Refolding defects in hemoglobin Rothschild

Hemoglobin Rothschild – Unimpaired physical performance and oxygen uptake – A case report with literature review

Asymptomatic patients with hemoglobin (Hb) variants can be detected by low oxygen levels in pulse oximetry (SpO₂).

Depending on the type of Hb variant, low SpO₂ values are either falsely low, with corresponding normal arterial oxygen saturation (SaO₂), or truly low, with low SaO₂ values, as observed in Hb variants with low oxygen binding affinity. In this context, attention must be paid to the method of determining SaO₂.

Low oxygen affinity Hb variants such as Hb Rothschild (HbR) might compensate for low oxygen loading in the lung through unloading more oxygen in peripheral tissues. This is the first case report to illustrate that maximal oxygen uptake and the workload are unimpaired in HbR variant patients.

Detection of Hb Rothschild HBB: c.[112T>A or 112T>C], Through High Index of Suspicion on Abnormal Pulse Oximetry

We describe a case with a low oxygen affinity hemoglobin (Hb) variant who presented with cyanosis in the absence of cardiopulmonary disease. The patient, a 27-year-old pregnant female (P1G2), complained of a productive cough and bluish discoloration of the lips that started 3 days prior to seeking attention. She had no previous episodes and has generally been in good health. A positive family history of cyanosis was obtained in one sibling. Systematic examination, notably the cardiorespiratory system, revealed no abnormalities. The arterial Hb oxygen saturation (SpO₂) on pulse oximetry was 81.0% and Hb separation studies revealed an Hb variant identified as Hb Rothschild [β37(C3)Trp→Arg] (HBB: c.[112 T>A or 112 T>C]) by gene sequencing. The amino acid substitution (Trp→Arg) is an important contact point at the α1β2 interface and favors a T-quaternary state of the Hb tetramer. This leads to a low oxygen affinity state, which results in premature release of oxygen and drop in oxygen saturation. In the absence of cardiopulmonary disease, a decreased oxygen saturation reading, with or without cyanosis, should arouse suspicion for a possible dysHb.

Dyshemoglobinemias and pulse oximetry: a therapeutic challenge

Pulse oximetry normally provides a reliable indicator of arterial blood oxygen saturation. Individuals with a variant hemoglobin with low oxygen affinity would exhibit pulse oximetry values consistent with hypoxemia despite maintaining adequate oxygen delivery to tissues. We describe a patient we diagnosed with hemoglobin Rothschild and his mother. He presented with SpO2 81% on pulse oximetry and PaO2 on arterial blood gas of 47 mm Hg, while his mother had SpO2 87%. These values were significantly lower than physical examination suggested. A possible dyshemoglobinemia should be suspected when discordance exists between pulse oximetry readings and physical examination findings.

Five variants of the beta-globin gene without clinical or hematological effects: Hb Maryland [beta 47(CD6)Asp-->His], Hb Kent [beta 37(C3)Trp-->Cys], Hb Visayan [beta 136(H14)Gly-->Cys], Hb Cutlerville [beta 138(H16)Ala-->Val] and Hb Hornchurch [beta 43(CD2)Glu-->Lys]

We report on five hemoglobin (Hb) beta chain variants that were initially identified either by electrophoretic, chromatographic or isoelectric focusing (IEF) methods. These variants do not appear to be associated with clinical or hematological abnormalities. All variants were confirmed by DNA sequence analysis.

The detection of hemoglobin dimers by intrinsic fluorescence

We have found that the intrinsic fluorescence emission maxima of oxy, met, and cyanmet hemoglobins have a concentration dependent shift to longer wavelengths. For oxy-hemoglobin, this effect is increased in the presence of 3M NaCl. At the protein concentrations studied, these liganded hemoglobins undergo dimerization. In contrast, horse-heart met myoglobin (which is a monomer), and deoxy Hb A and Hb Beth Israel (that have greatly decreased dissociation constants), exhibited a significantly smaller shift in fluorescence maxima. We conclude that hemoglobin dimers exhibit a bathochromic shift with respect to the tetramer. This shift is probably due to the increase in surface exposure of beta 37 Trp that occurs during hemoglobin dimerization.