1
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Nair SB, Athalye AS, Panphalia M, Parikh FR. First Report of an α Chain Variant [Hb Coombe Park ( HBA2: c.382A>G)] from India, Coinherited with a Novel SERPINC1 Gene Mutation: A Double Whammy? Hemoglobin 2022; 46:269-271. [PMID: 36120956 DOI: 10.1080/03630269.2022.2122497] [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: 01/06/2023]
Abstract
Coinheritance of a high oxygen affinity structural hemoglobin (Hb) variant along with a thrombophilia marker is a rare occurrence. This may lead to a multi fold increase in the risk of thrombosis in patients. We report here a first case of Hb Coombe Park (HBA2: c.382A>G; p.Lys128Glu) from India, coinherited with a novel mutation (c.839C>G; p.Ser280Ter) on the SERPINC1 gene. This coinheritance has not been reported before. Though the patient is presently asymptomatic, identification of these variants will help in genetic counseling and to decide the future course of action in case of any clinical complications.
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Affiliation(s)
- Sona B Nair
- Department of Assisted Reproduction and Genetics, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Arundhati S Athalye
- Department of Assisted Reproduction and Genetics, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Madhavi Panphalia
- Department of Assisted Reproduction and Genetics, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Firuza R Parikh
- Department of Assisted Reproduction and Genetics, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
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2
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Mallik N, Jamwal M, Sharma R, Singh N, Sharma P, Bansal D, Trehan A, Chhabra S, Das R. Ultra-rare Hb Regina ( HBB:c.289C>G) with coinherited β-thalassaemia trait: solving the puzzle for extreme erythrocytosis. J Clin Pathol 2022; 75:791-792. [PMID: 35042755 DOI: 10.1136/jclinpath-2021-208013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/04/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Nabhajit Mallik
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manu Jamwal
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritika Sharma
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Namrata Singh
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prashant Sharma
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Department of Pediatrics (Hematology-Oncology Unit), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Department of Pediatrics (Hematology-Oncology Unit), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Chhabra
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Reena Das
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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3
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Gangat N, Oliveira JL, Hoyer JD, Patnaik MM, Pardanani A, Tefferi A. High-oxygen-affinity hemoglobinopathy-associated erythrocytosis: Clinical outcomes and impact of therapy in 41 cases. Am J Hematol 2021; 96:1647-1654. [PMID: 34633117 DOI: 10.1002/ajh.26375] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 12/18/2022]
Abstract
We describe presenting features, treatment strategies, and follow-up events involving 41 patients (median age 39 years, range 1-81; 54% males) with high oxygen affinity (HOA) hemoglobinopathy-associated erythrocytosis, seen at our institution (1973-2020). Thirty-four (83%) patients carried β-chain (13 Malmo, 4 Olympia, 3 San Diego, 2 Wood) and 7 (17%) α-chain (4 Dallas and one each Columbia-Missouri, Jackson, and Wayne) variants. Median (range) hemoglobin (Hgb)/hematocrit (Hct), serum erythropoietin and p50 were 18 g/dL/52.9% (16-21.9/48-66), 10.4 mIU (4-36.3), and 20 mmHg (12-25), respectively. Family history was documented in 24 patients and history of thrombosis in two (5%). Treatment included phlebotomy in 23 and antiplatelet therapy in 21 patients. At a median follow-up of 10 years, 23 (56%) patients reported one or more symptoms that were thought to be related to their increased Hct while thrombosis was documented in 10 (24%) patients. Neither Hgb/Hct level nor active phlebotomy showed a significant correlation with either thrombotic or nonthrombotic symptoms (p > .1 in all instances). Among 23 pregnancies recorded, 78% resulted in live births and no fetal loss was attributed to erythrocytosis. The current study does not implicate Hgb/Hct level as a major contributor of morbidity in HOA hemoglobinopathy-associated erythrocytosis and suggests limited therapeutic value for phlebotomy.
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Affiliation(s)
- Naseema Gangat
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Jennifer L. Oliveira
- Division of Hematopathology, Department of Laboratory Medicine Mayo Clinic Rochester Minnesota USA
| | - James D. Hoyer
- Division of Hematopathology, Department of Laboratory Medicine Mayo Clinic Rochester Minnesota USA
| | - Mrinal M. Patnaik
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Animesh Pardanani
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Ayalew Tefferi
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
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4
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Urrechaga E, Fernández M, Orbe RD. Hb Johnstown is detected on Mindray BC 6800 Plus analyzer. Clin Chem Lab Med 2021; 59:e386-e388. [PMID: 34087966 DOI: 10.1515/cclm-2021-0314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/10/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Eloísa Urrechaga
- Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain
| | | | - Rafael Del Orbe
- Erythropatology and Hematology, Hospital Universitario Cruces, Biscay, Spain
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5
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Oo TH. Secondary erythrocytosis due to hemoglobin San Diego. Proc (Bayl Univ Med Cent) 2020; 34:159-160. [PMID: 33456185 DOI: 10.1080/08998280.2020.1824980] [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: 10/23/2022] Open
Abstract
High-oxygen-affinity hemoglobin variants are a rare clinical entity that can present with secondary erythrocytosis. Herein, the author reports a case of a 41-year-old man with a 4-year history of secondary erythrocytosis of unknown etiology. Physical examination was unremarkable except for plethora of the palms. Myeloproliferative neoplasms and common causes of secondary erythrocytosis were ruled out. The P50 oxygen-hemoglobin dissociation curve was left shifted. Hemoglobin electrophoresis was silent; however, globin mass spectrometry revealed a β-globin variant. Globin sequencing confirmed hemoglobin San Diego. This case highlights the fact that rare high-oxygen-affinity variants should be considered in the differential diagnoses of secondary erythrocytosis.
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Affiliation(s)
- Thein Hlaing Oo
- Section of Benign Hematology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
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6
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Xiong H, Chen S. First Description of Hb San Diego ( HBB: c.328G>A) in a Chinese Family with Congenital Erythrocytosis. Hemoglobin 2019; 43:126-128. [PMID: 31304856 DOI: 10.1080/03630269.2019.1615940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Congenital erythrocytosis is a rare and hereditary disorder of red blood cell (RBC) production that can be caused by high oxygen affinity hemoglobin (Hb) variants. We applied a genetic approach including whole exome sequencing and Sanger sequencing. We identified a heterozygous β-globin gene (Hb San Diego or HBB: c.328G>A) in exon 3 as a causative germline mutation in a Chinese family with congenital erythrocytosis. We concluded that in erythrocytosis with a dominant inheritance and normal or inappropriately high erythropoietin (EPO) levels, the high oxygen affinity Hb variants should be considered. In addition, as a tool for identification of mutations in congenital erythrocytosis, whole exome sequencing improves diagnostic accuracy and provides the opportunity for discovery of novel variants.
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Affiliation(s)
- Huixia Xiong
- a Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University , Suzhou , Jiangsu Province , People's Republic of China
| | - Suning Chen
- a Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University , Suzhou , Jiangsu Province , People's Republic of China
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7
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Boster J, Howells J, Devine R. Hemoglobin San Diego: An Uncommon Cause of Hereditary Erythrocytosis Discovered Incidentally in a Military Trainee. Mil Med 2018; 184:e486-e488. [DOI: 10.1093/milmed/usy295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/08/2018] [Accepted: 10/15/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joshua Boster
- Department of Medicine, Internal Medicine Residency, Brooke Army Medical Center, San Antonio, TX
| | - Joseph Howells
- Department of Medicine, Division of Hematology Oncology, Brooke Army Medical Center, San Antonio, TX
| | - Ryan Devine
- Department of Medicine, Division of Hematology Oncology, Brooke Army Medical Center, San Antonio, TX
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8
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Yılmaz Keskin E, Fettah A, Oliveira AC, Toprak Ş, Lopes A, Bento C. First Observation of Hemoglobin San Diego, a High Oxygen Affinity Hemoglobin Variant, in Turkey. Turk J Haematol 2017; 34:372-373. [PMID: 28832008 PMCID: PMC5774358 DOI: 10.4274/tjh.2017.0213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Ebru Yılmaz Keskin
- Süleyman Demirel University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Isparta, Turkey
| | - Ali Fettah
- Süleyman Demirel University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Isparta, Turkey
| | | | - Şule Toprak
- Süleyman Demirel University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Isparta, Turkey
| | - Andreia Lopes
- Coimbra University, Centro Hospital, Clinic of Hematology, Coimbra, Portugal
| | - Celeste Bento
- Coimbra University, Centro Hospital, Clinic of Hematology, Coimbra, Portugal.,CIAS, Coimbra University, Department of Life Sciences, Coimbra, Portugal
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9
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Camps C, Petousi N, Bento C, Cario H, Copley RR, McMullin MF, van Wijk R, Ratcliffe PJ, Robbins PA, Taylor JC. Gene panel sequencing improves the diagnostic work-up of patients with idiopathic erythrocytosis and identifies new mutations. Haematologica 2016; 101:1306-1318. [PMID: 27651169 PMCID: PMC5394871 DOI: 10.3324/haematol.2016.144063] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 07/26/2016] [Indexed: 12/31/2022] Open
Abstract
Erythrocytosis is a rare disorder characterized by increased red cell mass and elevated hemoglobin concentration and hematocrit. Several genetic variants have been identified as causes for erythrocytosis in genes belonging to different pathways including oxygen sensing, erythropoiesis and oxygen transport. However, despite clinical investigation and screening for these mutations, the cause of disease cannot be found in a considerable number of patients, who are classified as having idiopathic erythrocytosis. In this study, we developed a targeted next-generation sequencing panel encompassing the exonic regions of 21 genes from relevant pathways (~79 Kb) and sequenced 125 patients with idiopathic erythrocytosis. The panel effectively screened 97% of coding regions of these genes, with an average coverage of 450×. It identified 51 different rare variants, all leading to alterations of protein sequence, with 57 out of 125 cases (45.6%) having at least one of these variants. Ten of these were known erythrocytosis-causing variants, which had been missed following existing diagnostic algorithms. Twenty-two were novel variants in erythrocytosis-associated genes (EGLN1, EPAS1, VHL, BPGM, JAK2, SH2B3) and in novel genes included in the panel (e.g. EPO, EGLN2, HIF3A, OS9), some with a high likelihood of functionality, for which future segregation, functional and replication studies will be useful to provide further evidence for causality. The rest were classified as polymorphisms. Overall, these results demonstrate the benefits of using a gene panel rather than existing methods in which focused genetic screening is performed depending on biochemical measurements: the gene panel improves diagnostic accuracy and provides the opportunity for discovery of novel variants.
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Affiliation(s)
- Carme Camps
- National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre, Oxford, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, UK
| | - Nayia Petousi
- Nuffield Department of Medicine, University of Oxford, UK
| | - Celeste Bento
- Hematology Department, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Holger Cario
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Ulm, Germany
| | - Richard R Copley
- National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre, Oxford, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, UK
| | | | | | | | - Peter A Robbins
- Department of Physiology, Anatomy and Genetics, University of Oxford, UK
| | - Jenny C Taylor
- National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre, Oxford, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, UK
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10
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Oksenberg D, Dufu K, Patel MP, Chuang C, Li Z, Xu Q, Silva-Garcia A, Zhou C, Hutchaleelaha A, Patskovska L, Patskovsky Y, Almo SC, Sinha U, Metcalf BW, Archer DR. GBT440 increases haemoglobin oxygen affinity, reduces sickling and prolongs RBC half-life in a murine model of sickle cell disease. Br J Haematol 2016; 175:141-53. [PMID: 27378309 DOI: 10.1111/bjh.14214] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/25/2016] [Indexed: 11/27/2022]
Abstract
A major driver of the pathophysiology of sickle cell disease (SCD) is polymerization of deoxygenated haemoglobin S (HbS), which leads to sickling and destruction of red blood cells (RBCs) and end-organ damage. Pharmacologically increasing the proportion of oxygenated HbS in RBCs may inhibit polymerization, prevent sickling and provide long term disease modification. We report that GBT440, a small molecule which binds to the N-terminal α chain of Hb, increases HbS affinity for oxygen, delays in vitro HbS polymerization and prevents sickling of RBCs. Moreover, in a murine model of SCD, GBT440 extends the half-life of RBCs, reduces reticulocyte counts and prevents ex vivo RBC sickling. Importantly, oral dosing of GBT440 in animals demonstrates suitability for once daily dosing in humans and a highly selective partitioning into RBCs, which is a key therapeutic safety attribute. Thus, GBT440 has the potential for clinical use as a disease-modifying agent in sickle cell patients.
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Affiliation(s)
- Donna Oksenberg
- Global Blood Therapeutics Inc., South San Francisco, CA, USA.
| | - Kobina Dufu
- Global Blood Therapeutics Inc., South San Francisco, CA, USA
| | - Mira P Patel
- Global Blood Therapeutics Inc., South San Francisco, CA, USA
| | | | - Zhe Li
- Global Blood Therapeutics Inc., South San Francisco, CA, USA
| | - Qing Xu
- Global Blood Therapeutics Inc., South San Francisco, CA, USA
| | | | - Chengjing Zhou
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | | | - Uma Sinha
- Global Blood Therapeutics Inc., South San Francisco, CA, USA
| | - Brian W Metcalf
- Global Blood Therapeutics Inc., South San Francisco, CA, USA
| | - David R Archer
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA
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11
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Barba T, Boileau JC, Pasquet F, Hot A, Pavic M. [Inherited primitive and secondary polycythemia]. Rev Med Interne 2016; 37:460-5. [PMID: 26827274 DOI: 10.1016/j.revmed.2015.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 10/21/2015] [Accepted: 12/28/2015] [Indexed: 12/12/2022]
Abstract
Myeloproliferative disorders and secondary polycythemia cover most of the polycythemia cases encountered in daily practice. Inherited polycythemias are rare entities that have to be suspected when the classical causes of acquired polycythemia have been ruled out. Recent advances were made in the understanding of these pathologies, which are still little known to the physicians. This review reports the state of knowledge and proposes an algorithm to follow when confronted to a possible case of inherited polycythemia.
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Affiliation(s)
- T Barba
- Service de médecine interne, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
| | - J-C Boileau
- Service d'hématologie-oncologie, faculté de médecine et des sciences de la santé, CHU de Sherbrooke, 2500, boulevard de l'Université, Sherbrooke, Canada
| | - F Pasquet
- Service de médecine interne, hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - A Hot
- Service de médecine interne, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - M Pavic
- Service d'hématologie-oncologie, faculté de médecine et des sciences de la santé, CHU de Sherbrooke, 2500, boulevard de l'Université, Sherbrooke, Canada
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12
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Tamura S, Tamura T, Gima H, Nishikawa A, Okamoto Y, Kanazawa N, Relvas L, Cunha E, Frances McMullin M, Bento C. A Japanese Family with Congenital Erythrocytosis Caused by Haemoglobin Bethesda. Intern Med 2015; 54:2389-93. [PMID: 26370867 DOI: 10.2169/internalmedicine.54.4520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein present a case of congenital erythrocytosis caused by haemoglobin (Hb) Bethesda in a Japanese family. A 55-year-old asymptomatic man was referred to our hospital for the investigation of erythrocytosis, which was present in other members of his family. The patient's serum erythropoietin level was normal, and the JAK2 V617F mutation was not detected. His P50 value was mildly decreased, thus we suspected the presence of an Hb variant with a high oxygen affinity. The high-performance liquid chromatography analysis showed an abnormal Hb, and by direct sequencing we identified the Hb Bethesda variant in this patient. For the differential diagnosis, we recommend the estimation of the P50 value as a practical and useful test.
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Affiliation(s)
- Shinobu Tamura
- Department of Hematology and Oncology, Kinan Hospital, Japan
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13
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Santbergen B, van der Heul C. At high altitude in the Netherlands: secondary erythrocytosis due to HB-Malmö. BMJ Case Rep 2014; 2014:bcr-2014-203701. [PMID: 24599433 DOI: 10.1136/bcr-2014-203701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe two patients, a father and a son, presenting with erythrocytosis. Evaluation showed no pulmonal or cardial disorders. Owing to an elevated erythropoietin level after phlebotomy, a physiological secondary polycythaemia was suspected. A haemoglobin electrophoresis showed that our patients have a haemoglobinopathy with high affinity for oxygen, called Hb-Malmö (exon 3: c.294 C>G p.His98Gln). Hb-Malmö is a congenital disorder located on a gene at chromosome 11, in the B-chain on codon 97, decoding the α-subunit and β-subunit of the haemoglobin. Through a mutation (CAC→CAG), histidine is replaced by glutamine. The mutation causes a disorder in the connection between the α1-subunit and β2-subunit of the haemoglobin structure. These connections are important sites for binding oxygen. Mutated haemoglobin has a preference for an oxygenated status, which implicates that there is an increased binding and decreased release of oxygen. To compensate, there will be an erythrocytosis to transport sufficient oxygen to the peripheral tissues.
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Affiliation(s)
- Bart Santbergen
- Department of Internal Medicine, St. Elisabeth Hospital, Tilburg, The Netherlands
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14
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Nygaard M, Petersen J, Bjerrum OW. Haemoglobinopathia Ypsilanti – A rare, but important differential diagnosis to polycythaemia vera. Leuk Res Rep 2013; 2:86-8. [PMID: 24371790 PMCID: PMC3850385 DOI: 10.1016/j.lrr.2013.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 09/12/2013] [Indexed: 11/29/2022] Open
Abstract
We present a case of a mother and daughter who were initially diagnosed with polycythaemia vera and treated with venesectio. As JAK2 V6217F/exon 12 mutation analyses became available, these were performed and turned out negative. Haemoglobin electrophoresis was performed and the patients were found to have high oxygen affinity haemoglobin Ypsilanti. It is important and relevant to look for high oxygen affinity variants of haemoglobin when there is a family history of erythrocytosis, in young persons and when there is no apparent reason or clonal marker present.
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Affiliation(s)
- Marietta Nygaard
- Hematological Department, Rigshospitalet, Copenhagen, Denmark
- Corresponding author. Tel.: +45 35456799.
| | | | - Ole W. Bjerrum
- Hematological Department, Rigshospitalet, Copenhagen, Denmark
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15
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Inoue S, Oliveira JL, Hoyer JD, Sharman M. Symptomatic Erythrocytosis Associated with a Compound Heterozygosity for Hb Lepore-Boston-Washington (δ87-β116) and Hb Johnstown [β109(G11)Val→Leu,GTG>TTG]. Hemoglobin 2012; 36:362-70. [DOI: 10.3109/03630269.2012.679717] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Esparcieux A, Francina A, Vital-Durand D. [Abnormal hemoglobins with high oxygen affinity in the differential diagnosis of polycythemia]. Rev Med Interne 2011; 32:e105-7. [PMID: 21511372 DOI: 10.1016/j.revmed.2010.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 10/15/2010] [Accepted: 11/21/2010] [Indexed: 11/16/2022]
Abstract
Hemoglobin variant with high oxygen affinity is an uncommon, often misdiagnosed, etiology of erythrocytosis. We report two cases of erythrocytosis. Their hemoglobin-oxygen dissociation curve showed a P50 value (the oxygen tension at which hemoglobin is 50% saturated) below the normal range. Globin chains electrophoresis and DNA analysis evidenced hemoglobin Olympia and hemoglobin Malmö, respectively. More than 200 variants of hemoglobin with increased oxygen affinity have been described, that are in about one-third responsible of secondary erythocytosis because of tissular hypoxia. Such abnormal haemoglobin identification should be routinely included in the diagnostic work-up of unexplained erythocytosis, particularly in young people.
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Affiliation(s)
- A Esparcieux
- Service de médecine interne, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
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17
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Zaldivar-Lopez S, Chisnell HK, Couto CG, Westendorf-Stingle N, Marin LM, Iazbik MC, Cooper ES, Wellman ML, Muir Iii WW. Blood gas analysis and cooximetry in retired racing Greyhounds. J Vet Emerg Crit Care (San Antonio) 2011; 21:24-8. [PMID: 21288290 DOI: 10.1111/j.1476-4431.2010.00607.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purposes of this study were to evaluate the oxygen affinity of hemoglobin (Hb) in healthy retired racing Greyhounds via cooximetry, and to establish reference intervals for blood gases and cooximetry in this breed. DESIGN Prospective clinical study. SETTING University Teaching Hospital. ANIMALS Fifty-seven Greyhounds and 30 non-Greyhound dogs. INTERVENTIONS Venous blood samples were collected from the jugular vein and placed into heparinized tubes. The samples were analyzed within 30 minutes of collection using a blood gas analyzer equipped with a cooximeter. MEASUREMENTS AND MAIN RESULTS Greyhounds had significantly higher pH, PO(2) , oxygen saturation, oxyhemoglobin, total Hb, oxygen content, and oxygen capacity and significantly lower deoxyhemoglobin and P(50) when compared with non-Greyhound dogs. CONCLUSION These findings support the fact that this breed is able to carry a higher concentration of total oxygen in the blood. As reported previously, this breed also has lower P(50) and, therefore, high oxygen affinity. In light of recent findings suggesting that in certain tissues a high affinity for oxygen is beneficial, this adaptation may be of benefit during strenuous exercise.
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Affiliation(s)
- Sara Zaldivar-Lopez
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, OH 43210, USA.
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18
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Teawtrakul N, Sirijirachai C, Chansung G, Fucharoen G. Compound heterozygous Hb Tak/Hb E causes secondary erythrocytosis in a Thai family. Hemoglobin 2010; 34:165-8. [PMID: 20353353 DOI: 10.3109/03630261003680498] [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
Hb Tak is a rare cause of secondary erythrocytosis. It results from the insertion of two nucleotides (AC) at the termination codon between codon 146 and codon 147 of the beta-globin gene. This insertion causes a frameshift in the terminating codon 147 resulting in an elongated beta chain with an impaired formation of the T-state. We report a Thai family with a compound heterozygosity for Hb Tak [beta147 (+ AC)] and Hb E [beta26(B8)Glu-->Lys] which displayed an asymptomatic erythrocytosis.
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Affiliation(s)
- Nattiya Teawtrakul
- Hematology Division, Department of Internal Medicine, Srinagarind hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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Huang LJ, Shen YM, Bulut GB. Advances in understanding the pathogenesis of primary familial and congenital polycythaemia. Br J Haematol 2010; 148:844-52. [PMID: 20096014 DOI: 10.1111/j.1365-2141.2009.08069.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Primary familial and congenital polycythemia (PFCP) is an autosomal-dominant proliferative disorder characterized by erythrocytosis and hypersensitivity of erythroid progenitors to erythropoietin (Epo). Several lines of evidence suggest a causal role of truncated erythropoietin receptor (EpoR) in this disease. In this review, we discuss PFCP in the context of erythrocytosis and EpoR signalling. We focus on recent studies describing mechanisms underlying Epo-dependent EpoR down-regulation. One mechanism depends on internalization mediated through the p85 regulatory subunit of the Phosphoinositide 3-Kinase, and the other utilizes ubiquitin-based proteasomal degradation. Truncated PFCP EpoRs are not properly down-regulated upon stimulation, underscoring the importance of these mechanisms in the pathogenesis of PFCP.
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Affiliation(s)
- Lily J Huang
- Department of Cell Biology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9039, USA.
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Abstract
The approach to a patient with erythrocytosis is greatly simplified by assessing the clonality of the process upfront. In this regard, there has been a dramatic shift toward genetic testing and away from traditional tests, such as measurement of red cell mass. Clonal erythrocytosis is the diagnostic feature of polycythemia vera (PV) and is almost always associated with a JAK2 mutation (JAK2V617F or exon 12). All other scenarios represent non-clonal erythrocytosis, often referred to as secondary erythrocytosis. Serum erythropoietin (Epo) level is usually normal or elevated in secondary erythrocytosis and subnormal in PV. Therefore, in a patient with acquired erythrocytosis, it is reasonable to begin the diagnostic work-up with peripheral blood JAK2 mutation analysis and serum Epo measurement to distinguish PV from secondary erythrocytosis. Conversely, the patient with life-long erythrocytosis is more likely to suffer from congenital polycythemia and should therefore be evaluated for germline mutations that result in enhanced Epo effect (for example, Epo receptor mutations), altered intracellular oxygen sensing (for example, mutations involving the von Hippel-Lindau tumor suppressor gene) or decreased P50 (for example, high-oxygen-affinity hemoglobinopathy). The order of tests in this instance depends on the clinical scenario and serum Epo level.
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