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Colah RB, Nadkarni AH, Gorakshakar AC, Sawant PM, Mehta PR, Gorivale MS, Hariharan P, Mohanty D, Ghosh K. The Changing Trends in Prenatal Diagnosis of Hemoglobinopathies in India: The Quest of a Single Center to Reduce the Burden of Disease over Three Decades. Hemoglobin 2021; 45:112-118. [PMID: 33829933 DOI: 10.1080/03630269.2021.1908346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The β-thalassemias and sickle cell disorders pose a considerable health burden in India. Of the more than 10,000 annual births of children with a severe hemoglobinopathy, only around 10.0% are managed optimally. Thus, genetic counseling and prenatal diagnosis (PND) is a valid option for a large and diverse country. Our center was one of the first to initiate PND and we present our experience over 30 years to evaluate the impact of awareness in changing the trends of PND of hemoglobinopathies. Both second and first-trimester diagnoses were undertaken by fetoscopy/cordocentesis and globin biosynthesis/high-performance liquid chromatography (HPLC) analysis of fetal blood and chorionic villus sampling (CVS) and DNA analysis. Over 30 years, 3478 couples (first trimester: 2475; second trimester: 1003) from all over India were offered PND. The number of couples coming in the first trimester increased significantly over each decade and couples coming prospectively increased from 2.5 to 18.4%. A cost-effective stepwise approach was used for molecular analysis. Eight hundred and one fetuses (23.0%) were affected and all except three couples opted for termination of these pregnancies. Genetic counseling and PND is the only way to reduce the burden of disease. With awareness, there was a shift from second trimester to first trimester PND over each decade, with an increasing number of couples coming during the first pregnancy. There are only 15 to 20 centers in India offering PND. We have compared our study with other reports on PND from different regions in India.
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Affiliation(s)
- Roshan B Colah
- Department of Haematogenetics, Indian Council of Medical Research, National Institute of Immunohaematology, Mumbai, India
| | - Anita H Nadkarni
- Department of Haematogenetics, Indian Council of Medical Research, National Institute of Immunohaematology, Mumbai, India
| | - Ajit C Gorakshakar
- Department of Haematogenetics, Indian Council of Medical Research, National Institute of Immunohaematology, Mumbai, India
| | - Pratibha M Sawant
- Department of Haematogenetics, Indian Council of Medical Research, National Institute of Immunohaematology, Mumbai, India
| | - Pallavi R Mehta
- Department of Haematogenetics, Indian Council of Medical Research, National Institute of Immunohaematology, Mumbai, India
| | - Manju S Gorivale
- Department of Haematogenetics, Indian Council of Medical Research, National Institute of Immunohaematology, Mumbai, India
| | - Priya Hariharan
- Department of Haematogenetics, Indian Council of Medical Research, National Institute of Immunohaematology, Mumbai, India
| | - Dipika Mohanty
- Department of Haematogenetics, Indian Council of Medical Research, National Institute of Immunohaematology, Mumbai, India
| | - Kanjaksha Ghosh
- Department of Haematogenetics, Indian Council of Medical Research, National Institute of Immunohaematology, Mumbai, India
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Yang Y, He P, Li DZ. Analysis of Fetal Blood: Is There Still a Role for Prenatal Diagnosis of Thalassemia? Hemoglobin 2015; 40:29-31. [DOI: 10.3109/03630269.2015.1096284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rao S, Saxena R, Deka D, Kabra M. Use of HbA estimation by CE-HPLC for prenatal diagnosis ofβ-thalassemia; experience from a tertiary care centre in north India: a brief report. Hematology 2013; 14:122-4. [DOI: 10.1179/102453309x385269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Seema Rao
- Department of HematologyAll India Institute of Medical Sciences, New Delhi 110029, India
| | - Renu Saxena
- Department of HematologyAll India Institute of Medical Sciences, New Delhi 110029, India
| | - Deepika Deka
- Department of Obstetrics and GynaecologyAll India Institute of Medical Sciences, New Delhi 110029, India
| | - Madhulika Kabra
- Department of PediatricsAll India Institute of Medical Sciences, New Delhi 110029, India
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Karnpean R, Fucharoen G, Fucharoen S, Ratanasiri T. Fetal Red Blood Cell Parameters in Thalassemia and Hemoglobinopathies. Fetal Diagn Ther 2013; 34:166-71. [DOI: 10.1159/000354343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/10/2013] [Indexed: 11/19/2022]
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Verma IC, Saxena R, Kohli S. Hemoglobinopathies in India—Clinical and Laboratory Aspects. Clin Lab Med 2012; 32:249-62. [DOI: 10.1016/j.cll.2012.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Italia KY, Sawant PM, Nadkarni AH, Ghosh K, Colah RB. Is the poly A (T>C) mutation a causative factor for misdiagnosis in second trimester prenatal diagnosis of β-thalassemia by fetal blood analysis on high performance liquid chromatography? Hemoglobin 2012; 36:114-23. [PMID: 22296681 DOI: 10.3109/03630269.2011.654144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report the problems in diagnosis faced by two families referred for prenatal diagnosis of thalassemia where cordocentesis and fetal blood analysis by high performance liquid chromatography (HPLC) had to be done. The Hb A levels of the fetal blood measured by HPLC on the VARIANT™ Hemoglobin Testing System were 1.2 and 6.7%, respectively, suggestive of a heterozygous β-thalassemia (β-thal) fetus in the first case and a normal fetus in the second case. In one family, one of the parents had a borderline Hb A(2) level and in the other, one parent had normal RBC indices. However, DNA sequencing, done later, showed that in the first case the fetus was a compound heterozygote for the IVS-I-5 (G>C) and the polyadenylation signal site [poly A (T>C)] mutation, while in the second case, the fetus was homozygous for the poly A mutation. This emphasizes that characterization of β-thal mutations must be done whenever one of the parents has a borderline Hb A(2) level or normal RBC indices, and one should not rely on fetal blood analysis by HPLC for prenatal diagnosis of β-thal so as to avoid misdiagnosis.
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Affiliation(s)
- Khushnooma Y Italia
- National Institute of Immunohematology, King Edward Memorial Hospital Campus, Parel, Mumbai, India
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Sirichotiyakul S, Saetung R, Sanguansermsri T. Prenatal Diagnosis of β-Thalassemia/Hb E by Hemoglobin Typing Compared to DNA Analysis. Hemoglobin 2009; 33:17-23. [DOI: 10.1080/03630260802626046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Srivorakun H, Fucharoen G, Sae-Ung N, Sanchaisuriya K, Ratanasiri T, Fucharoen S. Analysis of fetal blood using capillary electrophoresis system: a simple method for prenatal diagnosis of severe thalassemia diseases. Eur J Haematol 2009; 83:57-65. [DOI: 10.1111/j.1600-0609.2009.01245.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wadia MR, Phanasgaokar SP, Nadkarni AH, Surve RR, Gorakshakar AC, Colah RB, Mohanty D. Usefulness of automated chromatography for rapid fetal blood analysis for second trimester prenatal diagnosis of beta-thalassemia. Prenat Diagn 2002; 22:153-7. [PMID: 11857624 DOI: 10.1002/pd.251] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prenatal diagnosis of beta-thalassemia is now ideally done in the first trimester of pregnancy by chorionic villus tissue DNA analysis. Nevertheless, fetal blood analysis in the second trimester is required either when the mutation in both parents cannot be characterised or when the couple comes late for investigations. We evaluated the usefulness of analysis of fetal blood on the Biorad Variant Hemoglobin Testing System using the beta-thalassemia short programme in comparison with the conventional globin biosynthesis in 58 pregnancies. The beta/alpha biosynthesis ratios in 13 homozygous fetuses ranged from 0 to 0.03 and the adult hemoglobin (HbA) levels by automated chromatography varied from 0% to 0.4%. The normal or heterozygous fetuses had beta/alpha ratios of >0.04 and HbA levels ranging from 2.1% to 10.6%. In 17 fetuses we also correlated the beta gene mutations with the predicted genotypes using automated high-performance liquid chromatography (HPLC). Follow-up of 18 unaffected fetuses using the Variant System at birth showed a significant increase in HbA levels.
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Affiliation(s)
- Mahrukh R Wadia
- Institute of Immunohaematology (ICMR), KEM Hospital Campus, Mumbai 400 012, India
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Sanguansermsri T, Thanarattanakorn P, Steger HF, Tongsong T, Chanprapaph P, Wanpirak C, Siriwatanapa P, Sirichotiyakul S, Flatz G. Prenatal diagnosis of beta-thalassemia major by high-performance liquid chromatography analysis of hemoglobins in fetal blood samples. Hemoglobin 2001; 25:19-27. [PMID: 11300346 DOI: 10.1081/hem-100103066] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In Thailand and adjacent countries, most of the beta-thalassemia genes are beta(0)-thalassemia mutations that prevent the production of Hb A. We propose the quantitation of the Hb A fraction in fetal blood in the mid-trimester of pregnancy by automated high performance liquid chromatography as a reasonable prenatal diagnostic method to be applied in areas with limited laboratory facilities. Forty pregnant women at risk of delivering a child with beta-thalassemia major were identified using an erythrocyte osmotic fragility test and quantitation of Hb A2. Cordocentesis was performed at the gestational age of 18-22 weeks and fetal blood was analyzed for hemoglobin fractions by automated high performance liquid chromatography. The beta-globin gene mutations were characterized by beta-globin gene sequencing. The 4 bp deletion at codons 41/42 (-TTCT) was the most frequent of the 40 beta-thalassemia mutations observed (20/40 = 50%), followed by the splice site mutation IVS-I-1 (G-->T) (7/40 = 17.5%), the nonsense mutation at codon 17 (A-->T) (7/40 = 17.5%), the nonsense mutation at codon 35 (C-->A) (3/40 = 7.5%), and the beta(+)-thalassemia promoter mutation at -28 (A-->G) (3/40 = 7.5%). High performance liquid chromatography revealed nine fetuses which had only Hb F and no Hb A. All were homozygotes or compound heterozygotes for beta(0)-thalassemia mutations. In the remaining 31 fetuses, a Hb A peak was present in the chromatograms. One fetus with 0.5% Hb A was a compound heterozygote for the -28 (A-->G) and codons 41/42 (-TTCT) mutations. In the remaining 30 fetuses, the Hb A values ranged between 0.8 and 7.4%. Twenty of these, with a Hb A concentration of 1.82 +/- 0.49% (range 0.8-2.8%), were beta-thalassemia heterozygotes. The remaining 10 fetuses had Hb A values of 4.89 +/- 1.47% (range 2.9-7.4%) and normal beta-globin genes. The absence of Hb A in homozygotes or compound heterozygotes for beta(0)-thalassemia mutations and the presence of measurable amounts of Hb A in heterozygotes and normal homozygotes, permits the diagnosis of fetuses expected to develop postnatal beta-thalassemia major.
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Affiliation(s)
- T Sanguansermsri
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Thailand.
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Thakur (Mahadik) C, Vaz F, Banerjee M, Kapadia C, Natrajan PG, Yagnik H, Gangal S. Prenatal diagnosis of ?-thalassaemia and other haemoglobinopathies in India. Prenat Diagn 2000. [DOI: 10.1002/(sici)1097-0223(200003)20:3<194::aid-pd778>3.0.co;2-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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