health/diseases/4579-sickle-cell-anemia, https://kidshealth.org/en/parents/test-electrophoresis.html, https://labtestsonline.org/tests/hemoglobinopathy-evaluation, https://labtestsonline.org/conditions/jaundice, https://www.marchofdimes.org/baby/newborn-screening-tests-for-your-baby.aspx, https://www.merckmanuals.com/home/blood-disorders/anemia/hemoglobin-c,-s-c,-and-e-diseases?query=hemoglobin%20electrophoresis, https://www.nhlbi.nih.gov/health-topics/blood-tests, https://www.nhlbi.nih.gov/health-topics/sickle-cell-disease, https://www.nhlbi.nih.gov/health-topics/thalassemias, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252227, https://ufhealth.org/hemoglobin-electrophoresis, https://patient.uwhealth.org/healthwise/article/hw39098, What You Need to Know About Blood Testing, U.S. Department of Health and Human Services. Hoffman: Hematology: Basic Principles and Practice. A value that isn't in the normal range may still be normal for you. Washington D.C.: American Association for Clinical Chemistry; c20012020. Hemoglobin is a protein found in red blood cells that carries oxygen from the lungs to the rest of the body. Background Hemoglobin (Hb) measurement is a standard test among pregnant women during the first perinatal visit that is used to evaluate physical status and anemia. Hemoglobin electrophoresis is used as a screening test to identify normal and abnormal hemoglobins and assess their quantity. The tests measure the levels of certain enzymes and proteins in your blood. Healthcare providers place dissolved red blood cells from the sample on a cellulose strip. Our website services, content, and products are for informational purposes only. Beta thalassemia is the result of deficient or absent synthesis of beta globin chains, leading to excess alpha chains. In: Hoffman R BJE, Shattil SJ, Furie B, Silberstein LE, McGlave P, Heslop HE, ed. Hemoglobin is the protein inside red blood cells responsible for transporting oxygen to your tissues and organs. (III-A) 3. Hemoglobin electrophoresis is a test that measures the different types of hemoglobin in the blood. Chorionic villus sampling using polymerase chain reaction technology to detect point mutations or deletions can identify infants affected with beta thalassemia. All samples must be sent in a sealed, leak-proof container marked with a biohazard sticker to comply with Occupational Safety and Health Administration (OSHA) safety standards. The major hemoglobin types have different electrical charges. The screening, diagnosis, potential complications, and routine management of sickle cell trait are discussed here. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. Persons with thalassemia should be referred for preconception genetic counseling, and persons with alpha thalassemia trait should consider chorionic villus sampling to diagnose infants with hemoglobin Bart's, which increases the risk of toxemia and postpartum bleeding. The "Dancing with the Stars" judge and co-host of "The Talk" opens up about living with iron deficiency anemia. The vial is submitted for analysis. Hematopoietic stem cell transplantation generally results in an excellent outcome in low-risk persons, defined as those with no hepatomegaly, no portal fibrosis on liver biopsy, and regular chelation therapy, or at most, two of these abnormalities.2, If hypersplenism causes a marked increase in transfusion requirements, splenectomy may be needed. Hemoglobin has a unique property to bind with oxygen and carry it to various body parts. This is because the volume of blood has to increase up to 50% in order for a body to provide the baby with all necessary nutrients. Hemoglobin levels normally fall duringpregnancy. Therefore, daily oral supplementation with 1 mg of folic acid is recommended for persons with evidence of folate deficiency.18. L'electrophoresis of hemoglobesna is a test that measures different types of hemoglobin in the blood and also looks for abnormal types of hemoglobin. It is responsible for carrying oxygen throughout the body. Sickle cell can be diagnosed by a blood test. Haemoglobin is a protein present on red blood cells. In addition to the increase of blood volume being the reason behind low hemoglobin, deficiency of iron, vitamin B12, vitamin C and folic acid could also be responsible for it. Definition HB electrophoresis is used as a screening test to identify variant and abnormal hemoglobins HB electrophoresis help in diagnosis of diseases in which abnormal hemoglobin production occur Electrophoresis uses an electrical current to separate normal and abnormal types . Hemoglobin A1 (96% to 98% of total hemoglobin), Hemoglobin A2 (1.5% to 3.5% of total hemoglobin), Hemoglobin F (0.5% to 1% of total hemoglobin). IEF and electrophoresis both use electric currents to separate hemoglobin types. A new technique for differentiation of hemoglobin. Unisex. Normal adult hemoglobin (HbA) has two - and two -globin chains (2 2). 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.hematology.org/education/patients/blood-basics). The hemoglobin electrophoresis testsfor abnormal forms of hemoglobin (hemoglobinopathy). Sickle cell trait. The problem can be so severe that it can even interrupt the regular progression of the gestation, causing side effects such as: As your hemoglobin levels keep falling, the symptoms will get worse and worse. drug screen serum. If you or your child was diagnosed with a sickle cell disease or other hemoglobin disorder, talk to your provider about treatment options. Interpretation of hemoglobin electrophoresis results should be placed in the clinical context, including the family history and results of serum iron studies, red cell morphology, hemoglobin, hematocrit, and red cell indices (eg, mean corpuscular volume). The chamber is a machine that passes electrical currents through the sample. This cookie is set by GDPR Cookie Consent plugin. Normal value ranges are: Total protein: 6.4 to 8.3 grams per deciliter (g/dL) or 64 to 83 grams per . Let's see what it consists of and what it is used for. Silent carriers of alpha thalassemia and persons with alpha or beta thalassemia trait are asymptomatic and require no treatment. Persons with a microcytic anemia but milder symptoms that start later in life have beta thalassemia intermedia. The levels that a hemoglobin electrophoresis test refer to are the percentages of the different types of hemoglobin that may be found in your blood. Available from. The lab technician may also perform a test known as hemoglobin electrophoresis. Bethesda (MD): U.S. Department of Health and Human Services; Blood Tests; [cited 2020 Jan 10]; [about 3 screens]. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjA4NTYzNy1vdmVydmlldw==. How the Test is Performed A blood sample is needed. Persons with a history of thrombosis may be treated with low-molecular-weight heparin. Washington D.C.: American Society of Hematology; c2020. Thalassemia, a condition that affects the production of hemoglobin. It is mostly used to diagnose Mediterranean anemia (or Thalassemia), sickle cell anemia, and other hemoglobin disorders. Jaundice; [updated 2019 Oct 30; cited 2020 Jan 10]; [about 2 screens]. Policy. Cleveland Clinic Cancer Center provides world-class care to patients with cancer and is at the forefront of new and emerging clinical, translational and basic cancer research. This content is owned by the AAFP. National Human Genome Research Institute. Most patients with abnormal hemoglobins have no symptoms but could potentially transmit the gene to their fetus. High and low values. By clicking Accept All, you consent to the use of ALL the cookies. Test Code: 121690 Specimen Type: Blood Description: Hemoglobin Electrophoresis Blood Test (Labcorp) The Hemoglobin Electrophoresis test is used to detect and quantify both normal and abnormal forms of Hemoglobin . The thalassemias are a group of inherited hematologic disorders caused by defects in the synthesis of one or more of the hemoglobin chains. Though there are no major side effects of the test except bruising of the injection site, it is best to consult a physician before ordering the test. Beta thalassemia intermedia is less severe than beta thalassemia major and may require episodic blood transfusions. These are the possible outcomes with each pregnancy. Persons with beta thalassemia major often die from cardiac complications of iron overload by 30 years of age. 96. This is because the volume of blood has to increase up to 50%in order for a body to provide the baby with all necessary nutrients. 2023. 1500 in India. The band is removed after enough blood is acquired. The good sources of folic acid are foods like banana, avocado, corn, lettuce, and sprouts. Untreated infants have poor growth, skeletal abnormalities, and jaundice. There are several types of hemoglobin, and the proportions of each type can vary . ReadDr. Amos' full bio, the book about him "Lessons in Survival: All About Amos," and afictionalized account of his father's lifein the novel, "Through Walter's Lens.". A more recent article on alpha- and beta-thalassemia is available. Available from: National Heart, Lung, and Blood Institute [Internet]. Fetal hemoglobin (HbF) has two - and two -globin chains (2 2). The test will help them find any abnormal types of hemoglobin in your blood. A normal serum lead level excludes lead poisoning. Our blood contains a protein called Hemoglobin or Hgb. PTH SST 2d Test Name Alt Spec Add- on Salicylate N/A 1d Blood Bank None 3d Sodium None 7d Adenovirus PCR, Plasma Lav EDTA 3d RED NO GEL Theophylline None 7d Ammonia + None 3hrs Test Name Alt Spec Add- on Tobramycin None 2d BK Virus PCR, Plasma Lav EDTA 3d Ethanol GC None 7d Transferrin None 7d BNP Lav EDTA 3d 4. 3. Heres the typical test procedure: Isoelectric focusing (IEF) is another technique for identifying abnormal hemoglobin. The test separates proteins in the blood based on their electrical charge. A single gene deletion results in alpha thalassemia silent carrier status, which is asymptomatic with normal hematologic findings. No randomized or observational studies regarding anticoagulation, antiplatelet therapy, or both have been reported for persons at greater risk of thromboembolic events. Pressure is applied on the site and then a bandage is put. The cookie is used to store the user consent for the cookies in the category "Analytics". The test results of Hemoglobin electrophoresis help to check for any abnormal hemoglobin. All Rights Reserved. Serum ferritin is the best test to screen for iron deficiency anemia.10 In the absence of inflammation, a normal ferritin level generally excludes iron deficiency. Hemoglobin electrophoresis uses electrical charges to separate hemoglobin types so healthcare providers can compare the level of each type with normal levels. They include: A hemoglobin electrophoresis test doesnt tell you about the amount of hemoglobin in your blood thats done in a complete blood count. This test separates out the different molecules in the red blood cells, allowing them to identify the. This patient probably:-is normal-has sickle cell anemia . In a study of 1019 women, the 95% reference range in non-anemic women rose from 4-57 mm/h in first trimester to 13-70 mm/h in third trimester. The hemoglobin electrophoresis test is designed to detect genetic abnormalities in the structure of a person's hemoglobin. To monitor treatment: If youre being treated for a condition that causes abnormal types of hemoglobin, your doctor will monitor your levels of the different types of hemoglobin with a hemoglobin electrophoresis. In addition to his current work, Dr. Amos is using his vast experience to launch Obie, a science-based app that offers personalized fertility advice. When enough blood has been drawn, they remove the needle and cover the site with a gauze pad. Available from: National Heart, Lung, and Blood Institute [Internet]. Family physicians need to know how to diagnose thalassemias, how to distinguish them from other causes of a microcytic anemia, and the treatment options for severe forms of thalassemia. Learn more about laboratory tests, reference ranges, and understanding results. Itching in pregnancy: how to relieve it, when to worry. Haemoglobin F. Anemia was defined as a hemoglobin level less than 11.0 g/dl in the first and third trimester or less than 10.5 g/dl in the second trimester of pregnancy. donath landsteiner. Various seeds such as flax seeds and sunflower seeds should also be a part of your diet as they are rich in folate too. Sickle Cell Disease; [cited 2020 Jan 10]; [about 3 screens]. In the United States, most people with sickle cell disease are of African ancestry. In the lab, the technician places the blood sample on special paper and applies an electric current. Hemoglobin is a protein in your red blood cells that helps cells carry oxygen throughout your body. You may also want testing if you are at risk for having a child with sickle cell disease or another inherited hemoglobin disorder. 2. A test . In this study, we established the normal ranges of haemoglobin A2 (HbA2) and haemoglobin F (HbF) levels for normal individuals using this system and also the HbA2 level in beta thalassaemia and haemoglobin E (HbE) individuals. Preconception genetic counseling is strongly advised for all persons with thalassemia.20 Two parents, each with beta thalassemia trait, have a one in four chance of conceiving a child with beta thalassemia major and a three in four chance the child will have thalassemia trait or be normal (Online Figure A). They then send your blood sample to a laboratory for analysis. Please confirm that you would like to log out of Medscape. Hemoglobin Electrophoresis,HGB Variants,HB S,Hemoglobin F,HGB Evaluation,Hemoglobin S,HB A2,HGB Electrophoresis,Hemoglobin Variants,Hemoglobin A2,Thalassemia Screen,HB F. LOINC Codes, Performing Laboratory . (: Hb Electrophoresis Test) Hb . To gauge the effectiveness of treatment of above conditions, Hemoglobin A or Adult hemoglobin- Most common type of hemoglobin found in healthy adults. These cookies will be stored in your browser only with your consent. Ongoing bleeding could be a problem if you have a bleeding disorder or are taking blood-thinning medication, such as warfarin (Coumadin) or aspirin (Bufferin). During the test your healthcare provider will collect the blood sample in a vial. The normal range is just a guide. Last reviewed by a Cleveland Clinic medical professional on 02/11/2022. It quickly declines by the time your baby is a year old: The normal levels of the types of hemoglobin in adults are: You acquire different abnormal types of hemoglobin by inheriting gene mutations on the genes that are responsible for producing hemoglobin. The risks are low and may include: Bleeding Passing out or feeling lightheaded Blood building up under your skin ( hematoma) Infection At the lab, a technician. hemoglobin < 27 pg) in the presence of a normal hemoglobin electrophoresis or high performance liquid chromatography the patient should be investigated with a brilliant cresyl blue stained blood smear to identify H bodies. Hemoglobin Electrophoresis. Persons with beta thalassemia major require periodic and lifelong blood transfusions to maintain a hemoglobin level higher than 9.5 g per dL (95 g per L) and sustain normal growth.2,15 The need for blood transfusions may begin as early as six months of age. Gainesville (FL): University of Florida Health; c2020. When HbF is higher than 2% of the total hemoglobin, then this is considered abnormal. Persons at risk of having a child with thalassemia should be offered preconception genetic counseling. Cleveland (OH): Cleveland Clinic; c2020. However, you may visit "Cookie Settings" to provide a controlled consent. Blood. HPCL, also called High-performance chromatography test, is used to screen thalassemia and other blood diseases. The presence of M proteins can be a sign of a type of cancer called myeloma, or multiple myeloma. There are some normal and some abnormal hemoglobin types in human body, and if the abnormal hemoglobin exceeds the amount of normal hemoglobin, this will result in a blood disorder. Usually, this issue is related to either lungs, kidneys or the heart. Cellulose acetate/citrate agar electrophoresis of filter paper hemolysates from heel stick. Commom laboratory tests. Hemoglobin electrophoresis test is used to identify and measure different types of Hemoglobin that can be found in the blood. Blood from healthy newborns typically shows 20-30% Hb A, 70-80% hemoglobin F (22), and no Hb A2. [6], Mass spectrometry, a newer analytical technology, may be used to identify highly unstable hemoglobins that may manifest clinically as hemolytic anemia or thalassemia. By approximately six months of age, healthy infants will have transitioned to mostly HbA, a small amount of HbA2, and negligible HbF. Hemoglobin electrophoresis is a test that measures the different types of hemoglobin in the blood. A patient has target cells and a positive tube solubility test. The electrophoresis results will then show the types of hemoglobin present and the levels of each type. These include: If you've just had a baby, your newborn will be tested as part of a newborn screening. The provider will collect a few drops of blood and put a bandage on the site. Transfusion requirements are episodic and become necessary when the person's hemoglobin is inadequate for a normal life or when the anemia impairs growth and development. If one parent has hemoglobin C trait and the other parent has normal hemoglobin, there is a 50 percent (1 in 2) chance with each pregnancy of having a child who has hemoglobin C trait. Your healthcare provider is your best resource for understanding your specific results. Necessary cookies are absolutely essential for the website to function properly. Here is the normal range of haemoglobin in adults. My doctor however suggested normal FBS and PPBS instead. Available from: Merck Manual Consumer Version [Internet]. Transfusion-dependent patients develop iron overload because they have no physiologic process to remove excess iron from multiple transfusions. The hemoglobin electrophoresis, on the other hand, offers a complete and more comprehensive breakdown of the hemoglobin in the test results. St. Louis, Mo: Elsevier; 2019. Available from: UW Health [Internet]. Diagnosis is based on genetic testing and quantitative hemoglobin analysis. You can learn more about how we ensure our content is accurate and current by reading our. Most people with sickle cell trait do not have health problems. Washington D.C.: American Association for Clinical Chemistry; c20012020. Learn what high and low numbers. Water retention in pregnancy: causes and remedies, Nausea in pregnancy: times, causes and remedies, Exercises to strengthen your back in pregnancy. Pallor, irritability, growth retardation, abdominal swelling, and jaundice appear during the second six months of life.6. To screen for genetic conditions: People who have a family history of inherited anemias such as thalassemia or sickle cell anemia may choose to screen for these genetic disorders before having children. Hemoglobin electrophoresis measures the levels of the different types of this protein in the blood. Normal adult: mainly HbA, small amounts HbA 2 (1.5-3.5%), HbF. This should go away quickly. d-lactate. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Available from: Kids Health from Nemours [Internet]. Patients with thalassemia have target cells and hypochromic (low color) and microcytic (small-sized) red blood cells. Hemoglobin C trait is inherited from one's parents, like hair color or eye color. This leads to the decrease of RBC concentration in blood, causing hemoglobin levels to drop. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. Available from: March of Dimes [Internet]. One study found osteoporosis in 51 percent of persons older than 12 years with thalassemia major.14, Persons with thalassemia trait require no treatment or long-term monitoring. Hb Electrophoresis Hb Electrophoresis Also known as Haemoglobin Electrophoresis Electrophoresis Blood This test is not available in your city Change City Home sample collection for FREE A certified professional will collect your sample from your preferred location Get digital report within 2 days 11.9. Normal Results In adults, these are normal percentages of different hemoglobin molecules: HbA: 95% to 98% (0.95 to 0.98) HbA2: 2% to 3% (0.02 to 0.03) HbE: Absent HbF: 0.8% to 2% (0.008 to 0.02) HbS: Absent HbC: Absent In infants and children, these are normal percentage of HbF molecules: HbF (newborn): 50% to 80% (0.5 to 0.8) HbF (6 months): 8% Sickle Cell Anemia: Overview; [cited 2020 Jan 10]; [about 3 screens]. A hemoglobin electrophoresis test applies an electric current to a blood sample. The three-gene deletion results in significant production of hemoglobin H (HbH), which has four beta chains (beta4). A he m oglobin electrophoresis test is a blood test used to measure and identify the different hemoglobin in your bloodstream. We will review it in the next few hours. Bone marrow aspiration and biopsy are generally not. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. -hemoglobin levels in the 4 to 6 g/dL range. As with any blood test, there are minimal risks. bin A2 level, PCR for alpha-1(SEA type) and hemoglobin electrophoresis. Infantile hemangiomas: here are all the European recommendations , Caffeine: that's why it would be best to avoid it in pregnancy, Cytomegalovirus (CMV): how to read the test results, Shingles in pregnancy, what is it and what are the symptoms. The loss of three alpha genes is termed Hb H disease. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". This cookie is set by GDPR Cookie Consent plugin. Analytical cookies are used to understand how visitors interact with the website. Your baby may feel a little pinch when the heel is poked, and a small bruise may form at the site. Reasons your doctor may want you to do a hemoglobin electrophoresis test include: 1. Available from: Salinas Cisneros G, Thein SL. These could be a sign of disorders including: 3. Approximately 5 percent of the world's population has a globin variant, but only 1.7 percent has alpha or beta thalassemia trait.2 Thalassemia affects men and women equally and occurs in approximately 4.4 of every 10,000 live births. Hemoglobin types react to the electric current, moving away from each other. Hemoglobin (HEE-muh-glow-bin) is the protein inside red blood cells that carries oxygen. In the newborn period, if the electrophoresis shows Hb Bart's or HbH, the infant has alpha thalassemia. Genetic mutations can cause your body to produce hemoglobin that is formed incorrectly. Abstract Using a method involving elution of hemoglobin bands from cellulose acetate strips following electrophoresis of hemolysates, hemoglobin A2 (Ab A2) was quantitated in bloods from 300 healthy individuals and 904 patients. To rule out any blood disorders like thalassemia, sickle cell anemia etc. There is very little risk to having a blood test. Here is information about ways providers obtain blood samples. Expediting rare variant hemoglobin characterization by combined HPLC/electrospray mass spectrometry. In this condition, you have one sickle cell gene and one normal gene. Hemoglobin electrophoresis in pregnancy it is a blood test that can be recommended to future parents both before and during pregnancy, especially if they are healthy carriers of Thalassemia. Your doctor may use it to diagnose or monitor hemolytic, Hemoglobin is a protein in your red blood cells that carries oxygen to the rest of your body. Copyright 2009 by the American Academy of Family Physicians.
Jp Holley Funeral Home Obituaries, Sylva Herald Obituaries, Mick Martin Kitchen Nightmares, Articles H