Aberrant transcripts of FHIT, TSG101 and PTEN/MMAC1 genes in normal peripheral mononuclear cells

Aberrant transcripts of FHIT and TSG101 using nested RT-PCR were reported in many human tumours. The role of these aberrant transcripts in tumourigenesis is not clear. We, therefore, analyzed the aberrant transcripts of FHIT, TSG101 and PTEN/MMAC1 in peripheral mononuclear cells of normal individuals using nested RT-PCR to explore the role of these genes in cancer development. The results showed that there are at least five types of aberrant transcripts: type I is the deletion at junction located in-between normal exon and intron; type II has deletion of some bases and subsequent insertion of several bases in the deletion area; type III accommodates splicing donor or acceptor site-like sequence; type IV has homologous sequences near the deleted junction; and type V comprises the homologous sequences at the deletion junction. A normal healthy person can have more than one aberrant transcripts of FHIT, TSG101 and PTEN/MMAC1 genes. The size and the number of the transcripts vary and the diversity is unconstrained. It is not depended on the time, condition of the reaction, or the isolation method. From these results, we suggested that the aberrant transcripts of FHIT, TSG101 and PTEN/MMAC1 genes may be the imperfect products of splicesome which occur one in every thousands, ten thousands or more. As a result, these data implied no direct association between the aberrant transcripts and tumourigenesis.

Muscarinic regulation of basal versus thyrotropin-releasing hormone-induced prolactin secretion in rat anterior pituitary cells. differential roles of nitric oxide and intracellular calcium mobilization

Acetylcholine (ACh), synthesized in the pituitary, can act locally to modulate pituitary function. We used rat primary anterior pituitary (AP) cells to investigate how ACh affects pituitary prolactin (PRL) secretion in the presence or absence of known PRL regulators: thyrotropin-releasing hormone (TRH), 17beta-estradiol (E(2)) and triiodothyronine (T(3)). Cultured AP cells were prepared from ovariectomized rats and pretreated with diluent, 0.6 nM E(2), 10 nM T(3), or E(2) plus T(3) for 5 days, then challenged with various doses of ACh or muscarinic receptor agonists (oxotremorine or carbachol) and TRH (100 nM) for 20 min. Significant ACh (10(-5) M) suppression of both basal and TRH-induced PRL secretion was not evident in diluent-, E(2)- or T(3)-pretreated cells, but observed only in cells pretreated with both E(2) and T(3). Moreover, in E(2) plus T(3)-pretreated cells, oxotremorine and carbachol, like ACh (10(-7)-10(-5) M), suppressed both responses in a dose- related manner. Pertussis toxin (PTX; 100 ng/ml) as well as atropine (a muscarinic receptor antagonist; 1 mM) blocked these effects of cholinomimetics. ACh also inhibited both PRL responses elicited by drugs elevating intracellular cAMP (10 microM forskolin) or Ca(2+) (1 microM Bay K-8644) in a PTX-sensitive manner. ACh inhibition of basal PRL secretion was unaltered by intracellular Ca(2+) mobilization blockers, TMB-8 (100 microM) and thapsigargin (1 microM), but abrogated by the nitric oxide synthase inhibitor (300 microM L-NAME). ACh inhibition of TRH-induced PRL secretion was accentuated by TMB-8 and alleviated by thapsigargin or L-NAME. In summary, muscarinic inhibition of either basal or TRH-induced PRL secretion was augmented by E(2) and T(3), and involved the PTX-sensitive cAMP/Ca(2+) pathways. Furthermore, nitric oxide mediated the basal rather than TRH-induced PRL response to ACh, whereas the intracellular Ca(2+) mobilization concerned the TRH-induced rather than the basal PRL response to ACh. Thus, ACh synthesized in the AP appears to inhibit basal vs. TRH-induced PRL secretion via different mechanisms.

Real-Ear to coupler difference in patients with ear drum perforation

The aim of this study is to investigate the effects of ear drum perforation on real-ear to coupler difference (RECD) in adults. RECD was measured using a probe tube microphone system in 22 patients with ear drum perforations. Twenty-two normal subjects served as controls. For normal subjects, RECD was in good agreement with the values reported in the literature. For the perforated ears, the RECD was up to 8 dB smaller in the frequency range from 0.5 to 1 kHz. There was no significant difference at frequencies below 0.25 kHz and above 1 kHz. A much larger intersubject variability was found in the experimental group. The mean intersubject standard deviation was 4.4 dB in the experimental group as contrasted with 2.2 dB in the control group. Neither the equivalent ear canal volume nor the perforation size appeared to be correlated with the degree of RECD reduction over lower frequencies. These results strongly suggest the need for individual RECD measurements, rather than using the average normal RECD, to appropriately compensate for the reduced transmission of lower-frequency sounds in fitting hearing aids for patients with ear drum perforations.

Molecular characterization of secretor type alpha(1, 2)-fucosyltransferase gene deficiency in the Philippine population

We analyzed the seven mutations which are responsible for the deficiency of the secretor type alpha(1,2)-fucosyltransferase gene product, Se enzyme, in the Philippine population. One hundred and one unrelated Filipinos in Taiwan were studied. A new mutation, a 3-base pair deletion from nt 688 through 690, was found in two (0. 1%) of 202 chromosomes. The frequencies of six other mutated alleles were as follows: 71/202 (35.2%) were cDNA 385 A-->T missensed mutation (se2), 28/202 (13.9%) were C571T nonsense mutation (se3), 16/202 (7.9%) were G849A nonsense mutation (se4), 4/202 (1.9%) were G428A nonsense mutation (se1), and 81/202 (40.1%) were wild-type allele (Se). No C628T nonsense mutations (se5) or fusion genes of pseudogene and FUT2 gene (se 6) were found in this population. For the molecular basis of phenotype Le(a+ b-): eight cases had se2/se2, six cases had se2/se3, two cases had se3/se4, one case was homozygous of se4, one case was se3/se1, and two cases were se2/se7. For the Le(a+ b+) phenotype: four cases had se2/se2, two cases had se2/se3, one case was se3/se3, and one case was se2/se4. For the Le(a- b+) phenotype: 16 cases were Se/Se, 21 cases were Se/se2, six cases were Se/se3, five cases were Se/se4, and two cases had Se/se1. Our results suggest that the genotypes of the alpha(1, 2)-fucosyltransferase gene in phenotypes Le(a+ b+) and Le(a+ b-) are the same. Other factors that play important roles may cause the differences between these two phenotypes. Several hotspot mutations in the alpha(1,2)-fucosyltransferase gene are responsible for the nonsecretor phenotype.

Molecular analysis of secretor type alpha(1,2)-fucosyltransferase gene mutations in the Chinese and Thai populations

BACKGROUND

The human Lewis histo-blood group system belongs to a family of structurally related oligosaccharides. The mutations of fucosyltransferase genes alpha(1,2)-fucosyltransferase (FUT2 or Se) and alpha(1,3/1,4)-fucosyltransferase (FUT3 or Le), are responsible for the polymorphism of Lewis blood group phenotypes. However, a population study of the FUT2 mutation in Chinese and Thais has not yet been done, and there is some controversy about the phenotypes of Le(a+b+) and Le(a+b-).

STUDY DESIGN AND METHODS

One hundred twentyfour Chinese and 70 Thais were phenotyped for Lea and Le(b). DNA samples were studied by polymerase chain reaction and then by a restriction enzyme digestion method to distinguish wild-type and six known mutations. Direct sequencing was done for controls and some uncertain cases.

RESULTS

A new mutation, C302T mutation, was found in 2 of 136 chromosomes in the Thai population; none were discovered in Chinese. The frequencies of the normal and six mutant alleles among Chinese and Thais, respectively, were as follows: 134 (54.0%) of 248 and 58 (41.4%) of 140 were wild-type (Se); 0 of 248 and 2 of 140 (both 1.4%) had the G428A mutation; 120 (48.4%) of 248 and 75 (53.6%) of 140 had the A385T mutation; 2 (0.81%) of 248 and 0 of 140 had the C571T mutation; and 1 (0.4%) of 248 and 3 (2.2%) of 140 had the G849A mutation. Only 1 Chinese (0.4%) of 248 had the C628T mutation, and none had fusion gene mutation.

CONCLUSION

The FUT2 genes encoding for the phenotypes Le(a+b+) and Le(a+b-) are the same. The function and character of the mutant enzyme may play an important role in the phenotype. The methods used in this study are clinically applicable in population studies of the FUT2 gene polymorphism to explore relationships among different ethnic groups and correlations between phenotype and genotype.

External ear resonance in patients with tympanic membrane perforations

This study investigated the effects of a tympanic membrane perforation on the external ear resonance. Measurements of external ear resonance using a probe-tube microphone system were performed in 14 patients who had medium to large unilateral tympanic membrane perforations. The contralateral normal ears of these 14 patients served as control. The results showed that there were no significant differences in the peak frequency, peak amplitude and peak sharpness between perforated and normal ears. However, intersubject variability in the resonant frequency was greater in the perforated group. In addition, the resonance curves of these two groups were substantially different. In 10 out of the 14 patients in the perforated group, the resonance curves showed 2-3 prominent peaks separated by valleys of about 10 dB reduced gain. In addition, in 11 out of 14 perforated ears, reduced responses (3.8 dB in average) occurred consistently in the lower frequency region (0.3-2 kHz). Clinically, the abnormal external ear resonance and the larger intersubject variation must be taken into consideration in fitting hearing aids for this group of patients.

Site-directed mutagenesis of human dihydrolipoamide dehydrogenase: role of lysine-54 and glutamate-192 in stabilizing the thiolate-FAD intermediate

The roles of lysine-54 (K54) and glutamate-192 (E192) of human dihydrolipoamide dehydrogenase (E3) in stabilizing the thiolate-FAD intermediate during electron transfer were investigated by site-directed mutagenesis. Recombinant human E3s, wild-type, K54E, S53K54-K53S54 (SK-KS), and E192Q, were overexpressed, purified, and characterized. Only K54E and SK-KS E3s had about 25% less bound FAD compared to wild-type, implicating that K54 is crucial for the protein-FAD interaction. The specific activities of all mutant E3s were markedly decreased (<5% wild-type). In the case of K54E E3, the Km for lipoamide in the reverse reaction was increased by about twofold. Surprisingly, for both SK-KS and E192Q E3s, the Kms for both dihydrolipoamide (forward reaction) and lipoamide (reverse reaction) were markedly reduced. The catalytic rate constants (kcat/Km) for both reactions for SK-KS E3 were significantly lower than wild-type, indicating that K54 is crucial for the catalytic efficiency of the enzyme. Fluorescence spectral analyses showed that the FAD in E3s were reduced by the addition of dihydrolipoamide, and that its reoxidation by NAD+ in the mutant E3s was slower than wild-type E3. Interestingly, in K54E E3 dihydrolipoamide reduced FAD efficiently only when NAD+ was present, indicating that K54 stabilizes the thiolate-FAD interaction. The lack of the formation of thiolate-FAD intermediate in the absence of NAD+ in K54E E3 was also confirmed by CD spectra. The SK-KS mutation demonstrates that the correct sequence of residues is as critical as the nature of the amino acid residues. These results suggest that K54 plays an important role in stabilizing the thiolate-FAD intermediate during the electron transfer in the reaction, and E192 is involved in maintaining correct orientation of K54 during catalysis.

Allogeneic bone marrow transplantation of chronic myeloid leukemia from an HLA-matched unrelated donor with the beta-thalassemic trait

We report a chronic myeloid leukemia patient who underwent allogeneic bone marrow transplantation from an HLA-matched unrelated donor with the beta-thalassemic trait. The donor was a heterozygote for the -28 A-->G mutation. We examined the recipient's bone marrow and peripheral blood using the polymerase chain reaction (PCR) method to detect the -28 G-->A mutation of the donor type and monitored the sustained engraftment. This case suggests that a donor with the thalassemic trait can be a candidate for matched unrelated bone marrow transplantation for hematological malignancies and that PCR based genetic examination of the thalassemic mutation is a useful tool to detect early engraftment.

Effect of acoustic trauma on cytochrome oxidase activity in stria vascularis

The present study was undertaken to determine the role of metabolic disturbance in noise-induced hearing loss by histochemical studies of cytochrome oxidase activity. Adult normal albino guinea pigs were used. The experimental animals were exposed to broad-band noise at 105 dB SPL for 24 h. The control animals were not exposed to the noise. The thresholds of the auditory brainstem response (ABR) of all guinea pigs were measured 3 times: before noise exposure, 1 day and 1 month later. The difference between the ABR thresholds before and after noise exposure was statistically significant. Vibratome sections of decalcified cochleae of the noise-exposed (n = 8) and control groups (n = 4) were incubated with Spector's medium and embedded with Epon. Thin sections (2 microm) and ultrathin sections (100 nm) were cut to observe cytochrome oxidase activity in the stria vascularis under light and electron microscopes, respectively. A decreased activity of cytochrome oxidase was consistently shown in the normal-appearing stria vascularis of most noise-exposed ears. Acoustic trauma has an adverse effect on cytochrome oxidase activity in the stria vascularis as well as on hearing. A decrease in the activity of cytochrome oxidase implicates that metabolic damage may play a role in noise-induced hearing loss.

Nitric oxide enhances the growth of U937 human leukemic cells through a cyclooxygenase-mediated pathway

The mechanisms of exogenous nitric oxide (NO)-enhanced growth of the U937 human myeloid leukemic cells were examined using sodium nitroprusside (SNP) as a NO donor. Treatment with 0.1 mM SNP for 72 h caused a 45 +/- 2% increase in U937 cell growth with significantly increased S/G2+M-phase and decreased G0/G1-phase of the cell cycle. The growth-enhancing effect of SNP was blocked by indomethacin, a cyclooxygenase inhibitor, but not by H7, a broad spectrum kinase inhibitor, or PD98059, a mitogen-activated protein kinase inhibitor. SNP treatment resulted in a dose-dependent increase in prostaglandin E2 (PGE2) production. Furthermore, the addition of exogenous PGE2 not only enhanced U937 cell growth but restored the indomethacin-inhibited mitogenic effect of SNP. We suggest that NO can enhance cell growth through activating the cyclooxygenase pathway and that PGE2 may be an effector molecule for NO-regulated cell proliferation. Our data provide a mechanistic insight into the regulatory role of NO in myelopoiesis.

Aberrant TSG101 transcripts in acute myeloid leukaemia

Recently, a tumour susceptibility gene, TSG101, has been identified at chromosome 11p15. A large intragenic deletion of this gene has been demonstrated in primary breast tumours. To evaluate the role of the TSG101 gene in leukaemia, bone marrow and/or peripheral blood from 68 acute myeloid leukaemia patients, five haemopoietic cell lines (HL60, U937. Raji, KG-1, K562) and 30 normal controls were analysed by reverse transcription of the TSG101 mRNA, followed by PCR amplification and sequencing of the products. The results showed aberrant TSG101 transcripts in 24/68 (35%) acute myeloid leukaemia (AML) patients, all of the cell lines (100%) and 3/30 (10%) normal controls. Our study indicated that the abnormal transcripts may have resulted from aberrant RNA splicing as evidenced by these aberrant transcripts. Also, normal full-length transcripts were present in all specimens examined. The aberrant transcript occurred more frequently in the AML and cell lines. However, because aberrant transcripts of TSG101 were also found in the normal controls, the role of TSG101 as a tumour suppressor gene should be evaluated carefully.

Structuring a safer donor-replacement program

BACKGROUND

Replacement donors are more likely than volunteer donors to have positive or abnormal tests for transfusion-transmissible disease. In an effort to increase the donor pool, workers sought to identify a safer replacement-donor subgroup that may be acceptable for routine donations.

STUDY DESIGN AND METHODS

In a retrospective review and cohort study, the replacement-donor effect was separated from the new-donor effect. The relative effect the replacement donor has on the risk of transfusion-transmissible diseases, donor retention, and frequency of returning donations was then quantified by comparison against the effect of repeat volunteer donors.

RESULTS

The replacement donor had 3.1 times the risk and 0.72 times the donor retention rate and made 0.81 times as many returning donations as the repeat volunteer donor. The figures for the new-donor effect were similar. The two risks were additive, making a new replacement donor particularly hazardous. If replacement donations only from repeat replacement donors were considered, the donor risk and the number of donations per returning donor were made comparable to those for the general (combined) volunteer donor.

CONCLUSION

The negative effect of the replacement donor is similar in magnitude to that of the new volunteer donor. A replacement-donation program targeting repeat replacement donors has an acceptable risk profile and may be a valuable adjunct to the collection of blood from general volunteer donors.

Donor leukocyte infusion as salvage therapy in an adult with relapsed acute lymphoblastic leukemia after allogeneic bone marrow transplantation

Relapse of malignancy after allogeneic bone marrow transplantation remains the major cause of treatment failure in patients with leukemia. While donor leukocyte infusion (DLI) has been used to treat such patients, its use in patients with acute lymphoblastic leukemia is seldom reported. We describe a 35-year-old woman who suffered relapse of acute lymphoblastic leukemia after allogeneic bone marrow transplantation. She received DLI twice as salvage therapy. This patient achieved complete remission following DLI and has remained in remission for more than 11 months without further chemotherapy. We suggest DLI can be used as an initial salvage therapy, without significant toxicity, for patients with relapsed acute lymphoblastic leukemia following bone marrow transplantation.

Deficiency of dihydrolipoamide dehydrogenase due to two mutant alleles (E340K and G101del). Analysis of a family and prenatal testing

A male child with metabolic acidosis was diagnosed as having dihydrolipoamide dehydrogenase (E3) deficiency. E3 activity of the proband's cultured fibroblasts and blood lymphocytes was 3-9% of normal, while in the parent's lymphocytes it was about 60% of normal. The proband's pyruvate dehydrogenase complex (PDC) and the alpha-ketoglutarate dehydrogenase complex activities from cultured skin fibroblasts were 12% and 6% of normal, respectively. PDC activity in the parents cultured fibroblasts was 25-31% of normal. Western and Northern blot analyses showed similar quantities of E3 protein and mRNA in cultured fibroblasts from the proband and his parents. DNA sequencing of cloned full-length E3 cDNAs, from the proband and the parents, showed two mutations on different alleles of proband were inherited from the parents. One mutation is a three nucleotide (AGG) deletion, from the mother, resulting in deletion of Gly101 in the FAD binding domain. The other mutation is a nucleotide substitution (G to A), from the father, leading to substitution of Lys for Glu340 in the central domain. The same deletion mutation was found in E3 cDNA from a chorionic villus sample and cultured fibroblasts obtained from the mother's subsequent offspring. This finding illustrates the possibility of successful prenatal diagnosis of E3 deficiency utilizing mutations characterized prior to initiation of pregnancy.

Interaction between triiodothyronine and ovarian steroid hormones on the regulation of the release of thyrotropin and thyrotropin-releasing hormone in vitro

In vivo and in vitro experiments were designed to examine [1] the effect of triiodothyronine (T3) and/or ovarian steroids on the spontaneous and thyrotropin-releasing hormone (TRH)-stimulated release of thyrotropin (TSH) by the anterior pituitary gland (AP) in vitro; and [2] the in vivo effects of T3 and ovarian steroids on TRH-release in vitro. In the experiment 1, ovariectomized-thyroidectomized (Ovx-Tx) rats were injected with triiodothyronine (T3, 2 micrograms/kg), estradiol benzoate (EB, 25 micrograms/kg), progesterone (P, 10 mg/kg), T3 plus EB, T3 plus P, EB plus P, or T3 plus EB and P for 6 days before decapitation. The AP was incubated with Locke's medium, challenged with TRH (30 nM), recovered and then with T3 (10 nM) only or with T3+TRH, 30 min for each interval. Mediobasal hypothalami (MBHs) were challenged with high potassium (60 mM) for 30 min. In the experiment 2, the APs of Ovx-Tx rats were enzymatically dispersed and the AP cells were pretreated with or without EB (0-6 nM) for 72 h, and further with T3 (10 nM) for 24 h, followed by an incubation for 30 min with TRH (0-100 nM). The spontaneous and TRH-induced release of TSH in vitro from rat APs, and pituitary TSH content were increased by T3, or T3 plus P as compared with the animals injected with vehicle, or P alone. EB inhibits the effect of T3 on TSH release in vitro. Application of T3 in vitro prevented the release of TSH in response to TRH. EB dose-dependently relieved the inhibitory effect of T3 on TRH-induced TSH release in vitro. TRH release from MBH was increased by EB and inhibited by T3 or P. EB prevented the inhibitory effect of T3 on TRH release. P plus T3 potentiated the stimulatory effects of EB on TRH release. These results suggest that [1] the reduction of the concentration of plasma TSH by T3 is at least in part due to the inhibitory effects of T3 on TRH release from mediobasal hypothalamus, and TSH release in response to TRH, [2] the increased content and release of TSH from rat AP tissue by T3 via an in vivo effect may be involved in a short feedback loop of TSH on TRH release, and [3] ovarian steroid hormones play an inhibitory role in regulating T3 effects on the release of TSH and TRH.

Aberrant FHIT transcripts in acute myeloid leukaemia

Recently the FHIT gene (fragile histidine triad gene) has been identified at chromosome 3p14.2 and a high frequency of abnormalities in this gene has been demonstrated in various cancers. To determine the role of the FHIT gene in leukaemia, bone marrow or peripheral blood from 62 acute myeloid leukaemia patients and five haemopoietic cell lines (HL60, U937, Raji, KC-1, K562) were analysed by reverse transcription of the FHIT mRNA followed by PCR amplification and sequencing of the products. To detect the deletion of the FHIT gene, 17 cases were evaluated using microsatellite polymorphism analysis. In this study, 17/62 (27%) AML patients expressed aberrant transcripts which lack two or more exons of the FHIT gene, and all the cell lines exhibited the aberrant FHIT transcripts. No cases exhibited a loss of the FHIT alleles. Our data indicated that the FHIT gene may play a role in myeloid carcinogenesis and may be indicated in the late progression of the disease.

A prospective clinical and electrophysiologic survey of acute flaccid paralysis in Chinese children

We studied 29 children admitted to Beijing Children's Hospital (BCH) with acute flaccid paralysis between June 1991 and June 1993. Twenty-seven patients had Guillain-Barré syndrome--7 with acute inflammatory demyelinating polyneuropathy and 20 with acute motor axonal neuropathy (AMAN). Two had poliomyelitis. The most common cause of acute flaccid paralysis at BCH is the AMAN pattern of GBS.

Measurement of [Ca2+]i and [Na+]i in outer hair cells isolated from gerbil cochlea

Outer hair cells (OHCs) become sodium- and calcium-overloaded after being isolated in high-sodium medium. Most of the sodium and calcium leak occurs through 10-15% of the transduction channels that are open at the resting position of the hair bundle. However, [Ca2+]i and [Na+]i in OHCs can vary greatly from cell to cell even though they all appear normal. Different [Ca2+]i and [Na+]i may result from different leak conductance through the transduction channels. The leak was determined by the degree of damage inflicted upon the tip-link of the hair bundle during isolation. Excessive sodium accumulation may explain why OHCs cannot maintain their normal resting membrane potential in some experimental conditions.

Splenic lymphoma with villus lymphocytes--an uncommon cause for lymphocytosis

We describe the clinical and laboratory features of four patients who presented with mild to moderate lymphocytosis but with no peripheral lymphadenopathy. These patients in the past, would have been classified as chronic lymphocytic leukaemia (CLL). However, it is now realised that chronic lymphoproliferative disorders are very heterogeneous and the clinical and laboratory features of our patients would support a diagnosis of splenic lymphoma with villus lymphocytes (SLVL) with characteristic morphological features. SLVL usually runs a benign clinical course but symptoms related a benign clinical course but symptoms related to splenomegaly or hypersplenism may be a problem. Splenectomy is considered the treatment of choice in these patients. Two of our patients had splenectomy and the other two patients are on regular follow-up without any specific treatment. It is therefore important to recognise this uncommon condition and also to differentiate it from CLL.

A novel, simple organotypic culture method to study the organ of Corti from the neonatal gerbil

An original, simple organotypic culture method was developed to grow the organ of Corti from the neonatal gerbil on the bottom of a Petri dish. In comparison with the commonly used Maximov slide assembly method, this method is easier, less time-consuming, and more economic. Our results in this study using fluorescent live/dead viability assay and fluorescein-conjugated antineurofilament antibodies show that the cultured organ of Corti and spiral ganglion cells not only survived for at least 14 days but also maintained their basic organization and normal development in vitro. Therefore, our method can serve as a reliable and easier alternative to the traditional techniques for studying the development as well as other physiological properties of the cultured organ of Corti.

Prenatal diagnosis of thalassemia in the Chinese

There is a high prevalence of thalassemia in the Taiwan area. Prenatal diagnosis of severe forms of thalassemia is important for the prevention of this disease. We performed prenatal diagnosis in 167 cases, of which 59 cases were diagnosed by chorionic villi biopsy, 91 cases by amniotic fluid analysis, and 17 cases by cord blood analysis. Hb Bart's hydrops was detected by amplifying the break junction area of the alpha-thalassemia-1 Southeast Asia (SEA)-type gene, and beta-thalassemia major was detected by using naturally occurring restriction sites and the amplified created restriction sites (ACRS) method. Screening for hemoglobin (Hb) Bart's hydrops revealed 26 cases of Hb Bart's hydrops, 67 cases of alpha-thalassemia-1 (including 6 Hb Bart's hydrops falsely diagnosed as alpha-thalassemia-1 from chorionic villi samples), and 38 normal cases. Screening for beta-thalassemia major revealed 8 cases of beta-thalassemia major, 17 cases of beta-thalassemia minor, and 11 normal cases. In cases of alpha-thalassemia, maternal tissue contamination in the chorionic villi samples occurred in the diagnosis of the carrier state and further amniotic fluid analysis will be necessary. There were no any false-positive or false-negative results in beta-thalassemia major screening. We conclude that prenatal diagnosis is a reliable and accurate screening method for thalassemia and may be valuable in other areas of high prevalence for thalassemia in Southeast Asia and in Southern China.

The erythrocyte cell hemoglobin distribution width segregates thalassemia traits from other nonthalassemic conditions with microcytosis

Red cell heterogeneity, as represented by the red cell distribution width (RDW), can be used to distinguish thalassemia traits from iron deficiency. Two other indices of heterogeneity, the hemoglobin distribution width and the cell hemoglobin distribution width (CHDW), are also available. In addition, the CHDW may reflect the process of cell hemoglobinization more accurately than does the RDW. In this study, recursive partitioning methods were used to compare the ability of these three indices to discriminate between thalassemia traits and other nonthalassemic conditions among hospital patients who had microcytosis. The data indicate that the CHDW can segregate patients who have either iron replete or iron deficient nonthalassemic conditions from those who have thalassemia traits. A CHDW level of less than 3.05 correctly discriminated 78.4% of patients in a mixed hospital sample. A CHDW/RBC ratio of 0.57 improved the segregation further, with a sensitivity of 79.2% and a specificity of 88.5% for the identification of a thalassemia trait.