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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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Pei LX, Leepile TT, Cochrane KM, Samson KLI, Fischer JAJ, Williams BA, Kroeun H, Bonifacio L, Karakochuk CD. Can Automated Hematology Analyzers Predict the Presence of a Genetic Hemoglobinopathy? An Analysis of Hematological Biomarkers in Cambodian Women. Diagnostics (Basel) 2021; 11:diagnostics11020228. [PMID: 33546311 PMCID: PMC7913495 DOI: 10.3390/diagnostics11020228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/03/2022] Open
Abstract
Genetic hemoglobinopathies are the most common single-gene disorder worldwide. Some automated hematology analyzers have the capability of flagging individuals who may have hematological disorders based on complete blood count (CBC) biomarkers. We aimed to evaluate the accuracy of a hematology analyzer in identifying genetic hemoglobinopathies in Cambodian women and to determine which hematological biomarkers are the best predictors. A CBC was completed using a Sysmex XN-1000 analyzer and hemoglobinopathies were determined with capillary hemoglobin electrophoresis for 808 nonpregnant Cambodian women. Sysmex XN-1000 Interpretive Program (IP) messages, which flag potential hematological disorders, were produced from CBC results. Then, 2 × 2 tables were used to determine sensitivity and specificity of the IP message “Hemoglobin defect” to detect a genetic hemoglobinopathy. Receiver operating characteristic (ROC) analyses assessed the diagnostic ability of six CBC biomarkers to predict a genetic hemoglobinopathy. In total, 74% of women had a hemoglobinopathy (predominantly Hb E and α-thalassemia). “Hb defect” IP message sensitivity and specificity for genetic hemoglobinopathy detection were 10.4% and 98.6%, respectively. Variable selection strategies yielded a two-variable model including mean corpuscular volume (MCV) and red blood cell (RBC) count (AIC = 99.83, AUCROC = 0.98 (95% CI: 0.97, 0.99)) for the prediction of a homozygous EE disorder. Sensitivity and specificity values do not justify the use of Sysmex XN-1000 IP flag messages for identification of genetic hemoglobinopathies in Cambodian women. Development of an algorithm based on MCV and RBC biomarkers may optimize the screening ability of automated hematology analyzers.
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Affiliation(s)
- Lulu X. Pei
- Food, Nutrition and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (L.X.P.); (K.M.C.); (K.L.I.S.); (J.A.J.F.); (B.A.W.); (L.B.)
- Department of Statistics, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Tebogo T. Leepile
- Integrated Studies in Land and Food Systems, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Kelsey M. Cochrane
- Food, Nutrition and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (L.X.P.); (K.M.C.); (K.L.I.S.); (J.A.J.F.); (B.A.W.); (L.B.)
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Kaitlyn L. I. Samson
- Food, Nutrition and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (L.X.P.); (K.M.C.); (K.L.I.S.); (J.A.J.F.); (B.A.W.); (L.B.)
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Jordie A. J. Fischer
- Food, Nutrition and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (L.X.P.); (K.M.C.); (K.L.I.S.); (J.A.J.F.); (B.A.W.); (L.B.)
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Brock A. Williams
- Food, Nutrition and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (L.X.P.); (K.M.C.); (K.L.I.S.); (J.A.J.F.); (B.A.W.); (L.B.)
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Hou Kroeun
- Helen Keller International, Phnom Penh, Cambodia;
| | - Lizl Bonifacio
- Food, Nutrition and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (L.X.P.); (K.M.C.); (K.L.I.S.); (J.A.J.F.); (B.A.W.); (L.B.)
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Crystal D. Karakochuk
- Food, Nutrition and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (L.X.P.); (K.M.C.); (K.L.I.S.); (J.A.J.F.); (B.A.W.); (L.B.)
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
- Correspondence:
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Singha K, Taweenan W, Fucharoen G, Fucharoen S. Erythrocyte indices in a large cohort of β‐thalassemia carrier: Implication for population screening in an area with high prevalence and heterogeneity of thalassemia. Int J Lab Hematol 2019; 41:513-518. [DOI: 10.1111/ijlh.13035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/24/2019] [Accepted: 04/04/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Kritsada Singha
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences Khon Kaen University Khon Kaen Thailand
| | - Wachiraporn Taweenan
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences Khon Kaen University Khon Kaen Thailand
| | - Goonnapa Fucharoen
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences Khon Kaen University Khon Kaen Thailand
| | - Supan Fucharoen
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences Khon Kaen University Khon Kaen Thailand
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Karnpean R, Fucharoen G, Fucharoen S, Ratanasiri T. Fetal Red Blood Cell Parameters in Thalassemia and Hemoglobinopathies. Fetal Diagn Ther 2013; 34:166-71. [DOI: 10.1159/000354343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/10/2013] [Indexed: 11/19/2022]
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