Among more than 800 hemoglobin (Hb) variants currently described in the HBVar database of the Globin Gene Server (1 ), variants with elongated chains are very rare. Standard protein techniques such as ion-exchange HPLC and isoelectric focusing (IEF) on polyacrylamide gel can detect many Hb variants (2 ), but correct identification of single mutated, inserted, or deleted amino acid residues requires more sophisticated techniques, such as electrospray ionization mass spectrometry (ESI-MS) or matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) (3-5 ). The interpretation of DNA sequencing in the presence of inserted nucleotide sequences in the heterozygous state can be difficult and requires direct and reverse sequencing. Protein analysis by MS can be used to check results from DNA sequencing and also can detect posttranslational changes such as acetylation (NH 2 terminus), deamidation, methionine oxidation, Hb addition products, or artifacts. ESI-MS and MALDI-TOF MS combined with specific tryptic digestion for peptide mass mapping are rapid and sensitive techniques to confirm inserted amino acid residues. We applied these techniques to the identification of a novel Hb variant with a five-amino acid insertion in the -globin chain. These techniques allowed us to confirm the DNA sequencing results.Standard Hb analysis was performed by ion-exchange HPLC, IEF on polyacrylamide gel, and reversed-phase (RP)-HPLC of globin chains (6, 7 ). RP-HPLC was performed with a Vydac C 4 analytical column (The Separations Group) with CH 3 CN-H 2 O containing 1 mL/L trifluoroacetic acid (TFA) as the mobile phase (7 ). The same RP-HPLC system was also used for isolation of globin chains for MS studies. Electrospray experiments were performed on a SCIEX API 165 instrument (Applied Biosystems). Solutions were introduced by direct infusion at a flow rate of 5 L/min. Mass spectra were acquired at a 50-V orifice value in the positive ion mode, and the scan range was set at m/z 650-2150 Th (Thompson).For ESI-MS samples, we prepared a stock solution by diluting the whole blood 50-fold with water and desalting the stock solution by mixing with ϳ5 mg of AG 50W-X8 cation-exchange resin (Bio-Rad). We diluted 20 L of the desalted stock solution by adding 40 L of CH 3 OH-H 2 O (50:50 by volume) containing 1 mL/L HCOOH, and this solution was used for ESI-MS analysis. MALDI-TOF mass spectra were recorded on a Voyager DE-PRO mass spectrometer (Applied Biosystems) in the 700-5000 Da mass range. Use of a delayed extraction source and reflector instrumentation gave sufficient resolution to detect the monoisotopic peptide masses of [M ϩ H] ϩ ions. For MALDI-TOF sample preparation, we dried 0.5 mL of the 2-mL -globin chain sample collected from RP-HPLC purification in a vacuum concentrator and redissolved the residue in 90 L of 50 mmol/L NH 4 HCO 3 buffer. This solution was digested with 10 L of trypsin solution (Promega; 0.1 g/L in 50 mmol/L NH 4 HCO 3 buffer) for 5 h at 37°C. We then dried 10 L of the digest so...