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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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Kalle Kwaifa I, Lai MI, Md Noor S. Non-deletional alpha thalassaemia: a review. Orphanet J Rare Dis 2020; 15:166. [PMID: 32600445 PMCID: PMC7322920 DOI: 10.1186/s13023-020-01429-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/28/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Defective synthesis of the α-globin chain due to mutations in the alpha-globin genes and/or its regulatory elements leads to alpha thalassaemia syndrome. Complete deletion of the 4 alpha-globin genes results in the most severe phenotype known as haemoglobin Bart's, which leads to intrauterine death. The presence of one functional alpha gene is associated with haemoglobin H disease, characterised by non-transfusion-dependent thalassaemia phenotype, while silent and carrier traits are mostly asymptomatic. MAIN BODY Clinical manifestations of non-deletional in alpha thalassaemia are varied and have more severe phenotype compared to deletional forms of alpha thalassaemia. Literature for the molecular mechanisms of common non-deletional alpha thalassaemia including therapeutic measures that are necessarily needed for the understanding of these disorders is still in demand. This manuscript would contribute to the better knowledge of how defective production of the α-globin chains due to mutations on the alpha-globin genes and/or the regulatory elements leads to alpha thalassaemia syndrome. CONCLUSION Since many molecular markers are associated with the globin gene expression and switching over during the developmental stages, there is a need for increased awareness, new-born and prenatal screening program, especially for countries with high migration impact, and for improving the monitoring of patients with α-thalassaemia.
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Affiliation(s)
- Ibrahim Kalle Kwaifa
- Haematology Unit, Department of Pathology, Faculty of Medicine and Health Sciences, University Putra Malaysia (UPM), Serdang, Selangor, Malaysia
- Department of Haematology, School of Medical Laboratory Sciences, College of Health Sciences, Usmanu Danfodiyo University (UDU), Sokoto, North-Western, Nigeria
| | - Mei I Lai
- Haematology Unit, Department of Pathology, Faculty of Medicine and Health Sciences, University Putra Malaysia (UPM), Serdang, Selangor, Malaysia
- Genetics and Regenerative Medicine Research Centre, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia(UPM), Serdang, Selangor, Malaysia
| | - Sabariah Md Noor
- Haematology Unit, Department of Pathology, Faculty of Medicine and Health Sciences, University Putra Malaysia (UPM), Serdang, Selangor, Malaysia.
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Tampaki A, Theodoridou S, Apostolou C, Delaki EE, Vlachaki E. Α case of late diagnosis of compound heterozygosity for Hb Adana (HBA2:c.179G>A) in trans to an α+- thalassemia deletion: guilty or innocent. Hippokratia 2020; 24:43-45. [PMID: 33364739 PMCID: PMC7733358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Hemoglobin Adana is a non-deletional alpha chain mutation, particularly rare, and to date, it is mostly described in coinheritance to other a-thalassemia mutations. Such interactions result in various phenotypes depending on the underlying genotype. Since routine hematological tests do not detect the aforementioned unstable variant, it is quite likely a diagnosis to be missed or delayed, with any complications this may have for a patient. Description of the case: A case report of late mutation identification in a 64-year-old woman of Greek origin is described. The importance of conducting not only molecular studies to confirm common mutations, such as the -a3.7 kb deletion, but also DNA studies in patients whose phenotype and results of standard tests are not consistent or who present with severe, late complications is highlighted. CONCLUSION The awareness of the necessity for accurate diagnosis is raised, especially in populations that thalassemia prevails and is attributed to numerous mutations. HIPPOKRATIA 2020, 24(1): 38-42.
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Affiliation(s)
- A Tampaki
- Adults Thalassemia Unit, Second Department of Internal Medicine, Hippokration Hospital of Thessaloniki, Greece
| | - S Theodoridou
- Haemoglobinopathy Prevention Unit, Hippokration Hospital of Thessaloniki, Greece
| | - Ch Apostolou
- Adults Thalassemia Unit, Second Department of Internal Medicine, Hippokration Hospital of Thessaloniki, Greece
| | - E E Delaki
- National Centre for Thalassemia and Hemoglobinopathies of Greece, Laiko, General Hospital of Athens, Athens, Greece
| | - E Vlachaki
- Adults Thalassemia Unit, Second Department of Internal Medicine, Hippokration Hospital of Thessaloniki, Greece
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Achour A, Grouw E, Erp F, Arkesteijn S, Schaap R, Huurne JT, Bisoen S, Verschuren M, Harteveld CL. The first report of hemoglobin E in combination with the highly unstable alpha‐globin variant Hb Adana: The importance of molecular confirmation. Int J Lab Hematol 2019; 41:e76-e78. [PMID: 30663218 PMCID: PMC6936223 DOI: 10.1111/ijlh.12965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ahlem Achour
- Department of Clinical genetics/LDGA Leiden University Medical Centre Leiden The Netherlands
| | - Elke Grouw
- Department of Clinical Chemistry RadboudUMC Nijmegen The Netherlands
| | - Femke Erp
- Department of Clinical Genetics RadboudUMC Nijmegen The Netherlands
| | - Sandra Arkesteijn
- Department of Clinical genetics/LDGA Leiden University Medical Centre Leiden The Netherlands
| | - Rianne Schaap
- Department of Clinical genetics/LDGA Leiden University Medical Centre Leiden The Netherlands
| | - Jeanet ter Huurne
- Department of Clinical genetics/LDGA Leiden University Medical Centre Leiden The Netherlands
| | - Sharda Bisoen
- Department of Clinical genetics/LDGA Leiden University Medical Centre Leiden The Netherlands
| | - Maaike Verschuren
- Department of Clinical genetics/LDGA Leiden University Medical Centre Leiden The Netherlands
| | - Cornelis L. Harteveld
- Department of Clinical genetics/LDGA Leiden University Medical Centre Leiden The Netherlands
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Singh SA, Sarangi S, Appiah-Kubi A, Hsu P, Smith WB, Gallagher PG, Glader B, Chui DHK. Hb Adana (HBA2 or HBA1: c.179G > A) and alpha thalassemia: Genotype-phenotype correlation. Pediatr Blood Cancer 2018; 65:e27220. [PMID: 29749692 DOI: 10.1002/pbc.27220] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/17/2018] [Accepted: 03/29/2018] [Indexed: 11/11/2022]
Abstract
Alpha thalassemia due to nondeletional mutations usually leads to more severe disease than that caused by deletional mutations. Devastating outcomes such as hydrops fetalis can occur with two nondeletional mutations, therefore warranting DNA-based workup for suspected carriers with subtle hematological abnormalities for family counseling purposes. We describe three cases with hemoglobin (Hb) Adana, a nondeletional alpha chain mutation, compounded with an alpha globin gene deletion resulting in thalassemia intermedia. We review the literature, draw genotype-phenotype correlations from published cases of Hb Adana, and propose that this correlation can be used by clinicians to help direct diagnostic studies and urge hematologists to thoroughly workup high-risk patients.
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Affiliation(s)
- Sharon A Singh
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
| | | | | | | | | | | | - Bertil Glader
- Stanford University Medical Center, Palo Alto, California
| | - David H K Chui
- Boston University School of Medicine, Boston, Massachusetts
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Farashi S, Harteveld CL. Molecular basis of α-thalassemia. Blood Cells Mol Dis 2017; 70:43-53. [PMID: 29032940 DOI: 10.1016/j.bcmd.2017.09.004] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 02/05/2023]
Abstract
α-Thalassemia is an inherited, autosomal recessive, disorder characterized by a microcytic hypochromic anemia. It is one of the most common monogenic gene disorders in the world population. The clinical severity varies from almost asymptomatic, to mild microcytic hypochromic, and to a lethal hemolytic condition, called Hb Bart's Hydrops Foetalis Syndrome. The molecular basis are usually deletions and less frequently, point mutations affecting the expression of one or more of the duplicated α-genes. The clinical variation and increase in disease severity is directly related to the decreased expression of one, two, three or four copies of the α-globin genes. Deletions and point mutations in the α-globin genes and their regulatory elements have been studied extensively in carriers and patients and these studies have given insight into the α-globin genes are regulated. By looking at naturally occurring deletions and point mutations, our knowledge of globin-gene regulation and expression will continue to increase and will lead to new targets of therapy.
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Affiliation(s)
- Samaneh Farashi
- Dept. of Clinical Genetics, Hemoglobinopathy Expert Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelis L Harteveld
- Dept. of Clinical Genetics, Hemoglobinopathy Expert Center, Leiden University Medical Center, Leiden, The Netherlands.
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