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Yıldırım AT, Gülen H, Türkmen H, Özek G, Oymak Y, Durmaz B, Karaca E. Successful Treatment of a Child with Hemoglobin Hammersmith with Hematopoietic Stem Cell Transplantation. Hemoglobin 2023; 47:137-139. [PMID: 37605549 DOI: 10.1080/03630269.2023.2219007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 05/22/2023] [Indexed: 08/23/2023]
Abstract
Hemoglobin (Hb) Hammersmith, formed by serine substitution for phenylalanine at residue 42 in the beta-globin chain, is a very rare variant of unstable hemoglobin with low oxygen affinity. For patients with hemoglobinopathies, it is well-established that hematopoietic stem cell transplantation provides a complete cure, but the literature on its role for those with Hb Hammersmith is limited. A seven-month-old girl who was examined for anemia and splenomegaly was followed up for congenital hemolytic anemia. The patient with visible cyanosis of the lips and whose p50 was low in blood gas was diagnosed with Hb Hammersmith through the DNA sequence analysis. During the follow-up, frequent blood transfusions had to be given due to anemia aggravated by infections. Following a successful hematopoietic stem cell transplant from an HLA-matched sibling, the patient completely recovered from Hb Hammersmith. The case is presented because of its rarity.
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Affiliation(s)
- Ayşen Türedi Yıldırım
- Department of Pediatric Hematology and Oncology, Manisa Celal Bayar University, Manisa, Turkey
| | - Hüseyin Gülen
- Department of Pediatric Hematology and Oncology, Manisa Celal Bayar University, Manisa, Turkey
| | - Hülya Türkmen
- Department of Pediatric Hematology and Oncology, Manisa Celal Bayar University, Manisa, Turkey
| | - Gülcihan Özek
- Department of Pediatric Hematology and Oncology, Pediatric Bone Marrow Transplant Unit, Ege University, İzmir, Turkey
| | - Yeşim Oymak
- Department of Pediatric Hematology and Oncology, Pediatric Bone Marrow Transplant Unit, Ege University, İzmir, Turkey
| | - Burak Durmaz
- Department of Medical Genetics, Ege University, İzmir, Turkey
| | - Emin Karaca
- Department of Medical Genetics, Ege University, İzmir, Turkey
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Chan WYK, Chan NCN, So JCC, Lee PPW, Cheuk DKL, Ha SY, Chan GCF, Leung W. Successful haploidentical hematopoietic stem cell transplantation (HSCT) and durable engraftment by repeated donor lymphocyte infusions for a Chinese patient with transfusion-dependent hemoglobin (Hb) Hammersmith and massive splenomegaly. Pediatr Transplant 2022; 26:e14278. [PMID: 35396908 DOI: 10.1111/petr.14278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/15/2022] [Accepted: 03/24/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hemoglobin (Hb) Hammersmith is a rare form of unstable β-chain hemoglobinopathy causing hemolytic anemia. This rare event led to a more serious transfusion-dependent phenotype in a patient. It was successfully cured by haploidentical hematopoietic stem cell transplantation (HSCT). METHODS AND RESULTS A 9-year-old mainland Chinese male with a history of neonatal unconjugated hyperbilirubinemia was diagnosed to have hemoglobin (Hb) Hammersmith. He required regular blood transfusion but was unable to be transfused to desired parameters for 8 years prior to transplant due to social and geographical reasons. He subsequently developed marrow hyperplasia and progressive splenomegaly (down to umbilicus level), suggestive of extramedullary hematopoiesis. Eventually, the family came to Hong Kong and complied to a more intensive transfusion regimen and preconditioning chemotherapy 3 months prior to transplant. He underwent haploidentical HSCT using paternal TCRαβ/CD45RA-depleted graft but suffered from graft rejection, despite splenic irradiation for massive splenomegaly. It was successfully salvaged with second HSCT with unmanipulated graft from the same donor with additional serotherapy and donor lymphocyte infusions. CONCLUSION Allogenic haploidentical HSCT for hemoglobin Hammersmith is feasible but adequate immunosuppression during conditioning is crucial. Precise adoptive cell therapy can promote durable engraftment.
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Affiliation(s)
- Wilson Y K Chan
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong Special Administrative Region, China
| | - Nelson C N Chan
- Division of Haematology, Department of Pathology, Hong Kong Children's Hospital, Hong Kong Special Administrative Region, China
| | - Jason C C So
- Division of Haematology, Department of Pathology, Hong Kong Children's Hospital, Hong Kong Special Administrative Region, China
| | - Pamela P W Lee
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong Special Administrative Region, China
| | - Daniel K L Cheuk
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong Special Administrative Region, China
| | - S Y Ha
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong Special Administrative Region, China
| | - Godfrey C F Chan
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong Special Administrative Region, China
| | - Wing Leung
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong Special Administrative Region, China
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Pesce MM, Atkinson MM, Sridhar V, Edwards EG. Consideration of Splenectomy in Unstable Hemoglobinopathy: A Case Report of Hb Hammersmith ( HBB: c.128T>C). Hemoglobin 2022; 46:197-200. [PMID: 35762361 DOI: 10.1080/03630269.2022.2072318] [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: 11/04/2022]
Abstract
A 5-year-old female has been diagnosed with Hb Hammersmith (HBB: c.128T>C) and has required three blood transfusions thus far, with hemoglobin (Hb) levels dropping as low as 5.4 g/dL. An elective splenectomy is now being considered in order to reduce hemolysis and the need for transfusions. Of 18 previously reported cases of Hb Hammersmith, eight patients have reportedly undergone splenectomy, with only four of those studies reporting clinical improvement. Therefore, the role of splenectomy in unstable hemoglobinopathies remains unclear, but seems to be a promising option in Hb Hammersmith.
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Affiliation(s)
| | - Mandy M Atkinson
- Department of Pediatric Hematology/Oncology, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA
| | | | - Erwood G Edwards
- Department of Pediatric Hematology/Oncology, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA
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Grimholt RM, Vestli A, Urdal P, Bechensteen AG, Fjeld B, Dalhus B, Klingenberg O. Hb Oslo [β42(CD1)Phe→Ile; HBB: c.127T>A]: A Novel Unstable Hemoglobin Variant Found in a Norwegian Patient. Hemoglobin 2018; 42:78-83. [DOI: 10.1080/03630269.2018.1468773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Runa M. Grimholt
- Department of Medical Biochemistry, Oslo University Hospital, Ullevaal, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Vestli
- Department of Pediatric Medicine, Oslo University Hospital, Rikshopitalet, Oslo, Norway
| | - Petter Urdal
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Bente Fjeld
- Department of Medical Biochemistry, Oslo University Hospital, Ullevaal, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Dalhus
- Department of Medical Biochemistry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Olav Klingenberg
- Department of Medical Biochemistry, Oslo University Hospital, Ullevaal, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Palasuwan D, Palasuwan A, Charoensappakit A, Noulsri E. A novel flow cytometry-based method of analyzing Heinz bodies. Int J Lab Hematol 2016; 39:68-75. [DOI: 10.1111/ijlh.12576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/02/2016] [Indexed: 01/10/2023]
Affiliation(s)
- D. Palasuwan
- Department of Clinical Microscopy; Faculty of Allied Health Sciences; Chulalongkorn University; Bangkok Thailand
| | - A. Palasuwan
- Department of Clinical Microscopy; Faculty of Allied Health Sciences; Chulalongkorn University; Bangkok Thailand
| | - A. Charoensappakit
- Department of Clinical Microscopy; Faculty of Allied Health Sciences; Chulalongkorn University; Bangkok Thailand
| | - E. Noulsri
- Research Division; Faculty of Medicine; Siriraj Hospital; Mahidol University; Bangkok Thailand
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Li R, Wang T, Xie XM, Li DZ. Case report: prenatal diagnosis of Hb Hammersmith [β42(CD1)Phe→Ser; HBB: c.128T > C] in a family with an adult male patient. Hemoglobin 2014; 38:142-5. [PMID: 24471820 DOI: 10.3109/03630269.2014.880352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hb Hammersmith [β42(CD1)Phe → Ser; HBB: c.128T > C] is a rare, unstable hemoglobin (Hb) variant. In this case report, we describe another male case of Hb Hammersmith. A 39-year-old male had hemolytic anemia, cyanosis and splenomegaly since 6 months after birth. He passed the disease allele to his daughter, a 3-year-old girl, who also had hemolytic anemia and splenomegaly. This mutation was not identified in the parents and two brothers of the father. Early prenatal diagnosis was performed in the second pregnancy in this family. This is the first case of Hb Hammersmith in an adult male patient.
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Affiliation(s)
- Ru Li
- Prenatal Diagnostic Center, Guangzhou Women & Children Medical Center, Guangzhou Medical University , Guangzhou, Guangdong , People's Republic of China
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Park S, Kang HJ, Cho SI, Kim SY, Seong MW, Park SS. A case report of a male patient with Hb Hammersmith [β42(CD1)Phe→Ser, TTT>TCT]. Hemoglobin 2012; 36:161-5. [PMID: 22217314 DOI: 10.3109/03630269.2011.645179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
All Hb Hammersmith [β42(CD1)Phe→Ser, TTT>TCT] patients reported so far have been female, suggesting that this condition may occur as a negative, fatal intrauterine selection against males. In this case report, we describe a male case of Hb Hammersmith. A 6-month-old male patient, born from ovum donation, presented with hemolytic anemia and cyanosis. Hemoglobin (Hb) electrophoresis revealed decreased Hb A (54.0%) and Hb A(2) (0.3%) and markedly increased Hb F (45.7%) levels. Direct sequencing revealed a missense mutation in the HBB gene, c.128T>C (p.Phe42Ser), which is known as Hb Hammersmith. This mutation was not identified in any of this patient's family members. This is the first case of Hb Hammersmith in a male patient, and this study demonstrates that Hb Hammersmith is likely a non fatal condition for males during the intrauterine period.
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Affiliation(s)
- Seungman Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
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Conran N, Costa FF. Hemoglobin disorders and endothelial cell interactions. Clin Biochem 2009; 42:1824-38. [PMID: 19580799 DOI: 10.1016/j.clinbiochem.2009.06.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 06/20/2009] [Indexed: 11/15/2022]
Abstract
Endothelial damage and inflammation make a significant contribution to the pathophysiology of sickle cell disease (SCD) and the beta-thalassemia syndromes. Endothelial dysfunction and ensuing vasculopathy are implicated in pulmonary hypertension in the hemoglobinopathies and endothelial activation and endothelial-blood cell adhesion, accompanied by inflammatory processes and oxidative stress, are imperative to the vaso-occlusive process in SCD. Herein, we discuss the role that the endothelium plays in all of these processes and the effect that genetic modifiers and hydroxyurea therapy may have upon endothelial interactions. Therapies targeting the endothelium and endothelial interactions may represent a promising approach for treating these diseases.
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Affiliation(s)
- Nicola Conran
- Hematology and Hemotherapy Centre, School of Medical Sciences, University of Campinas - UNICAMP, Brazil.
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