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Siti Asmaa MJ, Miin Phoon L, Zakaria NA, Hussin S, Bahar R, Hassan MN, Zulkafli Z, Iberahim S, Abdullah M, Mohd Noor NH, Mohamed Yusoff S, Ramli M. Hematological Profile of Hb Adana Among High School Students in Northeast Peninsular Malaysia. Cureus 2024; 16:e57353. [PMID: 38694420 PMCID: PMC11061810 DOI: 10.7759/cureus.57353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/04/2024] Open
Abstract
Background Hb Adana is a non-deletional alpha (α)-thalassaemia variant resulting from mutations in α1- or α2-globin codon 59 (αCD59), leading to the production of unstable α-globin. Clinical manifestations can vary from silent carrier status to dependence on blood transfusions, hepatosplenomegaly, skeletal deformities, and spinal cord compression. Despite the significance of Hb Adana inheritance, studying this variant poses challenges due to the scarcity of molecular tests and the potential for routine diagnoses to be overlooked. This study aims to investigate the prevalence of Hb Adana among local high school students and assess the hematological parameters and hemoglobin analysis of Hb Adana in Malaysia. Methodology This retrospective study analyzed 13,721 blood samples collected from high school students participating in Malaysia's National Thalassaemia Screening Program at Hospital Raja Perempuan Zainab II (HRPZ II). Deletional α-thalassaemia was detected using multiplex gap-polymerase chain reaction (PCR), while common non-deletional α-thalassaemia was identified using multiplex amplification refractory mutation system (ARMS) PCR. Data were extracted from the HRPZ II database for analysis. Results Among the participants, 2327 individuals were found to have either common deletional (n=1037, 44.6%) or non-deletional (n=1290, 55.4%) α-thalassaemia. Hb Constant Spring was the most prevalent non-deletional α-thalassaemia, accounting for 53.03% of cases. Thirty-one participants (1.33%) exhibited αCD59α/αα, and one (0.04%) had αCD59α/-α3.7. Among the 32 subjects with Hb Adana, 87.5% were Malay, and 12.5% were Orang Asli. Additionally, seven cases of HbE/Hb Adana co-inheritance were identified. Hemoglobin levels in heterozygous Hb Adana individuals ranged from mild anemia to normal, between 95 g/L and 153 g/L. Mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) were approximately 73 fL and 23 pg, respectively. Conclusion This study delineates the distribution of α-thalassaemia mutation patterns among high school students in Kelantan, Northeast Peninsular Malaysia. Our findings indicate that Hb Adana is rare in our region and co-inheritance with an α-gene deletion results in α+-thalassaemia and with HbE, α0-thalassaemia. All heterozygous Hb Adana individuals exhibited low MCVs and MCHs.
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Affiliation(s)
- Mat Jusoh Siti Asmaa
- Department of Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Lee Miin Phoon
- Hematology Unit, Department of Pathology, Hospital Raja Perempuan Zainab II, Kota Bharu, MYS
| | - Nur Atikah Zakaria
- Department of Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Suryati Hussin
- Hematology Unit, Department of Pathology, Hospital Raja Perempuan Zainab II, Kota Bharu, MYS
| | - Rosnah Bahar
- Department of Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Mohd Nazri Hassan
- Department of Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Zefarina Zulkafli
- Department of Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Salfarina Iberahim
- Department of Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Marne Abdullah
- Department of Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Noor Haslina Mohd Noor
- Department of Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Shafini Mohamed Yusoff
- Department of Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Marini Ramli
- Department of Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
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Guindo A, Cisse Z, Keita I, Desmonde S, Sarro YDS, Touré BA, Baraika MA, Tessougué O, Guindo P, Coulibaly M, Traore O, Sylla N, Diassana M, Saye A, Picot V, Lauressergues E, Leroy V. Potential for a large-scale newborn screening strategy for sickle cell disease in Mali: A comparative diagnostic performance study of two rapid diagnostic tests (SickleScan® and HemotypeSC®) on cord blood. Br J Haematol 2024; 204:337-345. [PMID: 37728227 DOI: 10.1111/bjh.19108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023]
Abstract
Sickle cell disease (SCD) is a life-threatening disease requiring reliable early diagnosis. We assessed the acceptability and diagnostic performances of two rapid diagnostic tests (RDTs) to identify SCD (HbSS, HbSC, HbS/β-thalassaemia) or SCD carrier (HbS/HbC) in a pilot SCD newborn screening (NBS) strategy in Mali. All consenting delivering women were offered SCD NBS using cord blood sampling on two RDTs (SickleScan® and HemotypeSC®) compared to the high-performance liquid chromatography (HPLC) gold standard to detect SCD states. From April 2021 to August 2021, 4333 delivering women were eligible of whom 96.1% were offered NBS: 1.6% refused, 13.8% delivered before consenting and 84.6% consented; 3648 newborns were diagnosed by HPLC; 1.64% had SCD (0.63% HbSS, 0.85% HbSC, 0.16 HbS/β-plus-thalassaemia); 21.79% were SCD carrier. To detect accurately SCD, SickleScan® had a sensitivity of 81.67% (95% confidence interval [CI]: 71.88-91.46) and a negative predictive value (NPV) of 99.69% (95% CI: 99.51-99.87); HemotypeSC® had a sensitivity of 78.33% (95% CI: 67.91-88.76) and a NPV of 99.64% (95% CI: 99.44-99.83). To detect SCD carrier: SickleScan® sensitivity was 96.10% (95% CI: 94.75-97.45) and NPV, 98.90% (95% CI: 98.51-99.29); HemotypeSC® sensitivity was 95.22% (95% CI: 93.74-96.70) and NPV, 98.66% (95% CI: 98.24-99.03). Routine SCD NBS was acceptable. Compared with HPLC, both RDTs had reliable diagnostic performances to exclude SCD-free newborns and to identify SCD carriers to be further confirmed. This strategy could be implemented in large-scale NBS programmes.
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Affiliation(s)
- Aldiouma Guindo
- Centre de Recherche et Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - Zenab Cisse
- CERPOP, UMR 1295, INSERM, Université Toulouse 3, Toulouse, France
| | - Ibrahima Keita
- Centre de Recherche et Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - Sophie Desmonde
- CERPOP, UMR 1295, INSERM, Université Toulouse 3, Toulouse, France
| | | | - Boubacari A Touré
- Centre de Recherche et Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - Mohamed Ag Baraika
- Centre de Recherche et Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - Oumarou Tessougué
- Centre de Recherche et Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - Pierre Guindo
- Centre de Recherche et Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - Moussa Coulibaly
- Centre de Recherche et Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - Oumar Traore
- Centre de santé de Reference de la commune 5 (CsREF-CV), Bamako, Mali
| | - Niagalé Sylla
- Centre de santé de Reference de la commune 5 (CsREF-CV), Bamako, Mali
| | - Mahamadou Diassana
- Service de Gynécologie et Obstétrique, Hopital Fousseyni Daou de Kayes, Kayes, Mali
| | - Amaguiré Saye
- Centre de santé de Reference de la commune 4 (CsREF-CIV), Bamako, Mali
| | | | | | - Valériane Leroy
- CERPOP, UMR 1295, INSERM, Université Toulouse 3, Toulouse, France
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Moore M, Courville EL. Work-up of Patients with Decreased Hemoglobin A2 Identified by Capillary Zone Electrophoresis: A North American Institutional Experience. Lab Med 2023; 54:235-240. [PMID: 36239634 DOI: 10.1093/labmed/lmac114] [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: 05/04/2023] Open
Abstract
OBJECTIVE Isolated low hemoglobin A2 (HbA2) is rarely encountered in our clinical practice using capillary zone electrophoresis. The study goal was to characterize the work-up at our institution of patients with low HbA2. METHODS Patients with low HbA2 and a control cohort with normal capillary zone electrophoresis were identified and relevant information extracted from the medical record. RESULTS Of 44 patients with isolated decreased HbA2, 28 (64%) had corresponding complete blood count/ferritin values. Compared to control patients, patients with low HbA2 were more likely to have iron deficiency and demonstrated a more microcytic, hypochromic blood picture. However, 46% (13/28) of patients with low HbA2 and ferritin for evaluation did not have iron deficiency. Only 2 patients had genetic testing. CONCLUSION This study redemonstrates the association between low HbA2 and iron deficiency and reinforces the need for iron indices to interpret capillary zone electrophoresis results. Our study population showed incomplete or absent iron studies in most cases.
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Affiliation(s)
- Margaret Moore
- University of Virginia School of Medicine and University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Elizabeth L Courville
- University of Virginia School of Medicine and University of Virginia Health System, Charlottesville, VA 22908, USA
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Mandali PK, Prabakaran A, Annadurai K, Krishnan UM. Trends in Quantification of HbA1c Using Electrochemical and Point-of-Care Analyzers. SENSORS (BASEL, SWITZERLAND) 2023; 23:1901. [PMID: 36850502 PMCID: PMC9965793 DOI: 10.3390/s23041901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
Glycated hemoglobin (HbA1c), one of the many variants of hemoglobin (Hb), serves as a standard biomarker of diabetes, as it assesses the long-term glycemic status of the individual for the previous 90-120 days. HbA1c levels in blood are stable and do not fluctuate when compared to the random blood glucose levels. The normal level of HbA1c is 4-6.0%, while concentrations > 6.5% denote diabetes. Conventionally, HbA1c is measured using techniques such as chromatography, spectroscopy, immunoassays, capillary electrophoresis, fluorometry, etc., that are time-consuming, expensive, and involve complex procedures and skilled personnel. These limitations have spurred development of sensors incorporating nanostructured materials that can aid in specific and accurate quantification of HbA1c. Various chemical and biological sensing elements with and without nanoparticle interfaces have been explored for HbA1c detection. Attempts are underway to improve the detection speed, increase accuracy, and reduce sample volumes and detection costs through different combinations of nanomaterials, interfaces, capture elements, and measurement techniques. This review elaborates on the recent advances in the realm of electrochemical detection for HbA1c detection. It also discusses the emerging trends and challenges in the fabrication of effective, accurate, and cost-effective point-of-care (PoC) devices for HbA1c and the potential way forward.
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Affiliation(s)
- Pavan Kumar Mandali
- Centre for Nanotechnology& Advanced Biomaterials, SASTRA Deemed University, Thanjavur 613 401, India
- School of Chemical and Biotechnology, SASTRA Deemed University, Thanjavur 613 401, India
| | - Amrish Prabakaran
- Centre for Nanotechnology& Advanced Biomaterials, SASTRA Deemed University, Thanjavur 613 401, India
- School of Chemical and Biotechnology, SASTRA Deemed University, Thanjavur 613 401, India
| | - Kasthuri Annadurai
- Centre for Nanotechnology& Advanced Biomaterials, SASTRA Deemed University, Thanjavur 613 401, India
- School of Chemical and Biotechnology, SASTRA Deemed University, Thanjavur 613 401, India
- School of Arts, Sciences, Humanities & Education, SASTRA Deemed University, Thanjavur 613 401, India
| | - Uma Maheswari Krishnan
- Centre for Nanotechnology& Advanced Biomaterials, SASTRA Deemed University, Thanjavur 613 401, India
- School of Chemical and Biotechnology, SASTRA Deemed University, Thanjavur 613 401, India
- School of Arts, Sciences, Humanities & Education, SASTRA Deemed University, Thanjavur 613 401, India
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Zheng L, Huang H, Wu X, Su L, Shen Q, Wang M, Lin N, Xu L. Screening of Some Indicators for Alpha-Thalassemia in Fujian Province of Southern China. Int J Gen Med 2021; 14:7329-7335. [PMID: 34737627 PMCID: PMC8560072 DOI: 10.2147/ijgm.s338419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Carrier screening is the most effective means of controlling the prevalence of alpha-thalassemia. However, due to the differences in ethnic populations and genotypes, the distribution of mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and hemoglobin A2 (HbA2) varies in different regions. This study aimed to examine screening efficiency of these indicators in different genotypes of alpha-thalassemia in Fujian Province, China. Methods The data of 13,294 subjects collected from May 2016 to December 2019 were reviewed. The participants were categorized as alpha-thalassemia group and negative-for-alpha-thalassemia group based on the results of the genetic analysis. The distribution of MCV, MCH, and HbA2 in different groups was analysed statistically. And the screening efficiency of different indicators and schemes was compared in different genotypes. The positive criteria of MCV < 80fL, MCH < 27pg, and Hb A2< 2.5% were applied. Results Among the 13,294 subjects, 2658 were alpha-thalassemia carriers. The genotypes of –SEA/αα and -α3.7/αα are the most prevalent with 63.9% and 21.9% in Fujian Province, China. There were significant differences in the distribution of the three indicators in different groups. The detection rate of the three indicators combined screening was 92.6%. Conclusion The distribution of the three indicators overlapped partly between alpha-thalassemia group and negative-for-alpha-thalassemia group. They showed significant differences in the median comparison of seven common genotypes. Combined screening with MCV, MCH and HbA2 improved the detection rate of alpha-thalassemia. The results of this study provide a data basis for clinical laboratories and a reliable reference for clinical consultation.
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Affiliation(s)
- Lin Zheng
- Medical Genetic Diagnosis and Therapy Center of Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, Fujian, People's Republic of China
| | - Hailong Huang
- Medical Genetic Diagnosis and Therapy Center of Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, Fujian, People's Republic of China
| | - Xiaoqing Wu
- Medical Genetic Diagnosis and Therapy Center of Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, Fujian, People's Republic of China
| | - Linjuan Su
- Medical Genetic Diagnosis and Therapy Center of Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, Fujian, People's Republic of China
| | - Qingmei Shen
- Medical Genetic Diagnosis and Therapy Center of Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, Fujian, People's Republic of China
| | - Meiying Wang
- Medical Genetic Diagnosis and Therapy Center of Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, Fujian, People's Republic of China
| | - Na Lin
- Medical Genetic Diagnosis and Therapy Center of Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, Fujian, People's Republic of China
| | - Liangpu Xu
- Medical Genetic Diagnosis and Therapy Center of Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, Fujian, People's Republic of China
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Erythrocyte Indices and Hemoglobin Analysis for α-Thalassemia Screening in an Area with High Carrying Rate. Indian J Hematol Blood Transfus 2021; 38:352-358. [PMID: 35496953 PMCID: PMC9001776 DOI: 10.1007/s12288-021-01449-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 05/13/2021] [Indexed: 01/19/2023] Open
Abstract
Carriers of α-thalassemia exhibit hypochromic microcytosis with mean corpuscular volume (MCV) < 80 fL, mean corpuscular hemoglobin (MCH) < 27 pg, and reduced hemoglobin A2 (HbA2). We studied the distribution and diagnostic efficiencies of these indicators and their combinations in patients with and without alpha-thalassemia. Based on genetic diagnosis, 10,883 participants were divided into alpha-thalassemia group (n = 1655) and negative-for-alpha-thalassemia group (n = 9228). Erythrocyte parameters and hemoglobin analysis of the groups were analyzed. Moreover, we compared the four screening schemes (MCV/MCH, MCV/MCH/HbA2, MCV + MCH, MCV + MCH + HbA2) to find the best for α-thalassemia screening. The genotypes of --SEA/αα, and -α3.7/αα are the most prevalent with 54.9% and 27.6% in Fujian Province, China. There were significant differences in the distribution of MCV, MCH, and HbA2 in the two groups. Among the three, MCH exhibited the highest sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. Although the four screening schemes have their advantages, there are significant differences in their sensitivity and specificity. MCV + MCH had the best diagnostic performance (72.6% sensitivity, 89.0% specificity) as well as the highest Youden index (61.59%). Our results showed that MCH could be used to screen α-thalassemia instead of MCV and HbA2. However, it is recommended that MCV/MCH/HbA2 screening be used in areas with high α-thalassemia incidence to increased sensitivity.
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Lee SY, Chen CME, Lim EYP, Shen L, Sathe A, Singh A, Sauer J, Taghipour K, Yip CYC. Image Analysis Using Machine Learning for Automated Detection of Hemoglobin H Inclusions in Blood Smears - A Method for Morphologic Detection of Rare Cells. J Pathol Inform 2021; 12:18. [PMID: 34221634 PMCID: PMC8240546 DOI: 10.4103/jpi.jpi_110_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/06/2021] [Accepted: 02/04/2021] [Indexed: 12/17/2022] Open
Abstract
Background Morphologic rare cell detection is a laborious, operator-dependent process which has the potential to be improved by the use of image analysis using artificial intelligence. Detection of rare hemoglobin H (HbH) inclusions in red cells in the peripheral blood is a common screening method for alpha-thalassemia. This study aims to develop a convolutional neural network-based algorithm for the detection of HbH inclusions. Methods Digital images of HbH-positive and HbH-negative blood smears were used to train and test the software. The software performance was tested on images obtained at various magnifications and on different scanning platforms. Another model was developed for total red cell counting and was used to confirm HbH cell frequency in alpha-thalassemia trait. The threshold minimum red cells to image for analysis was determined by Poisson modeling and validated on image sets. Results The sensitivity and specificity of the software for HbH+ cells on images obtained at ×100, ×60, and ×40 objectives were close to 91% and 99%, respectively. When an AI-aided diagnostic model was tested on a pilot of 40 whole slide images (WSIs), good inter-rater reliability and high sensitivity and specificity of slide-level classification were obtained. Using the lowest frequency of HbH+ cells (1 in 100,000) observed in our study, we estimated that a minimum of 2.4 × 106 red cells would need to be analyzed to reduce misclassification at the slide level. The minimum required smear size was validated on 78 image sets which confirmed its validity. Conclusions WSI image analysis can be utilized effectively for morphologic rare cell detection. The software can be further developed on WISs and evaluated in future clinical validation studies comparing AI-aided diagnosis with the routine diagnostic method.
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Affiliation(s)
- Shir Ying Lee
- Department of Laboratory Medicine, Division of Haematology, National University Hospital, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Crystal M E Chen
- Department of Laboratory Medicine, Division of Haematology, National University Hospital, Singapore
| | - Elaine Y P Lim
- Department of Laboratory Medicine, Division of Haematology, National University Hospital, Singapore
| | - Liang Shen
- Unit of Biostatistics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | | | - Christina Y C Yip
- Department of Laboratory Medicine, Division of Haematology, National University Hospital, Singapore
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Oikonomidis IL, Tsouloufi TK, Mylonakis ME, Kritsepi-Konstantinou M. Capillary hemoglobin electrophoresis of healthy and anemic dogs: Quantification, validation, and reference intervals of hemoglobin fractions. PLoS One 2019; 14:e0217258. [PMID: 31483782 PMCID: PMC6726222 DOI: 10.1371/journal.pone.0217258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/17/2019] [Indexed: 11/19/2022] Open
Abstract
Despite the advances in canine medicine and the rapid gaining of attention of canine models in biomedical field and particularly in hemoglobin genes research, the studies on canine hemoglobin composition are sparse with ambiguous findings. Our aim was: i) to investigate the electrophoretic pattern of canine hemoglobin and the possible effects of age, sex, and anemia using a capillary electrophoresis assay, and ii) to validate this assay and calculate reference intervals (RIs) for canine hemoglobin fractions. Blood samples were collected from 53 healthy and 42 dogs with regenerative and non-regenerative anemias. The Sebia Capillarys 2 flex-piercing was used for hemoglobin analysis and it was validated using canine blood samples. R statistical language was employed for the statistical analyses. A major hemoglobin fraction (named HbA0) and a minor one (named HbA2) were identified in 100% and 47.4% of samples, respectively. The within-run and between-run CV was 0.1% for HbA0, and 9.1% and 11.2% for HbA2, respectively. The extremely narrow range of HbA0 and HbA2 values hampered a linearity study using canine blood samples. The RIs for HbA0 and HbA2 were 98.9-100% and 0-1.1%, respectively. HbA0 and HbA2 values were not significantly correlated with age (P = 0.866) or reticulocyte count (P = 0.731). No differences were observed in the median HbA0 and HbA2 between the two sexes (P = 0.887), and healthy and anemic dogs (P = 0.805). In conclusion, the capillary electrophoresis revealed a major hemoglobin fraction and an inconsistently present minor fraction. No effect of age, sex, anemia, or regenerative status of anemia was detected. The assay used was validated and RIs were generated, so as to be suitable for use in future investigations.
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Affiliation(s)
- Ioannis L. Oikonomidis
- Diagnostic Laboratory, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodora K. Tsouloufi
- Diagnostic Laboratory, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mathios E. Mylonakis
- Clinic of Companion Animal Medicine, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Kritsepi-Konstantinou
- Diagnostic Laboratory, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Lee SY, Yap ES, Lee EYP, Goh JH, Liu TC, Yip C. Evaluation of Thalassaemia Screening Tests in the Antenatal and Non-Antenatal Populations in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2019. [DOI: 10.47102/annals-acadmedsg.v48n1p5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Haemoglobinopathy testing is performed for carrier screening and evaluation of microcytic anaemia. We evaluated the effectiveness of thalassaemia screening tests at our institution and suggest ways of improving the testing algorithm. Materials and Methods: A total of 10,084 non-antenatal and 11,364 antenatal samples with alkaline gel electrophoresis (AGE), capillary electrophoresis (CE), haemoglobin H (HbH) inclusion test, mean corpuscular haemoglobin (MCH) and mean corpuscular volume (MCV) were retrospectively reviewed. A subgroup of 187 samples with genetic testing was correlated with HbH inclusions and MCH/MCV. The effect of iron deficiency on percentage haemoglobin A2 (HbA2) was studied. Results: HbH inclusion test showed low sensitivity of 21.43% for α-thalassaemia mutations but higher sensitivity of 78.95% for --SEA deletion. Byreceiver operating characteristic (ROC) analysis, MCH ≤28 pg or MCV ≤80 fl for non-antenatal samples and MCH ≤27 pg or MCV ≤81 fl for antenatal samples had >98% sensitivity for HbH inclusions. Above these thresholds, the probability that HbH inclusions would be absent was >99% (negative predictive value [NPV] >99%). MCH ≤28 pg had 100% sensitivity (95% CI 95.63%-100%) for α-thalassaemia mutations and 97.68% calculated NPV in the antenatal population. Detection of haemoglobin variants by CE correlated highly with AGE (99.89% sensitivity, 100% specificity). Severe iron deficiency reduced HbA2 in haemoglobin E (P <0.001) and α-thalassaemia (P = 0.0035), but not in β-thalassaemia. Conclusion: MCH/MCV thresholds have adequate sensitivity for α-thalassaemia in the antenatal population, and genotyping plays an important role as HbH inclusion test shows low sensitivity. CE without AGE, may be used as initial screening for haemoglobin variants. Our study provides contemporary data to guide thalassaemia screening algorithms in Singapore.
Key words: Haemoglobinopathy, Mean corpuscular haemoglobin, Mean corpuscular volume
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Viprakasit V, Ekwattanakit S. Clinical Classification, Screening and Diagnosis for Thalassemia. Hematol Oncol Clin North Am 2018; 32:193-211. [PMID: 29458726 DOI: 10.1016/j.hoc.2017.11.006] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
At present, thalassemia diseases are classified into transfusion-dependent thalassemia and non-transfusion-dependent thalassemia. This classification is based on the clinical severity of patients determining whether they do require regular blood transfusions to survive (transfusion-dependent thalassemia) or not (non-transfusion-dependent thalassemia). In addition to the previous terminology of "thalassemia major" or "thalassemia intermedia," this classification has embraced all other forms of thalassemia syndromes such as α-thalassemia, hemoglobin E/β-thalassemia and combined α- and β-thalassemias. Definitive diagnosis of thalassemia and hemoglobinopathies requires a comprehensive workup from complete blood count, hemoglobin analysis, and molecular studies to identify mutations of globin genes.
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Affiliation(s)
- Vip Viprakasit
- Siriraj Integrated Center of Excellence for Thalassemia (SiiCOE-T) and Division of Hematology/Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Siriraj, Bangkoknoi, Bangkok 10700, Thailand.
| | - Supachai Ekwattanakit
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Siriraj, Bangkoknoi, Bangkok 10700, Thailand
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Newborn Screening for Sickle Cell Disease and Other Hemoglobinopathies: A Short Review on Classical Laboratory Methods-Isoelectric Focusing, HPLC, and Capillary Electrophoresis. Int J Neonatal Screen 2018; 4:39. [PMID: 33072959 PMCID: PMC7548892 DOI: 10.3390/ijns4040039] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 11/01/2018] [Indexed: 12/04/2022] Open
Abstract
Sickle cell disease (SCD) and other hemoglobinopathies are a major health concern with a high burden of disease worldwide. Since the implementation of newborn screening (NBS) for SCD and other hemoglobinopathies in several regions of the world, technical progress of laboratory methods was achieved. This short review aims to summarize the current practice of classical laboratory methods for the detection of SCD and other hemoglobinopathies. This includes the newborn screening technologies of high-performance liquid chromatography (HPLC), capillary electrophoresis (CE), and isoelectric focusing (IEF).
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Vives Corrons JL, Mañú Pereira MDM, Trujillo JP, Surrallés J, Sevilla J. Anemias raras y fallos medulares hereditarios. ACTA ACUST UNITED AC 2018. [DOI: 10.3989/arbor.2018.789n3005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Las anemias raras y los fallos medulares hereditarios son enfermedades hematológicas caracterizadas, respectivamente, por una disminución de la concentración de hemoglobina o por diversos grados de defectos en la producción de células hematopoyéticas que conducen desde una citopenia de un solo linaje hasta una de múltiples linajes. Son enfermedades raras y difíciles de diagnosticar debido a la heterogeneidad clínica, citológica y genética. En este artículo abordaremos en primer lugar el diagnóstico de las anemias raras y sus causas principales: fallos medulares, defectos del hematíe y trastornos del metabolismo de los factores de maduración eritrocitario. Seguidamente introduciremos los fallos medulares hereditarios y su patología asociada, como son las malformaciones congénitas y la predisposición tumoral, haciendo especial hincapié en los más frecuentes: la anemia de Fanconi, la disqueratosis congénitca, la anemia de Diamond-Blackfan y el síndrome de Shwachman-Diamond.
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Segbena AY, Guindo A, Buono R, Kueviakoe I, Diallo DA, Guernec G, Yerima M, Guindo P, Lauressergues E, Mondeilh A, Picot V, Leroy V. Diagnostic accuracy in field conditions of the sickle SCAN® rapid test for sickle cell disease among children and adults in two West African settings: the DREPATEST study. BMC HEMATOLOGY 2018; 18:26. [PMID: 30237894 PMCID: PMC6142627 DOI: 10.1186/s12878-018-0120-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 08/31/2018] [Indexed: 01/22/2023]
Abstract
Background Sickle cell disease (SCD) accounts for 5% of mortality in African children aged < 5 years. Improving the care management and quality of life of patients with SCD requires a reliable diagnosis in resource-limited settings. We assessed the diagnostic accuracy of the rapid Sickle SCAN® point-of-care (POC) test for SCD used in field conditions in two West-African countries. Methods We conducted a case-control study in Bamako (Mali) and Lomé (Togo). Known cases of sickle cell disease (HbSS, HbSC), trait (HbAS), HbC heterozygotes (HbAC) and homozygous (HbCC), aged ≥6 months were compared to Controls (HbAA), recruited by convenience. All subjects received both an index rapid POC test and a gold standard (high-performance liquid chromatography in Bamako; capillary electrophoresis in Lomé). Personnel conducting tests were blinded from subjects' SCD status. Sensitivity and specificity were calculated for each phenotype. Practicality was assessed by local healthcare professionals familiar with national diagnostic methods and their associated constraints. Results In Togo, 209 Cases (45 HbAS, 39 HbAC, 41 HbSS, 44 HbSC and 40 HbCC phenotypes) were compared to 86 Controls (HbAA). 100% sensitivity and specificity were observed for AA Controls and HbCC cases. Estimated sensitivity was 97.7% [95% confidence interval: 88.0-99.9], 97.6% [87.1-99.9%], 95.6% [84.8-99.5%], and 94.9% [82.7-99.4], for HbSC, HbSS, HbAS, and HbAC, respectively. Specificity exceeded 99.2% for all phenotypes. Among 160 cases and 80 controls in Mali, rapid testing was 100% sensitive and specific. Rapid testing was well accepted by local healthcare professionals. Conclusion Rapid POC testing is 100% accurate for homozygote healthy people and excellent (Togo) or perfect (Mali) for sickle cell trait and disease patients. In addition to its comparable diagnostic performance, this test is cheaper, easier to implement, and logistically more convenient than the current standard diagnostic methods in use. Its predictive value indicators and diagnostic accuracy in newborns should be further evaluated prior to implementation in large-scale screening programs in resource-limited settings where SCD is prevalent.
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Affiliation(s)
| | - Aldiouma Guindo
- Centre de Recherche et Lutte contre la Drépanocytose, 03 BP: 186 BKO 03, Point G, Commune III, Bamako, Mali
| | - Romain Buono
- 3Inserm UMR 1027, Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps, Université Paul Sabatier Toulouse 3, Faculté de Médecine Purpan, 37 Allées Jules Guesde, 31073 Toulouse Cedex 7, France
| | | | - Dapa A Diallo
- Centre de Recherche et Lutte contre la Drépanocytose, 03 BP: 186 BKO 03, Point G, Commune III, Bamako, Mali
| | - Gregory Guernec
- 3Inserm UMR 1027, Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps, Université Paul Sabatier Toulouse 3, Faculté de Médecine Purpan, 37 Allées Jules Guesde, 31073 Toulouse Cedex 7, France
| | | | - Pierre Guindo
- Centre de Recherche et Lutte contre la Drépanocytose, 03 BP: 186 BKO 03, Point G, Commune III, Bamako, Mali
| | | | | | | | - Valériane Leroy
- 3Inserm UMR 1027, Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps, Université Paul Sabatier Toulouse 3, Faculté de Médecine Purpan, 37 Allées Jules Guesde, 31073 Toulouse Cedex 7, France
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Marull A, Ramirez JM, Bustins A, Morales-Indiano C, Tejerina P, Montesinos M, Serrando M. Epidemiological distribution of hemoglobinopathies in the area of Girona over 10 years. Int J Lab Hematol 2017; 39:e98-e101. [DOI: 10.1111/ijlh.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. Marull
- Laboratori Clínic; Haematology Department; Hospital Universitari Dr Josep Trueta; Girona Spain
| | - J. M. Ramirez
- Laboratori Clínic; Hospital Universitari Dr Josep Trueta; Girona Spain
| | - A. Bustins
- Institut Oncològic de Catalunya; Hospital Dr. Josep Trueta; Girona Spain
| | | | - P. Tejerina
- Laboratori Clínic; Haematology Department; Hospital Universitari Dr Josep Trueta; Girona Spain
| | - M. Montesinos
- Biochemistry Department; Hospital Universitari Dr Josep Trueta; Girona Spain
| | - M. Serrando
- Laboratori Clínic; Haematology Department; Hospital Universitari Dr Josep Trueta; Girona Spain
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Wajcman H, Azimi M, Cui J, Hoppe C, Flamini M, Ho C, Reddy S. Hemoglobinopathy testing: the significance of accuracy and pitfalls in HbA 2 determination. Int J Lab Hematol 2016; 39:e23-e27. [PMID: 27976500 DOI: 10.1111/ijlh.12584] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H Wajcman
- Inserm U955, Team 2, CHU Henri Mondor, Créteil, France
| | - M Azimi
- Children's Hospital & Research Center, Oakland, CA, USA
| | - J Cui
- Children's Hospital & Research Center, Oakland, CA, USA
| | - C Hoppe
- Children's Hospital & Research Center, Oakland, CA, USA
| | - M Flamini
- Bio-Rad Laboratories Inc., Clinical Systems Division, Hercules, CA, USA
| | - C Ho
- Division of Hematology, Lifelabs Medical Laboratory Services, Burnaby, BC, Canada
| | - S Reddy
- Division of Hematology, Lifelabs Medical Laboratory Services, Burnaby, BC, Canada
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Turner A, Sasse J, Varadi A. Rapid detection of pathological mutations and deletions of the haemoglobin beta gene (HBB) by High Resolution Melting (HRM) analysis and Gene Ratio Analysis Copy Enumeration PCR (GRACE-PCR). BMC MEDICAL GENETICS 2016; 17:75. [PMID: 27756326 PMCID: PMC5070150 DOI: 10.1186/s12881-016-0334-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 09/29/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Inherited disorders of haemoglobin are the world's most common genetic diseases, resulting in significant morbidity and mortality. The large number of mutations associated with the haemoglobin beta gene (HBB) makes gene scanning by High Resolution Melting (HRM) PCR an attractive diagnostic approach. However, existing HRM-PCR assays are not able to detect all common point mutations and have only a very limited ability to detect larger gene rearrangements. The aim of the current study was to develop a HBB assay, which can be used as a screening test in highly heterogeneous populations, for detection of both point mutations and larger gene rearrangements. METHODS The assay is based on a combination of conventional HRM-PCR and a novel Gene Ratio Analysis Copy Enumeration (GRACE) PCR method. HRM-PCR was extensively optimised, which included the use of an unlabelled probe and incorporation of universal bases into primers to prevent interference from common non-pathological polymorphisms. GRACE-PCR was employed to determine HBB gene copy numbers relative to a reference gene using melt curve analysis to detect rearrangements in the HBB gene. The performance of the assay was evaluated by analysing 410 samples. RESULTS A total of 44 distinct pathological genotypes were detected. In comparison with reference methods, the assay has a sensitivity of 100 % and a specificity of 98 %. CONCLUSION We have developed an assay that detects both point mutations and larger rearrangements of the HBB gene. This assay is quick, sensitive, specific and cost effective making it suitable as an initial screening test that can be used for highly heterogeneous cohorts.
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Affiliation(s)
- Andrew Turner
- Department of Pathology and Laboratory Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
| | - Jurgen Sasse
- Department of Pathology and Laboratory Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Aniko Varadi
- Department of Applied Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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Photoacoustic Flow Cytometry for Single Sickle Cell Detection In Vitro and In Vivo. Anal Cell Pathol (Amst) 2016; 2016:2642361. [PMID: 27699143 PMCID: PMC5028878 DOI: 10.1155/2016/2642361] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/03/2016] [Indexed: 01/18/2023] Open
Abstract
Control of sickle cell disease (SCD) stage and treatment efficiency are still time-consuming which makes well-timed prevention of SCD crisis difficult. We show here that in vivo photoacoustic (PA) flow cytometry (PAFC) has a potential for real-time monitoring of circulating sickled cells in mouse model. In vivo data were verified by in vitro PAFC and photothermal (PT) and PA spectral imaging of sickle red blood cells (sRBCs) expressing SCD-associated hemoglobin (HbS) compared to normal red blood cells (nRBCs). We discovered that PT and PA signal amplitudes from sRBCs in linear mode were 2–4-fold lower than those from nRBCs. PT and PA imaging revealed more profound spatial hemoglobin heterogeneity in sRBCs than in nRBCs, which can be associated with the presence of HbS clusters with high local absorption. This hypothesis was confirmed in nonlinear mode through nanobubble formation around overheated HbS clusters accompanied by spatially selective signal amplification. More profound differences in absorption of sRBCs than in nRBCs led to notable increase in PA signal fluctuation (fluctuation PAFC mode) as an indicator of SCD. The obtained data suggest that noninvasive label-free fluctuation PAFC has a potential for real-time enumeration of sRBCs both in vitro and in vivo.
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Schiemsky T, Brusselmans C, Nackers E, Vermeersch P, Poesen K, Desmet KJO, Boeckx N, Kieffer DMJ. Evaluation of the V8 E-Class, a Novel Automated Capillary Isoelectric Focusing Instrument for Hemoglobinopathy Screening. Am J Clin Pathol 2016; 146:361-8. [PMID: 27543981 DOI: 10.1093/ajcp/aqw124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We evaluated the performance of a novel capillary isoelectric focusing (CIEF) application for hemoglobinopathy screening on the recently introduced V8 E-Class platform. METHODS Analytical performance of the V8 E-Class was evaluated and included assessment of hemoglobin A2 (HbA2) imprecision; linearity for HbA2, fetal hemoglobin (HbF), and sickle hemoglobin (HbS); and carryover for HbS. Furthermore, a method comparison with the Minicap Flex Piercing (Sebia, Lisses, France), the Variant Classic (Bio-Rad Laboratories, Hercules, CA), and the G8 (Tosoh Europe, Amsterdam, the Netherlands) was done to assess analytical and clinical concordance. RESULTS Total HbA2 imprecision was 3.26% and 3.14% for normal and elevated HbA2 controls and 5.16% and 3.58% for a normal and a heterozygous HbS patient sample, respectively. HbA2, HbF, and HbS showed acceptable linearity, and no carryover was observed. The method comparison showed good analytical concordance (r > 0.95) except for a homozygous HbS subset (r = 0.532-0.704). A comparable phenomenon was seen for the clinical concordance with good agreement in samples without variants (weighted κ > 0.80) but poorer agreement in HbS samples (κ < 0.30). CONCLUSIONS Good analytical performance was demonstrated for this novel CIEF application for hemoglobinopathy screening. Method comparison showed generally good correlation but highlights the need for standardization. Finally, software optimization could further add to its use for routine hemoglobinopathy screening.
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Affiliation(s)
- Toon Schiemsky
- From the Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Elke Nackers
- From the Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Pieter Vermeersch
- From the Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium Department of Cardiovascular Medicine
| | - Koen Poesen
- From the Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium Department of Neurosciences, Laboratory for Molecular Neurobiomarker Research
| | - Koen J O Desmet
- From the Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Nancy Boeckx
- From the Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium Department of Oncology
| | - Davy M J Kieffer
- From the Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium Department of Microbiology and Immunology, KU Leuven-University of Leuven, Leuven, Belgium
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Wadowski B, Chang D, Khan SQ, Chadha T. Sometimes, It's Just Black and White: Dark Urine and Pallor in a 2-Year-Old Boy. Hosp Pediatr 2016; 6:560-5. [PMID: 27554269 DOI: 10.1542/hpeds.2015-0252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Denis Chang
- New York University Langone Medical Center, New York, New York
| | - Sabina Q Khan
- New York University Langone Medical Center, New York, New York
| | - Tanya Chadha
- New York University School of Medicine, New York, New York; and Division of Pediatric Critical Care,
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20
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Tan YL, Kidson‐Gerber G. Antenatal haemoglobinopathy screening in Australia. Med J Aust 2016; 204:226-30. [DOI: 10.5694/mja15.01115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/22/2016] [Indexed: 11/17/2022]
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21
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Braga JAP, Veríssimo MPDA, Saad STO, Cançado RD, Loggetto SR. Guidelines on neonatal screening and painful vaso-occlusive crisis in sickle cell disease: Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular: Project guidelines: Associação Médica Brasileira - 2016. Rev Bras Hematol Hemoter 2016; 38:147-57. [PMID: 27208574 PMCID: PMC4877615 DOI: 10.1016/j.bjhh.2016.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/04/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
| | | | | | - Rodolfo Delfini Cançado
- Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil; Hospital Samaritano, São Paulo, SP, Brazil
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Aprile A, Passerini G, Cappellini MD, Marktel S, Ciceri F, Ferrari G, Ceriotti F. When diagnostics meets translational research: detection of hemoglobin fractions in cellular lysates from in vitro erythroid cultures by Capillarys 2 Flex Piercing analyzer (Sebia). Transl Res 2016; 169:31-9.e1-4. [PMID: 26581433 DOI: 10.1016/j.trsl.2015.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/12/2015] [Accepted: 10/23/2015] [Indexed: 02/04/2023]
Abstract
Detection of hemoglobin (Hb) variants represents an important issue for diagnosis and adequate treatment of hemoglobinopathies. The Capillarys 2 Flex Piercing analyzer (Capillarys) by Sebia is routinely used in our clinical laboratories to detect Hb variants in peripheral blood (PB). This automated method separates Hb fractions by capillary electrophoresis, giving a spectrophotometric measure of their relative proportion. The scientific research in the field of hemoglobinopathies needs robust procedures to evaluate the efficacy of experimental therapies, as gene therapy. We investigated for the first time the feasibility to use Capillarys on cellular lysates from in vitro erythroid cultures. Because total Hb concentration in erythroid lysates is up to 20-fold lower than in hemolysates from PB, we analyzed diluted blood samples, thanks to the manual mode included in the Capillarys setting. We compared analytical precision, accuracy, sensitivity, and specificity of this procedure to the automatic method, routinely used in diagnostics. For instance, adult Hb intra- and interassay precision were estimated as coefficient of variation 0.2% and 0.3%, respectively. The manual mode is less robust for detection of fractions <3% and the lower level of sensitivity is 2 g/L of total Hb. Specificity of manual and automatic settings was equivalent. We confirmed the performance of the method by analyzing erythroid lysates from thalassemic patients' cultures. Our study demonstrated that the Capillarys 2 Flex Piercing manual method is comparable to the automatic one. The analysis is very robust at low Hb concentrations, as in erythroid cultures from patients affected by hemoglobinopathies, representing a useful tool also in translational research.
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Affiliation(s)
- Annamaria Aprile
- San Raffaele-Telethon Institute for Gene Therapy (TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; University of Rome "Tor Vergata", Rome, Italy
| | | | | | - Sarah Marktel
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Immunohematology and Transfusion Medicine Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuliana Ferrari
- San Raffaele-Telethon Institute for Gene Therapy (TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Mahmoud HM, Shoeib AASH, Abd El Ghany SM, Reda MM, Ragab IA. Study of alpha hemoglobin stabilizing protein expression in patients with β thalassemia and sickle cell anemia and its impact on clinical severity. Blood Cells Mol Dis 2015; 55:358-62. [DOI: 10.1016/j.bcmd.2015.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 11/29/2022]
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Lavee O, Kidson-Gerber G. Antenatal haemoglobinopathy screening: Patterns within a large obstetric service. Working towards a standard of care. Obstet Med 2015; 8:184-9. [PMID: 27512478 DOI: 10.1177/1753495x15598698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Antenatal screening can predict clinically significant haemoglobinopathies, however in Australia, practices are not standardised and are evolving as the population becomes more ethnically diverse. This study describes antenatal screening practices in a large Australian laboratory/antenatal service. METHODS Data were collected retrospectively on consecutive antenatal haemoglobin electrophoresis over 16 months and correlated with obstetric data, obtained from the local obstetric database. RESULTS 462 patients were included, with an average gestation of 25.8 weeks. 'Pregnancy' was the most common stated indication, with absent indication/clinical information in 8%. Gestational age was documented in 54%. In 15%, no contact details of the referrer were documented and partner screening was traceable in only 25 cases (5.4%). In 82% of cases, no abnormalities were detected. Beta thalassemia trait was the most common positive result. Only 52% of patients had recent iron studies. The mean haemoglobin was 111.6 g/L and mean cell volume was 80.5 fl at the time of testing. Ethnicity was documented on the request form in 3%. After Australasia, the most common ethnicity of patients was South East Asia and the Middle East. CONCLUSION Referral patterns in our health service are diverse and reflect our changing population and care practices. Detailed guidelines are required and we propose a comprehensive algorithm for general use where selective screening is practiced within an Australasian population or one with similar demographics.
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Affiliation(s)
- Orly Lavee
- South Eastern Area Laboratory Services, Department of Haematology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Giselle Kidson-Gerber
- South Eastern Area Laboratory Services, Department of Haematology, Prince of Wales Hospital, Randwick, New South Wales, Australia; Royal Hospital for Women, Randwick, New South Wales, Australia
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A novel double heterozygous Hb Fontainebleau/HbD Punjab hemoglobinopathy. Clin Biochem 2015; 48:904-7. [PMID: 26036869 DOI: 10.1016/j.clinbiochem.2015.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/24/2015] [Accepted: 05/26/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To report the finding of a novel double heterozygous hemoglobinopathy, the coinheritance of Hb Fontainebleau (α-chain variant) with HbD-Punjab (β-chain variant) discovered upon investigation of unexplained microcytosis in an infant. DESIGN AND METHODS Hemoglobinopathy investigation was performed by high performance liquid chromatography (HPLC) using the β-thalassemia Short Program on the Bio-Rad Variant II(TM) followed by gel electrophoresis at alkaline and acid pH (Sebia Hydrasys 2 Electrophoresis System) and molecular diagnostic testing. This study complied with our institutional board ethics requirements. RESULTS HPLC and electrophoresis suggested a complex α- and β-chain hemoglobinopathy with presumptive identification of the beta Hb variant as Hb D-Punjab. DNA sequencing analysis revealed the presence of a double heterozygous status for Hb Fontainebleau/Hb D-Punjab. CONCLUSIONS In this paper we report the coinheritance of Hb Fontainebleau with Hb D-Punjab.
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Adewoyin AS. Management of sickle cell disease: a review for physician education in Nigeria (sub-saharan Africa). Anemia 2015; 2015:791498. [PMID: 25667774 PMCID: PMC4312619 DOI: 10.1155/2015/791498] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/18/2014] [Accepted: 12/17/2014] [Indexed: 11/27/2022] Open
Abstract
Sickle cell disease (SCD) predominates in sub-Saharan Africa, East Mediterranean areas, Middle East, and India. Nigeria, being the most populous black nation in the world, bears its greatest burden in sub-Saharan Africa. The last few decades have witnessed remarkable scientific progress in the understanding of the complex pathophysiology of the disease. Improved clinical insights have heralded development and establishment of disease modifying interventions such as chronic blood transfusions, hydroxyurea therapy, and haemopoietic stem cell transplantation. Coupled with parallel improvements in general supportive, symptomatic, and preventive measures, current evidence reveals remarkable appreciation in quality of life among affected individuals in developed nations. Currently, in Nigeria and other West African states, treatment and control of SCD are largely suboptimal. Improved knowledge regarding SCD phenotypes and its comprehensive care among Nigerian physicians will enhance quality of care for affected persons. This paper therefore provides a review on the aetiopathogenesis, clinical manifestations, and management of SCD in Nigeria, with a focus on its local patterns and peculiarities. Established treatment guidelines as appropriate in the Nigerian setting are proffered, as well as recommendations for improving care of affected persons.
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Affiliation(s)
- Ademola Samson Adewoyin
- Department of Haematology and Blood Transfusion, University of Benin Teaching Hospital, PMB 1111, Benin City, Edo State, Nigeria
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27
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Ang SH, Thevarajah M, Alias Y, Khor SM. Current aspects in hemoglobin A1c detection: A review. Clin Chim Acta 2015; 439:202-11. [DOI: 10.1016/j.cca.2014.10.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/09/2014] [Accepted: 10/11/2014] [Indexed: 11/29/2022]
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Oyaert M, Van Laer C, Claerhout H, Vermeersch P, Desmet K, Pauwels S, Kieffer D. Evaluation of the Sebia Minicap Flex Piercing capillary electrophoresis for hemoglobinopathy testing. Int J Lab Hematol 2014; 37:420-5. [PMID: 25324031 DOI: 10.1111/ijlh.12305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 09/17/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Capillary zone electrophoresis (CZE) at alkaline pH is one of the techniques used for hemoglobinopathy screening. In this study, an evaluation of the performance of a lower throughput CZE instrument, the Sebia Minicap Flex Piercing system, for this purpose is reported for the first time. METHODS The analytical performance of the Sebia Minicap Flex Piercing system was evaluated. Furthermore, a method comparison between the Sebia Minicap Flex Piercing and two HPLC methods, that is, the Bio-Rad Variant Classic(™) and the Bio-Rad D-10(™) systems was performed by measuring samples with and without clinically relevant hemoglobin disorders. RESULTS The analytical performance was acceptable for the determination of HbA, HbA2, HbS, and HbF, with an imprecision ≤2.0%. Method comparison showed a linear correlation for HbA2, HbF, and HbS measurements. Clinical concordance was acceptable when comparing CZE and HPLC. CONCLUSIONS Lower throughput CZE using the Sebia Minicap Flex Piercing can be used for precise and accurate first line screening and follow-up of hemoglobinopathies.
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Affiliation(s)
- M Oyaert
- Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
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Frömmel C, Brose A, Klein J, Blankenstein O, Lobitz S. Newborn screening for sickle cell disease: technical and legal aspects of a German pilot study with 38,220 participants. BIOMED RESEARCH INTERNATIONAL 2014; 2014:695828. [PMID: 25147811 PMCID: PMC4132432 DOI: 10.1155/2014/695828] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 04/15/2014] [Accepted: 07/01/2014] [Indexed: 01/29/2023]
Abstract
Sickle cell disease (SCD) does not occur in the indigenous German population, but with the increasing number of immigrants from countries at high risk for hemoglobinopathies, the question emerges whether or not a newborn screening program (NBS) for SCD disease should be initiated in Germany anyhow. We have recently shown that in Berlin, a city with a very large immigrant population, the incidence of SCD is considerable, but our findings are insufficient to make a decision for the country as a whole. In this paper we will show that a large body of epidemiological data can be generated in a relatively short period of time, with a very high degree of precision and at relatively little expense--a result that might motivate other working groups to start such a pilot project locally. We examined previously collected dried blood cards that were up to six months old, using high performance liquid chromatography (HPLC) as first method and capillary electrophoresis (CE) as second method. A single, part-time laboratory technician processed 38,220 samples in a period of 162 working days. The total costs per sample including all incidentals (as well as labor costs) were EUR 1.44.
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Affiliation(s)
- Claudia Frömmel
- Labor Berlin-Charité Vivantes GmbH, Sylter Straße 2, 13353 Berlin, Germany
- INSTAND e.V., Gesellschaft zur Förderung der Qualitätssicherung in Medizinischen Laboratorien e.V., Ubierstraße 20, 40223 Düsseldorf, Germany
| | - Annemarie Brose
- Labor Berlin-Charité Vivantes GmbH, Sylter Straße 2, 13353 Berlin, Germany
| | - Jeannette Klein
- Newborn Screening Laboratory, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Oliver Blankenstein
- Newborn Screening Laboratory, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Stephan Lobitz
- Department of Pediatric Oncology/Hematology/BMT, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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Adeyemo T, Ojewunmi O, Oyetunji A. Evaluation of high performance liquid chromatography (HPLC) pattern and prevalence of beta-thalassaemia trait among sickle cell disease patients in Lagos, Nigeria. Pan Afr Med J 2014; 18:71. [PMID: 25400838 PMCID: PMC4230225 DOI: 10.11604/pamj.2014.18.71.4239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 05/14/2014] [Indexed: 12/13/2022] Open
Abstract
Introduction Sickle cell disease (SCD) is the most common inherited disorder of haemoglobin worldwide. This study evaluated the chromatographic patterns and red blood cell indices of sickle cell patients to determine the co-inheritance of other haemoglobin(Hb) variants and β-thalassaemia trait. Methods Red cell indices, blood film, sickle solubility test, Hb electrophoresis using alkaline cellulose acetate membrane, and chromatographic patterns using Bio Rad HPLC Variant II were evaluated for 180 subjects. Results Based on low MCV <76fL and MCH<25 pg, in the presence of elevated A2 >4.0% on HPLC and Hb variants eluting outside the S and C windows, at least four haemoglobin phenotypes (SS: 87.7%; SC: 1.1%; SD Punjab: 0.6%; Sβ-thalassemia: 10.6%) were identified. Mean Hb F% was 8.1±5.1 (median 7.65) for Hb SS and 6.03±5.2 (median 3.9) for Hb Sβ-thalassemia trait. Majority of Hb SS (69.1%) had Hb F% less than 10 while 27.6% had 10-19.9 and 3.2% had ≥ 20. Mean Hb F% was higher in female Hb SS (9.55±5.09; mean age 7.4±3.8 years) than the males (7.63±4.80; mean age 6.9±3.8 years) (P=0.02). A borderline significant negative correlation between age and Hb F levels among Hb SS subjects (r= -0.169 P=0.038) was also observed. Conclusion Our data suggests that α and β- thalassaemia traits, and other haemoglobin variants co-exist frequently with SCD in our population
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Affiliation(s)
- Titilope Adeyemo
- Department of Haematology and Blood transfusion, College of Medicine, University of Lagos, P.M.B 12003, Surulere, Lagos, Nigeria
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Agarwal AM, Nussenzveig RH, Hoke C, Lorey TS, Greene DN. Identification of one or two α-globin gene deletions by isoelectric focusing electrophoresis. Am J Clin Pathol 2013; 140:301-5. [PMID: 23955447 DOI: 10.1309/ajcpf4uijkh3eoby] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To investigate the utility of isoelectric focusing electrophoresis (IEF) for identifying patients with α-thalassemia, which results from the deletion of 1 or more of the α-globin genes. METHODS Samples were selected based on their hemoglobin H (HbH) concentration observed using IEF. The samples were analyzed for the most common α-globin gene deletions using molecular analysis. RESULTS α-Globin gene deletions corresponding to α-thalassemia trait or silent carrier were observed in all samples with the HbH less than 2% phenotype. The genotypes of the specimens with HbH greater than 5% were consistent with HbH disease, while the wild-type phenotype control samples showed a wild-type genotype. CONCLUSIONS Low concentrations of HbH can be detected in a patient with 1 or 2 α-gene deletions using IEF.
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Affiliation(s)
- Archana M. Agarwal
- Department of Pathology, University of Utah Health Sciences, Salt Lake City
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City
| | | | - Carolyn Hoke
- TPMG, Northern California Kaiser Permanente Regional Laboratories, Berkeley
| | - Thomas S. Lorey
- TPMG, Northern California Kaiser Permanente Regional Laboratories, Berkeley
| | - Dina N. Greene
- TPMG, Northern California Kaiser Permanente Regional Laboratories, Berkeley
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Das R, Mitra G, Mathew B, Ross C, Bhat V, Mandal AK. Automated Analysis of Hemoglobin Variants Using NanoLC–MS and Customized Databases. J Proteome Res 2013; 12:3215-22. [DOI: 10.1021/pr4000625] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rajdeep Das
- Division of Molecular Medicine,
Clinical Proteomics Unit, St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bangalore 560034, India
| | - Gopa Mitra
- Division of Molecular Medicine,
Clinical Proteomics Unit, St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bangalore 560034, India
| | - Boby Mathew
- Division of Molecular Medicine,
Clinical Proteomics Unit, St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bangalore 560034, India
| | - Cecil Ross
- Department of Medicine, St.
John’s Medical College and Hospital, St. John’s National Academy of Health Sciences, Bangalore 560034,
India
| | - Vijay Bhat
- Manipal Hospital, Old Airport Road, Bangalore, India
| | - Amit Kumar Mandal
- Division of Molecular Medicine,
Clinical Proteomics Unit, St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bangalore 560034, India
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Forces driving change in medical diagnostics. Clin Chim Acta 2013; 415:31-4. [PMID: 22982817 DOI: 10.1016/j.cca.2012.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 08/20/2012] [Accepted: 09/06/2012] [Indexed: 11/23/2022]
Abstract
This article reviews the external forces that affect and shape the future of medical diagnostics. A PESTELI model is retrospectively used to highlight the factors that drive change at an operational and management level. The author describes the future picture of clinical laboratory diagnostics and proposes ways to overcome current and pending challenges on clinical laboratories and university curriculum. An international committee with broad expertise in clinical laboratory diagnostics is proposed to examine these changes and provide guidance.
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Cotton F, Wolff F, Gulbis B. Automated capillary electrophoresis in the screening for hemoglobinopathies. Methods Mol Biol 2013; 984:227-35. [PMID: 23386347 DOI: 10.1007/978-1-62703-296-4_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Hemoglobinopathies are genetic disorders of globin chains characterized by the decreased expression of α- or β-globin chains (thalassemias) or by the synthesis of an abnormal protein (hemoglobin variants in, e.g., sickle cell disease). The screening of most hemoglobinopathies relies, together with hematological results and clinical elements, on the separation and quantification of normal and abnormal hemoglobin fractions. Gel electrophoresis, isoelectric focusing, and HPLC have been the methods of choice for many years. For about 20 years, capillary electrophoresis has appeared as a strong alternative method. Since the early 2000s, automated instruments are commercially available for the analysis of Hb fractions in adult patients but also for neonatal screening.
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Affiliation(s)
- Frédéric Cotton
- Department of Clinical Chemistry, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
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Agouti I, Merono F, Bonello-Palot N, Badens C. Analytical evaluation of the Capillarys 2 Flex piercing for routine haemoglobinopathies diagnosis. Int J Lab Hematol 2012; 35:217-21. [DOI: 10.1111/ijlh.12000] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 07/25/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | - F. Merono
- UMR_S 910; Faculté de Médecine; Aix-Marseille Université; Marseille; France
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Greene DN, Pyle AL, Chang JS, Hoke C, Lorey T. Comparison of Sebia Capillarys Flex capillary electrophoresis with the BioRad Variant II high pressure liquid chromatography in the evaluation of hemoglobinopathies. Clin Chim Acta 2012; 413:1232-8. [DOI: 10.1016/j.cca.2012.03.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 03/28/2012] [Accepted: 03/31/2012] [Indexed: 11/25/2022]
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