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Ma S, Tang L, Wu C, Tang H, Pu X, Niu J. Study on Management of Blood Transfusion Therapy in Patients with Hereditary Spherocytosis. Appl Bionics Biomech 2022; 2022:6228965. [PMID: 35126660 PMCID: PMC8816590 DOI: 10.1155/2022/6228965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 12/17/2022] Open
Abstract
Hereditary spherocytosis (HS) is a chronic hemolytic disorder caused by inherited defects in the red blood cell membrane. This study discusses the treatment strategy for the decline in hemoglobin level in three HS probands with moderately severe or severe hemolysis and summarizes the appropriate laboratory tests that help improve clinical management of blood transfusion in HS patients. Three probands who were diagnosed with HS in our hospital and their family members were included in this study. Clinical data of the three families were reviewed to summarize their hematopoietic characteristics. DNA from all family members of the 3 HS probands was amplified by polymerase chain reaction (PCR) and sequenced by the Sanger method to assess genetic relation for HS. Based on the sequencing results, the type of mutated membrane protein in each proband was analyzed using the eosin-5'-maleimide (EMA) binding test and sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The hemoglobin level was reduced in all 3 probands after different levels of infection. The fluorescence of EMA-labeled red blood cell (RBC) was decreased. DNA sequencing showed that His54Pro, Leu1858Val, and 6531-12C>T compound heterozygous mutations were present in the SPTA1 gene of patient I-1, Arg344Gln and c.609+86G>A heterozygous mutations were present in the SLC4A1 gene of patient II-1, and Leu2032Pro homozygous mutation was present in the SPTB gene of patient III-1. SDS-PAGE results demonstrated that the concentration of band 3 was reduced in II-1, whereas the levels of the corresponding mutant proteins in the other probands were unchanged. The family members of the respective patients presented mutations in major genes causing HS. The Leu2032Pro mutation identified in patient III-1 is a new missense mutation of the SPTB gene in the Chinese population that has never been reported in literature previously. The presence or absence of acute or chronic infections is a critical deciding factor for the treatment and clinical management of HS patient via blood transfusion. For patients with infections, hemoglobin concentration can be restored once the infection is controlled, thus obviating the need for proper infection control before blood transfusion.
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Affiliation(s)
- Shiyue Ma
- Department of Laboratory Medicine, Affiliated Hospital of Guilin Medical University, Guilin City 541001, Guangxi Zhuang Autonomous Region, China
| | - Lingjian Tang
- Department of Rehabilitation Medicine, Affiliated Hospital of Guilin Medical University, Guilin City 541001, Guangxi Zhuang Autonomous Region, China
| | - Chaoli Wu
- Department of Laboratory Medicine, Affiliated Hospital of Guilin Medical University, Guilin City 541001, Guangxi Zhuang Autonomous Region, China
| | - Hui Tang
- Department of Laboratory Medicine, Affiliated Hospital of Guilin Medical University, Guilin City 541001, Guangxi Zhuang Autonomous Region, China
| | - Xue Pu
- Department of Laboratory Medicine, Affiliated Hospital of Guilin Medical University, Guilin City 541001, Guangxi Zhuang Autonomous Region, China
| | - Jinhong Niu
- Department of Medical Administration, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin City 541002, Guangxi Zhuang Autonomous Region, China
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2
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Glenthøj A, Brieghel C, Nardo‐Marino A, van Wijk R, Birgens H, Petersen J. Facilitating EMA binding test performance using fluorescent beads combined with next-generation sequencing. EJHAEM 2021; 2:716-728. [PMID: 35845192 PMCID: PMC9176113 DOI: 10.1002/jha2.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/22/2022]
Abstract
The eosin-5'-maleimide (EMA) binding test is widely used as diagnostic test for hereditary spherocytosis (HS), one of the most common haemolytic disorders in Caucasian populations. We recently described the advantages of replacing the use of healthy control blood samples with fluorescent beads in a modified EMA binding assay. In this study we further explore this novel approach. We performed targeted next-generation sequencing, modified EMA binding test and osmotic gradient ektacytometry on consecutive individuals referred to our laboratory on the suspicion of HS. In total, 33 of 95 carried a (likely) pathogenic variant, and 24 had variants of uncertain significance (VUS). We identified a total 79 different (likely) pathogenic variants and VUS, including 43 novel mutations. Discarding VUS and recessive mutations in STPA1, we used the occurrence of (likely) pathogenic variants to generate a diagnostic threshold for our modified EMA binding test. Twenty-one of 23 individuals with non-SPTA1 (likely) pathogenic variants had EMA ≥ 43.6 AU, which was the optimal threshold in receiver operating characteristic (ROC) analysis. Accuracy was excellent at 93.4% and close to that of osmotic gradient ektacytometry (98.7%). In conclusion, we were able to simplify the EMA-binding test by using rainbow beads as reference and (likely) pathogenic variants to define an accurate cut-off value.
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Affiliation(s)
- Andreas Glenthøj
- Centre for HaemoglobinopathiesDepartment of HaematologyRigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Christian Brieghel
- Centre for HaemoglobinopathiesDepartment of HaematologyRigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Amina Nardo‐Marino
- Centre for HaemoglobinopathiesDepartment of HaematologyRigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Richard van Wijk
- Central Diagnostic Laboratory‐ResearchUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Henrik Birgens
- Centre for HaemoglobinopathiesDepartment of HaematologyRigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Jesper Petersen
- Centre for HaemoglobinopathiesDepartment of HaematologyRigshospitaletCopenhagen University HospitalCopenhagenDenmark
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3
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Wu Y, Liao L, Lin F. The diagnostic protocol for hereditary spherocytosis-2021 update. J Clin Lab Anal 2021; 35:e24034. [PMID: 34689357 PMCID: PMC8649336 DOI: 10.1002/jcla.24034] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/26/2021] [Accepted: 09/18/2021] [Indexed: 01/12/2023] Open
Abstract
Background Hereditary spherocytosis (HS), a commonly encountered hereditary hemolytic disease, is mostly inherited in an autosomal dominant manner. The clinical manifestations in patients with HS show obvious heterogeneity. Moreover, the sensitivity or specificity of some HS diagnostic tests are not ideal and may easily result in misdiagnosis or missed diagnosis in some patients. The objective of this study was to propose a simple and practical diagnostic protocol, which can contribute to the diagnosis of HS and its differential diagnosis with different types of hemolytic anemia such as thalassemia (THAL), autoimmune hemolytic anemia (AIHA), and glucose‐6‐phosphate dehydrogenase (G6PD) deficiency, thus, to provide an alternative simple and reliable method for better clinical diagnosis of HS. Methods Through combing our research with existing experimental technologies and studies, we propose a simple and practical protocol for HS diagnosis, which will help clinicians to improve HS diagnosis. Results Compared with the existing HS diagnostic protocols, the HS diagnostic protocol we proposed is simpler. In this new protocol, some experimental tests with ideal diagnostic efficiency are added, such as mean reticulocyte volume (MRV), mean sphered cell volume (MSCV), mean corpuscular volume (MCV), in combination with the observation of clinical manifestations, family investigation, routine tests for hemolytic anemia, genetic testing, and other screening tests. Conclusion The HS diagnostic protocol we proposed could improve the clinical practice and efficiency of HS diagnosis.
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Affiliation(s)
- Yangyang Wu
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lin Liao
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Faquan Lin
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Shahal-Zimra Y, Nosgorodcky Y, Eshel E, Rotem Z, Ross L, Pickholtz I, Rabizadeh E, Chezar J. Comparison of a modified flow cytometry osmotic fragility test with the classical method for the diagnosis of hereditary spherocytosis. CYTOMETRY PART B-CLINICAL CYTOMETRY 2021; 102:377-383. [PMID: 34528390 DOI: 10.1002/cyto.b.22032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/01/2021] [Accepted: 09/08/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hereditary spherocytosis (HS) is the most common inherited hemolytic anemia. The flow cytometric test using eosin-5'maleimide (EMA) is a well-established diagnostic method. However, in order to improve HS detection, it is recommended that EMA and an osmotic fragility test (OFT) both be performed. OFT is time consuming and labor intensive. We used a flow cytometric (FOFT) adaptation of the classical OFT reported by Yamamoto. We compare the FOFT to the classical OFT including practical data and propose options for simplifying this method. METHODS Suspected and known HS patients and controls were tested by the following methods: EMA, OFT, and FOFT including some modifications. RESULTS The FOFT method is robust and correlates to loss of red blood cells. OFT and FOFT gave similar results in healthy controls and four HS patients. Normal range for FOFT in 70 adults is shown and can be used as a reference value. Neonates should have their own normal range defined. Overnight sample incubation at 37°C did not add information to the FOFT results. CONCLUSION Our modified Yamomoto FOFT can replace the classic OFT as the addition to EMA for the diagnosis of HS. The use of flow cytometry in both these methods requires small sample volume, is reproducible, simpler, and produces results more rapidly.
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Affiliation(s)
- Yael Shahal-Zimra
- Hematology Laboratory, flow cytometry unit, Rabin Medical Center Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Yuval Nosgorodcky
- Hematology Laboratory, flow cytometry unit, Rabin Medical Center Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Elizabeth Eshel
- Hematology and Blood Bank Laboratories, Ziv Medical Center associated with the Bar Ilan University Faculty of Medicine, Safed, Israel
| | - Zohar Rotem
- Hematology Laboratory, flow cytometry unit, Rabin Medical Center Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Liron Ross
- Hematology Laboratory, flow cytometry unit, Rabin Medical Center Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Itay Pickholtz
- Hematology Laboratory, flow cytometry unit, Rabin Medical Center Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Esther Rabizadeh
- Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University Rabin Medical Center Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Judith Chezar
- Hematology Laboratory, flow cytometry unit, Rabin Medical Center Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
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Russo R, Marra R, Andolfo I, Manna F, De Rosa G, Rosato BE, Radhakrishnan K, Fahey M, Iolascon A. Uridine treatment normalizes the congenital dyserythropoietic anemia type II-like hematological phenotype in a patient with homozygous mutation in the CAD gene. Am J Hematol 2020; 95:1423-1426. [PMID: 32720728 DOI: 10.1002/ajh.25946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Roberta Russo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
| | - Roberta Marra
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
| | - Immacolata Andolfo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
| | | | | | - Barbara Eleni Rosato
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
| | - Kottayam Radhakrishnan
- Paediatric Haematology/Oncology Children's Cancer Centre, Monash Children's Hospital Melbourne Victoria Australia
- Department of Haematology Monash Medical Centre Melbourne Victoria Australia
| | - Michael Fahey
- Department of Paediatrics Monash University Clayton Victoria Australia
| | - Achille Iolascon
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
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Glenthøj A, Sharfo A, Brieghel C, Nardo-Marino A, Birgens H, Petersen JB. Improving the EMA Binding Test by Using Commercially Available Fluorescent Beads. Front Physiol 2020; 11:569289. [PMID: 33041866 PMCID: PMC7522531 DOI: 10.3389/fphys.2020.569289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/21/2020] [Indexed: 11/28/2022] Open
Abstract
Hereditary spherocytosis (HS) is a common anemia caused by germline mutations in red blood cell cytoskeleton proteins. The flow cytometry-based eosin-5′-maleimide (EMA) binding test is most frequently employed for reliable diagnostics. To perform this test, a number of healthy and ideally also age-matched controls are required, which can be challenging and complicates interlaboratory comparisons. To overcome this limitation, we modified the EMA binding test by replacing healthy controls with commercially available fluorescent beads. Blood samples from 289 individuals with suspected HS were analyzed using the EMA binding test with fluorescent beads and benchmarked against regular EMA binding test using two control samples. Using osmotic gradient ektacytometry as validation, 112 individuals (38.8%) were diagnosed with HS. Performance of the modified EMA binding test was not compromised (accuracy 90.3%) compared to EMA binding test using matched controls (accuracy 88.6%). Based on these findings, we conclude that the modified EMA binding test with fluorescent beads is an attractive alternative, especially in laboratories without easy access to matched controls. Furthermore, as fluorescent beads are stable and easily commutable, they could facilitate both interlaboratory comparisons and quality assessment programs.
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Affiliation(s)
- Andreas Glenthøj
- Danish Center for Hemoglobinopathies, Department of Hematology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Alaa Sharfo
- Danish Center for Hemoglobinopathies, Department of Hematology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | | | - Amina Nardo-Marino
- Danish Center for Hemoglobinopathies, Department of Hematology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Henrik Birgens
- Danish Center for Hemoglobinopathies, Department of Hematology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Jesper Brix Petersen
- Danish Center for Hemoglobinopathies, Department of Hematology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
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7
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Jamwal M, Sharma P, Das R. Laboratory Approach to Hemolytic Anemia. Indian J Pediatr 2020; 87:66-74. [PMID: 31823208 DOI: 10.1007/s12098-019-03119-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022]
Abstract
Hemolytic anemias are a group of disorders with varied clinical and molecular heterogeneity. They are characterized by decreased levels of circulating erythrocytes in blood. The pathognomic finding is a reduced red cell life span with severe anemia or, compensated hemolysis accompanied by reticulocytosis. The diagnostic workup or laboratory approach for hemolytic anemias is based on methodical step-wise testing which includes red blood cell morphology, hematological indices with increased reticulocyte count along with clinical features of hemolytic anemias. If conventional laboratory tests are unable to detect the underlying cause of hemolysis, genetic testing is recommended. Sanger sequencing along with conventional testing is the most efficient way to diagnose the underlying genetic causes, especially in thalassemias/hemoglobinopathies, if required. However, hemolytic anemias being highly heterogeneous disorders, next-generation sequencing-based screening is rapidly becoming an efficient way to decipher the etiologies where common causes have been excluded.
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Affiliation(s)
- Manu Jamwal
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Prashant Sharma
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Reena Das
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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8
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Mandy F. Issue Highlights - November 2016. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 90:480-482. [PMID: 27788287 DOI: 10.1002/cyto.b.21489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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9
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Chari PS, Prasad S. Flow Cytometric Eosin-5'-Maleimide Test is a Sensitive Screen for Hereditary Spherocytosis. Indian J Hematol Blood Transfus 2018; 34:491-494. [PMID: 30127559 DOI: 10.1007/s12288-017-0907-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022] Open
Abstract
Hereditary spherocytosis (HS) is a clinically heterogeneous disease characterized by mild to moderate hemolysis resulting from red cell membrane protein defects. Diagnostic tests include hemogram, reticulocyte count and blood smear evaluation, osmotic fragility, cryohemolysis, SDS-PAGE, flow cytometry using eosin-5'-maleimide (EMA) and genetic studies. We evaluated the flow cytometric EMA-binding test and compared it with osmotic fragility in 51 consecutive cases of suspected HS aged between 10 days and 62 years. In addition, 4 cases suspected on blood smears underwent EMA testing alone. The 16 EMA-positive cases who were determined to have HS had overlapping hemoglobin levels and reticulocyte counts with the 35 patients with normal EMA results, highlighting the importance of the flow cytometric test in providing a definitive diagnosis. Flow cytometric EMA binding test was thus a simple and relatively faster method to confirm HS in our experience.
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Affiliation(s)
- Preethi S Chari
- Anand Diagnostic Laboratory, 54, Bowring Tower, Bowring Hospital Road, Shivajinagar, Bengaluru, Karnataka 560001 India
| | - Sujay Prasad
- Anand Diagnostic Laboratory, 54, Bowring Tower, Bowring Hospital Road, Shivajinagar, Bengaluru, Karnataka 560001 India
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10
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Ma S, Qin J, Wei A, Li X, Qin Y, Liao L, Lin F. Novel compound heterozygous SPTA1 mutations in a patient with hereditary elliptocytosis. Mol Med Rep 2018; 17:5903-5911. [PMID: 29484404 PMCID: PMC5866036 DOI: 10.3892/mmr.2018.8632] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 01/24/2018] [Indexed: 12/19/2022] Open
Abstract
Hereditaryelliptocytosis (HE) is a hereditary hemolytic disease, characterized by the presence of many elliptical erythrocytes in the peripheral blood that is caused by abnormal cytoskeletal proteins in the erythrocyte membrane. In the present study, a novel, causal HE mutation was reported. Routine blood examinations were performed on the proband and their family, and the fluorescence intensity of eosin‑5‑maleimide (EMA)‑labeled erythrocytes was determined via flow cytometry. Subsequently, DNA was extracted from the peripheral blood of the proband and their family members, and amplified by quantitative polymerase chain reaction. The Sanger sequencing approach was used to determine and identify gene mutations, which were verified by matrix‑assisted laser desorption‑ionization time of flight (MALDI‑TOF) mass spectrometry. To exclude genetic polymorphisms, newly identified mutations were subjected to large‑scale gene screening using high‑resolution melt analysis. Protein expression levels in the erythrocyte membrane of the proband were determined via SDS‑PAGE, which demonstrated that, compared with healthy controls, the proband exhibited a reduction in EMA‑labeled erythrocytes. In addition, DNA analysis demonstrated that the proband carried three mutations in the spectrin α chain erythrocytic 1 (SPTA1) gene: c.161A>C, c.5572C>G and 6531‑12C>T. The corresponding mutant polypeptides were also analyzed by MALDI‑TOF mass spectroscopy. SDS‑PAGE analysis indicated that the proband exhibited normal levels of erythrocyte membrane proteins. In the present study, a novel HE case with a His54Pro mutation in the SPTA1 gene was reported. The results suggested that the His54Pro mutation influenced the role of erythrocyte membrane proteins without reducing its level of expression.
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Affiliation(s)
- Shiyue Ma
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Jinqiu Qin
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Aiqiu Wei
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Xiaohong Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Yuanyuan Qin
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Lin Liao
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Faquan Lin
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
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11
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Joshi P, Aggarwal A, Jamwal M, Sachdeva MUS, Bansal D, Malhotra P, Sharma P, Das R. A comparative evaluation of Eosin-5′-maleimide flow cytometry reveals a high diagnostic efficacy for hereditary spherocytosis. Int J Lab Hematol 2016; 38:520-6. [DOI: 10.1111/ijlh.12533] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 04/20/2016] [Indexed: 11/28/2022]
Affiliation(s)
- P. Joshi
- Department of Hematology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - A. Aggarwal
- Department of Hematology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - M. Jamwal
- Department of Hematology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - M. U. S. Sachdeva
- Department of Hematology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - D. Bansal
- Department of Pediatrics; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - P. Malhotra
- Department of Internal Medicine; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - P. Sharma
- Department of Hematology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - R. Das
- Department of Hematology; Postgraduate Institute of Medical Education and Research; Chandigarh India
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12
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Jamwal M, Aggarwal A, Kumar V, Sharma P, Sachdeva MUS, Bansal D, Malhotra P, Das R. Disease-modifying influences of coexistent G6PD-deficiency, Gilbert syndrome and deletional alpha thalassemia in hereditary spherocytosis: A report of three cases. Clin Chim Acta 2016; 458:51-4. [PMID: 27108201 DOI: 10.1016/j.cca.2016.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/28/2015] [Accepted: 04/18/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hereditary spherocytosis (HS) is a common inherited hemolytic anemia characterized by heterogeneous clinical presentations with variable degrees of anemia, jaundice, splenomegaly and gallstones. Although the underlying genetic defects in red cell membrane proteins may explain many phenotypic variations, a proportion of variability may be due to other co-inherited factors like enzymopathies, thalassemias and Gilbert syndrome. Associations of HS with glucose-6-phosphate dehydrogenase (G6PD) deficiency and Gilbert syndrome in isolation have been reported previously. METHODS We describe 3 adult cases of HS with concomitant Gilbert syndrome and G6PD-Mediterranean mutations (2 hemizygous males, aged 15 and 35y and 1 heterozygous 25-y female). RESULTS Two patients required multiple transfusions that required splenectomy for management. One patient (15y male) also carried the single gene alpha 4.2 deletion and was less symptomatic. CONCLUSIONS These cases illustrate the importance of clinico-pathological correlation and judicious extended testing for various contributing factors that may modify the clinical course of HS patients. G6PD deficiency is also a common enzymopathy in India and can contribute to the phenotypic heterogeneity. Its recognition is important for advising avoidance of oxidizing drug exposure.
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Affiliation(s)
- Manu Jamwal
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Anu Aggarwal
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Verinder Kumar
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Prashant Sharma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Man Updesh Singh Sachdeva
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Deepak Bansal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Pankaj Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Reena Das
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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13
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Farias MG, Freitas PAC. Percentage of hyperdense cells: Automated parameter to hereditary spherocytosis screening. Clin Biochem 2015. [DOI: 10.1016/j.clinbiochem.2015.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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14
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Béné MC, Le Bris Y, Robillard N, Wuillème S, Fouassier M, Eveillard M. Flow cytometry in hematological nonmalignant disorders. Int J Lab Hematol 2015; 38:5-16. [PMID: 26542092 DOI: 10.1111/ijlh.12438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/20/2015] [Indexed: 12/31/2022]
Abstract
Multiparameter flow cytometry (MFC) has become an integral part of the diagnosis and classification of hematological malignancies. However, several nonmalignant or premalignant disorders may benefit from this technology in hematology laboratories. This review provides information on the normal immunophenotypic characteristics of peripheral blood leukocyte subsets and their modifications in several clinical conditions. The usefulness of MFC and the specific markers that can be investigated in hyperlymphocytosis, infection, hypereosinophilia, paroxysmal nocturnal hemoglobinuria, and large granular lymphocyte disorders is described. Mention is also made of the developments of MFC for analyses of red blood cells or platelets.
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Affiliation(s)
- M C Béné
- Hematology Biology, University Hospital of Nantes, Nantes, France
| | - Y Le Bris
- Hematology Biology, University Hospital of Nantes, Nantes, France
| | - N Robillard
- Hematology Biology, University Hospital of Nantes, Nantes, France
| | - S Wuillème
- Hematology Biology, University Hospital of Nantes, Nantes, France
| | - M Fouassier
- Hematology Biology, University Hospital of Nantes, Nantes, France
| | - M Eveillard
- Hematology Biology, University Hospital of Nantes, Nantes, France
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Agarwal AM, Liew MA, Nussenzveig RH, Sangle N, Heikal N, Yaish H, Christensen R. Improved harmonization of eosin-5-maleimide binding test across different instruments and age groups. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 90:512-516. [PMID: 26384602 DOI: 10.1002/cyto.b.21326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/01/2015] [Accepted: 09/11/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND The eosin-5'maleimide (EMA) binding test has been studied extensively for the detection of hereditary spherocytosis (HS). Its performance characteristics have been compared to NaCl-based or glycerol lysis-based red cell osmotic fragility tests and cryohemolysis. HS samples are also better identified when both mean channel fluorescence (MCF) of EMA relative to controls and the coefficient of variation (CV) are analyzed. METHODS We looked at 65 normal controls including 30 adults 25-65 years old and 35 newborns and 12 HS cases. In addition to the MCF and the CV, we used a side scatter (SSC) vs. EMA fluorescence gate or "footprint" to depict where normal erythrocytes should appear. Erythrocytes that have reduced band 3 protein appear outside of the footprint. RESULTS In our study, newborn data did not cluster with the samples from working age individuals. The MCF and the CVs of normal newborns were higher than normal adult group. However, the footprint data of normal samples relative to their controls was around 99.5% for each group, because the footprint was moved to fit the pattern of the normal. CONCLUSIONS The inclusion of footprint parameter will help in better standardization as well as implementation of this test across different age groups as well as different instruments. © 2015 International Clinical Cytometry Society.
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Affiliation(s)
- Archana M Agarwal
- Department of Pathology, University of Utah, Salt Lake City, Utah, 84112.,Associated Regional and University Pathologists (ARUP) Laboratories, Salt Lake City, Utah, 84108
| | - Michael A Liew
- Associated Regional and University Pathologists (ARUP) Laboratories, Salt Lake City, Utah, 84108
| | - Roberto H Nussenzveig
- Associated Regional and University Pathologists (ARUP) Laboratories, Salt Lake City, Utah, 84108
| | - Nikhil Sangle
- Department of Pathology and Laboratory Medicine, Dental Sciences Building, Western University, London, Ontario, Canada
| | - Nahla Heikal
- Department of Pathology, University of Utah, Salt Lake City, Utah, 84112.,Associated Regional and University Pathologists (ARUP) Laboratories, Salt Lake City, Utah, 84108
| | - Hassan Yaish
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Robert Christensen
- Divisions of Neonatology and Hematology Oncology, University of Utah School of Medicine, Salt Lake City, Utah
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Mehra S, Tyagi N, Dorwal P, Pande A, Jain D, Sachdev R, Raina V. Stability of eosin-5'-maleimide dye used in flow cytometric analysis for red cell membrane disorders. Blood Res 2015; 50:109-12. [PMID: 26157781 PMCID: PMC4486153 DOI: 10.5045/br.2015.50.2.109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 05/30/2015] [Accepted: 06/04/2015] [Indexed: 01/20/2023] Open
Abstract
Background The eosin-5'-maleimide (EMA) binding test using flow cytometry is a common method to measure reduced mean channel fluorescence (MCF) of EMA-labeled red blood cells (RBCs) from patients with red cell membrane disorders. The basic principle of the EMA-RBC binding test involves the covalent binding of EMA to lysine-430 on the first extracellular loop of band 3 protein. Methods In the present study, the MCF of EMA was analyzed for samples derived from 12 healthy volunteers (controls) to determine the stability (i.e., the percentage decrease in fluorescence) of EMA over a period of 1 year. Results Comparison of periodical MCF readings over time, that is, at 2-month intervals, showed that there were no significant changes in mean channel fluorescence for up to 6 months; however, there was a significant decrease in MCF at 8 months. Conclusion For optimal dye utilization, EMA remained stable only for up to 6 months. Therefore, we recommend reconstitution of the dye every 6 months when implementing this test and storage at -80℃ in dark conditions.
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Affiliation(s)
- Simmi Mehra
- Department of Pathology, Medanta, The Medicity, Gurgaon, India
| | - Neetu Tyagi
- Department of Pathology, Medanta, The Medicity, Gurgaon, India
| | - Pranav Dorwal
- Department of Pathology, Medanta, The Medicity, Gurgaon, India
| | - Amit Pande
- Department of Pathology, Medanta, The Medicity, Gurgaon, India
| | - Dharmendra Jain
- Department of Pathology, Medanta, The Medicity, Gurgaon, India
| | - Ritesh Sachdev
- Department of Pathology, Medanta, The Medicity, Gurgaon, India
| | - Vimarsh Raina
- Department of Pathology, Medanta, The Medicity, Gurgaon, India
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Ciepiela O, Adamowicz-Salach A, Bystrzycka W, Łukasik J, Kotuła I. Mean corpuscular volume of control red blood cells determines the interpretation of eosin-5'-maleimide (EMA) test result in infants aged less than 6 months. Ann Hematol 2015; 94:1277-83. [PMID: 25907377 PMCID: PMC4488455 DOI: 10.1007/s00277-015-2377-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 04/06/2015] [Indexed: 11/13/2022]
Abstract
Eosin-5′-maleimide (EMA) binding test is a flow cytometric test used to detect hereditary spherocytosis (HS). To perform the test sample from patients, 5–6 reference samples of red blood are needed. Our aim was to investigate how the mean corpuscular volume (MCV) of red blood cells influences on the value of fluorescence of bounded EMA dye and how the choice of reference samples affects the test result. EMA test was performed in peripheral blood from 404 individuals, including 31 children suffering from HS. Mean fluorescence channel of EMA-RBCs was measured with Cytomics FC500 flow cytometer. Mean corpuscular volume of RBCs was assessed with LH750 Beckman Coulter. Statistical analysis was performed using Graph Pad Prism. The correlation Spearman coefficient between mean channel of fluorescence of EMA-RBCs and MCV was r = 0.39, p < 0.0001. Interpretation of EMA test depends on MCV of the reference samples. If reference blood samples have lower MCV than the patients MCV, EMA test result might be negative. Due to different MCV values of RBCs in infancy and ca. Three months later, EMA test in neonates might be interpreted falsely negative. Samples from children younger than 3 months old had EMA test result 86.1 ± 11.7 %, whereas same samples that analyzed 4.1 ± 2.1 later had results of 75.4 ± 4.5 %, p < 0.05. Mean fluorescence of EMA-bound RBC depends on RBC’s volume. MCV of reference samples affects EMA test results; thus, we recommend selection of reference samples with MCV in range of ±2 fL compared to MCV of patient RBC’s.
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Affiliation(s)
- Olga Ciepiela
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Marszalkowska 24, 00-576, Warsaw, Poland,
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King MJ, Garçon L, Hoyer JD, Iolascon A, Picard V, Stewart G, Bianchi P, Lee SH, Zanella A. ICSH guidelines for the laboratory diagnosis of nonimmune hereditary red cell membrane disorders. Int J Lab Hematol 2015; 37:304-25. [PMID: 25790109 DOI: 10.1111/ijlh.12335] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/22/2015] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Hereditary spherocytosis (HS), hereditary elliptocytosis (HE), and hereditary stomatocytosis (HSt) are inherited red cell disorders caused by defects in various membrane proteins. The heterogeneous clinical presentation, biochemical and genetic abnormalities in HS and HE have been well documented. The need to raise the awareness of HSt, albeit its much lower prevalence than HS, is due to the undesirable outcome of splenectomy in these patients. METHODS The scope of this guideline is to identify the characteristic clinical features, the red cell parameters (including red cell morphology) for these red cell disorders associated, respectively, with defective cytoskeleton (HS and HE) and abnormal cation permeability in the lipid bilayer (HSt) of the red cell. The current screening tests for HS are described, and their limitations are highlighted. RESULTS An appropriate diagnosis can often be made when the screening test result(s) is reviewed together with the patient's clinical/family history, blood count results, reticulocyte count, red cell morphology, and chemistry results. SDS-polyacrylamide gel electrophoresis of erythrocyte membrane proteins, monovalent cation flux measurement, and molecular analysis of membrane protein genes are specialist tests for further investigation. CONCLUSION Specialist tests provide additional evidence in supporting the diagnosis and that will facilitate the management of the patient. In the case of a patient's clinical phenotype being more severe than the affected members within the immediate family, molecular testing of all family members is useful for confirming the diagnosis and allows an insight into the molecular basis of the abnormality such as a recessive mode of inheritance or a de novo mutation.
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Affiliation(s)
- M-J King
- Membrane Biochemistry, NHS Blood and Transplant, Bristol, UK
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