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Murad H, Moassas F, Ali B, Katranji E, Mukhalalaty Y. The Spectrum of α-Thalassemia Mutations in Syrian Patients. Hemoglobin 2023; 47:245-248. [PMID: 38146675 DOI: 10.1080/03630269.2023.2296927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/13/2023] [Indexed: 12/27/2023]
Abstract
α-Thalassemia (α-thal) is a globally prevalent genetic disorder of hemoglobin (Hb) structure where the rate of α-globin chain synthesis is reduced or absent due to the presence of α-globin mutation(s). The aim of this study is to define the spectrum of α-globin gene mutations and evaluate their allele frequency in a group of α-thal carriers. A total of 55 individuals with possible α-thal patients were referred from the thalassemia centers in Syria. They have unexplained hypochromia and microcytosis. All patients were genetically tested for 21 common α-globin gene mutations using reverse hybridization kit. Seven different α-globin gene mutations and 13 different genotypes were detected in 55 patients. The two most frequently encountered mutations were -α3.7 deletion (47.1%) and --MED mutation (21.4%). The most commonly observed genotype was -α3.7/αα (40%), followed by --MED/αα genotype (21.8%). We determined the most common α thalassemia mutations in the Syrian patients. α-Thalassemia mutations with deletions were mostly observed in our study.
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Affiliation(s)
- Hossam Murad
- Molecular Biology and Biotechnology Department, Atomic Energy Commission of Syria, Damascus, Syria
| | - Faten Moassas
- Molecular Biology and Biotechnology Department, Atomic Energy Commission of Syria, Damascus, Syria
| | - Bouthina Ali
- Molecular Biology and Biotechnology Department, Atomic Energy Commission of Syria, Damascus, Syria
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Abolghasemi H, Kamfar S, Azarkeivan A, Karimi M, Keikhaei B, Abolghasemi F, Radfar MH, Eshghi P, Alavi S. Clinical and genetic characteristics of hemoglobin H disease in Iran. Pediatr Hematol Oncol 2022; 39:489-499. [PMID: 34951342 DOI: 10.1080/08880018.2021.2017529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Hemoglobin H (Hb H) disease is a subtype of α-thalassemia caused by deletional and/or non-deletional mutations in three alpha-globin genes in which the various genotypes determine the disease severity. This study was aimed to investigate the frequency of alpha gene mutations and genotypes and their correlation with hematological and clinical characteristics in Iran. Among 202 patients diagnosed with Hb H disease through a national study in Iran according to standard methods, we had access to the hematologic and clinical findings and genetic data of 101 patients in whom genetic study was performed. Genomic DNA from peripheral blood was extracted and analyzed for identification of α-globin gene mutations using Multiplex Gap Polymerase Chain Reaction, Reverse Hybridization Assay, and finally Direct DNA Sequencing method. Twenty-one different mutations and thirty genotypes were detected in 101 patients with Hb H disease. In total, 39 patients (38.6%) were deletional and 62 patients (61.4%) were non-deletional type of the disease. The --MED mutation was highly prevalent in almost half of the patients (56.4%). Among various genotypes, -MED/-a3.7 (29.7%) and -α20.5/-α5NT (6.9%) were the most prevalent genotypes found in the studied group. Patients with non-deletional type presented with more severe hematological and clinical findings. Hb H percentage and serum ferritin levels were significantly higher in non-deletional patients in comparison to the deletional group (p < 0.05). 12 (11.9%) and 40 (39.6%) out of 101 patients were on regular and occasional transfusions, respectively. 83% of those with regular transfusion belonged to the non-deletional group. Among transfusion-dependent patients, -MED/αCSα and α20.5/-α5NT were the most common genotypes. In this study, two patients with -α20.5/αCSα and -MED/α-5NT genotypes experienced thrombotic events. This study indicated that although non-deletional genotypes of Hb H disease were responsible for more clinical severity of the disease, due to the presence of severe phenotypes even in deletional types, no definite correlation was found between genotype and phenotype.
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Affiliation(s)
- Hassan Abolghasemi
- Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sharareh Kamfar
- Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azita Azarkeivan
- Research Center of Iranian Blood Transfusion Organization, Thalassemia Clinic, Tehran, Iran
| | - Mehran Karimi
- Hematology Research Center, Shiraz University of Medical Sciences, Nemazee Hospital, Shiraz, Iran
| | - Bijan Keikhaei
- Research Center for Thalassemia and Hemoglobinopathy, Health Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fahimeh Abolghasemi
- Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad H Radfar
- Department of Urology, School of Medicine, Shahid Labbafinezhad Hospital Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Peyman Eshghi
- Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samin Alavi
- Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Molecular Heterogeneity of Hb H Disease in India. THALASSEMIA REPORTS 2022. [DOI: 10.3390/thalassrep12030012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Alpha thalassemia is an autosomal recessive disorder caused by large deletions and/or point mutations in the α- globin genes. Hemoglobin H (Hb H) disease is most frequently due to deletion of three of the four α globin genes associated with variable clinical severity depending on the genotype. There are few reports on Hb H disease in Indians where genotyping has been done and we have reviewed the molecular and clinical heterogeneity of these cases. An electronic search for relevant articles was conducted using two journal databases, i.e., PubMed and Science Direct using the key words “Hb H Disease”, “Hemoglobin H”, “α-thalassemia”, “mutations”, “molecular heterogeneity”, “case reports” and “India”. This review was performed based on preferred reporting items for the systematic review and meta-analysis protocols (PRISMA-P) guidelines. The molecular spectrum of Hb H disease in Indians includes the most common [-α3.7, -α4.2, --SA, Poly A (AATAAA→AATA--), Hb Sallanches], rare [--SEA, --MED, IVS 1nt 1 (G→A), Hb Koya Dora, Hb Sun Prairie], very rare [Hb Iberia, Hb Seal Rock, Hb Zürich-Albisrieden] and novel [Codon 76 (+T) and --Kol] α-globin gene mutations inherited largely as compound heterozygotes with considerable clinical variability. The molecular diagnosis of Hb H disease is important for genetic counseling and management.
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Xu A, Chen W, Xie W, Wang Y, Ji L. Hemoglobin variants in southern China: results obtained during the measurement of glycated hemoglobin in a large population. Clin Chem Lab Med 2020; 59:227-232. [PMID: 32687481 DOI: 10.1515/cclm-2020-0767] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/08/2020] [Indexed: 01/10/2023]
Abstract
Objectives Hemoglobin (Hb) variant is one of the most common monogenic inherited disorders. We aimed to explore the prevalence and hematological and molecular characteristics of Hb variants in southern China. Methods We collected blood samples from all patients with suspected variants found during HbA1c measurement via a cation-exchange high-performance liquid chromatography system (Bio-Rad Variant II Turbo 2.0) or a capillary electrophoresis method (Sebia Capillarys). Hematological analysis, Sanger sequencing, and gap-PCR were performed for these samples. Results Among the 311,024 patients tested, we found 1,074 Hb variant carriers, including 823 identified using Capillarys and 251 using Variant II Turbo 2.0, with a total carrier rate of 0.35%. We discovered 117 types of Hb variants (52 HBB, 47 HBA, and 18 HBD mutations) containing 18 new mutations. The most common variant found was Hb E, followed by Hb New York, Hb J-Bangkok, Hb Q-Thailand, Hb G-Coushatta, Hb G-Honolulu, Hb G-Taipei, and Hb Broomhill. Most heterozygotes for the Hb variant exhibited normal hematological parameters. However, most patients with compound heterozygotes for the Hb variant and thalassemia showed varied degrees of microcytic hypochromic anemia. Conclusions The prevalence of hemoglobin variants remains high and exhibits genetic diversity and widespread distribution in the population of southern China.
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Affiliation(s)
- Anping Xu
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Weidong Chen
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Weijie Xie
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Yajun Wang
- Public Health Laboratory Centre, Kowloon, Hong Kong
| | - Ling Ji
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
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Al-Riyami AZ, Daar S, Kindi SA, Madhani AA, Wali Y, Rawahi MA, Zadjali SA. α-Globin Genotypes Associated with Hb H Disease: A Report from Oman and a Review of the Literature from the Eastern Mediterranean Region. Hemoglobin 2020; 44:20-26. [PMID: 32019385 DOI: 10.1080/03630269.2020.1720709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
α-Thalassemia (α-thal) is the most common autosomal recessive hemoglobinopathy. There is a vast diversity and geographical variability in underlying genotypes in Hb H (β4) patients. Herein, we describe the genotypes found in the largest report of Omani Hb H patients. Moreover, we reviewed and summarized the literature published from the Eastern Mediterranean region. A retrospective review of all genetically confirmed Hb H disease patients diagnosed between 2007 and 2017 at Sultan Qaboos University Hospital, Muscat, Oman, was performed. Hematological parameters and clinical presentations were assessed. Both α-globin genes were screened for deletional and nondeletional mutations using a stepwise diagnostic strategy as described before. A total of 52 patients (27 females and 25 males) with a mean age of 20.6 years (range 0.23-80.0) were molecularly confirmed to carry Hb H disease. The patients had a hemoglobin (Hb) level of 9.3 g/dL (range 5.7-13.0) and mean corpuscular volume (MCV) of 58.4 fL (range 48.2-82.1). A total of eight genotype combinations were identified, with α2 polyadenylation signal mutation (polyA1) (AATAAA>AATAAG (αPA1α/αPA1α), often cited as αT-Saudiα/αT-Saudiα, being the most common (53.8%) followed by -α3.7/- -MED I (28.8%). Our cohort also included patients with combinations of αPA1 with other Hb variants: αPA1α/αPA1α with Hb S (HBB: c.20A>T) trait (n = 2), -α3.7/αPA1α (n = 2) and αcodon 19α (HBA2: c.56delG)/αPA1α (n = 1). Nondeletional Hb H disease due to the αPA1 mutation is the most common in Omanis. Molecular diagnosis is necessary for accurate confirmation of the diagnosis of α-thal, determination of underlying genotypes, follow-up and counseling.
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Affiliation(s)
- Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Shahina Daar
- Department of Hematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Salam Al Kindi
- Department of Hematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ali Al Madhani
- Department of Medicine, Sohar Hospital, Ministry of Health, Muscat, Oman
| | - Yasser Wali
- Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mohammed Al Rawahi
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Shoaib Al Zadjali
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
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Brimson S, Suwanwong Y, Brimson JM. Nutritional anemia predominant form of anemia in educated young Thai women. ETHNICITY & HEALTH 2019; 24:405-414. [PMID: 28669237 DOI: 10.1080/13557858.2017.1346188] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 05/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Anaemia is one of the most common health problems worldwide, with a high prevalence in Africa and South East Asia, including Thailand. Thai women of childbearing age have an increased risk of anaemia due to several factors including underlying health problems, lifestyles and poor diet. Therefore, we investigated the prevalence of anaemia among female students of Chulalongkorn University (aged 18-22) and categorized causes of the anaemia. DESIGN 400 Thai female student-volunteers, without known underlying diseases were subjected to blood tests; complete blood count, Haemoglobin typing and serum ferritin level. Bloods, having haemoglobin under 12 g/dl and hematocrit under 36%, were designated as anaemia. Then causes of anaemia are categorized into 3 groups; Iron deficiency, Thalassemia and Others. RESULTS We found that 21% of the volunteers were anaemic. In 85 anaemic volunteers, they were classified as Iron deficiency anaemia (IDA); with low serum ferritin levels 42.4%, Thalassemia; total of 6 types 25.9%, IDA and Thalassemia 2.3% and Others 29.4% in which haemoglobin typing and serum ferritin level were normal. CONCLUSION Iron deficiency anaemia (IDA) is the major cause of anaemia in Thai female students in our study. Several students were gradually developing anaemia where their haematocrit (Hct) and haemaglobin (Hb) were within reference range but mean corpuscular volume (MCV), mean corpuscular haemaglobin (MCH) and serum ferritin fell below reference range, indicating latent iron deficiency. A few volunteers had both IDA and Thalassemia and also Thalassemia with iron overloaded where health can be deteriorated without knowledge of having these conditions or proper health care. To improve their health, universities or public organizations should provide education and/or screen for anaemia. With the knowledge and understanding of their health issues or underling diseases, students themselves can prevent serious health conditions, improve university performances, and improve their quality of life.
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Affiliation(s)
- Sirikalaya Brimson
- a Department of Clinical Microscopy, Faculty of Allied Health Sciences , Chulalongkorn University , Bangkok , Thailand
| | - Yaneenart Suwanwong
- a Department of Clinical Microscopy, Faculty of Allied Health Sciences , Chulalongkorn University , Bangkok , Thailand
| | - James M Brimson
- b Department of Clinical Chemistry, Faculty of Allied Health Sciences , Chulalongkorn University , Bangkok , Thailand
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Al Moamen NJ, Thabet A, Mahdi F, Newton H, Salman E. Various α-Thalassemia Genotype Combinations of the Saudi-Type Polyadenylation Signal Mutation (αT-Saudiα) in the Population of Bahrain: An Update of Genotype-Phenotype Analyses. Hemoglobin 2018; 42:166-170. [DOI: 10.1080/03630269.2018.1499523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nabeel J. Al Moamen
- Genetic Laboratory, Department of Pathology, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Ahmed Thabet
- Genetic Laboratory, Department of Pathology, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Fawzia Mahdi
- Genetic Laboratory, Department of Pathology, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Hema Newton
- Genetic Laboratory, Department of Pathology, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Ebtihal Salman
- Genetic Laboratory, Department of Pathology, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
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Theodoridou S, Teli A, Yfanti E, Vyzantiadis TA, Theodoridis T, Economou M. Compound Heterozygosity for Hb Adana (HBA2: c.179G>A) and the -α 3.7/αα Thalassemia Deletion in Greece: Clinical Phenotype and Genetic Counseling. Hemoglobin 2018; 42:129-131. [PMID: 30025477 DOI: 10.1080/03630269.2018.1466711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Hb Adana (HBA2: c.179G>A) is found worldwide but is extremely rare and carriers are asymptomatic, with red cell indices similar to α+-thalassemia (α+-thal) carriers. First line screening tests are unable to detect the unstable hemoglobin (Hb). Coinheritance with the α-thal (-α3.7) deletion is herein presented and the challenges involving genetic counseling of couples carrying the mutations are discussed.
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Affiliation(s)
- Stamatia Theodoridou
- a Haemoglobinopathy Prevention Unit , Hippokration Hospital of Thessaloniki , Thessaloniki , Greece
| | - Aikaterini Teli
- b First Depatment of Paediatrics , Aristotelion University of Thessaloniki , Thessaloniki , Greece
| | - Eleni Yfanti
- c Thalassaemia National Centre of Greece , Laikon General Hospital of Athens , Athens , Greece
| | | | - Theodoros Theodoridis
- e First Department of Obstetrics and Gynaecology , Aristotelion University of Thessaloniki , Thessaloniki , Greece
| | - Marina Economou
- b First Depatment of Paediatrics , Aristotelion University of Thessaloniki , Thessaloniki , Greece
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Pregnancy Complications in a-Thalassemia (Hemoglobinopathy H): A Case Study. Case Rep Obstet Gynecol 2018; 2018:8532081. [PMID: 29992068 PMCID: PMC5994311 DOI: 10.1155/2018/8532081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/22/2018] [Accepted: 04/22/2018] [Indexed: 11/18/2022] Open
Abstract
Thalassemia intermedia (TI) is a clinical definition which represents a wide spectrum of thalassemia genotypes but mainly includes patients who do not require or only occasionally require transfusion. An uncommon case of a 32-year-old Greek woman, para 1, at the 22nd week + day 3 of gestation with thalassemia intermedia (she was splenectomized), where her pregnancy was complicated with portal vein thrombosis, splenic thrombosis, and partial HELLP, is described. This is a generally uncommon event in thalassemia intermedia. She had no transfusion as her hematologist consulted and she took anticoagulation therapy. Thus, we present for the first time in the literature a case of HbH a-thalassemia pregnant woman whose pregnancy was complicated with portal vein thrombosis, splenic vein thrombosis, and partial HELLP; she was treated with anticoagulation therapy and she had a successful outcome.
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Dimishkovska M, Kuzmanovska M, Kocheva S, Martinova K, Karanfilski O, Stojanoski Z, Plaseska-Karanfilska D. First Cases of Hb Agrinio Described in Patients from the Republic of Macedonia. Hemoglobin 2017; 41:308-310. [PMID: 29219637 DOI: 10.1080/03630269.2017.1397016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Previous molecular analyses of α-thalassemia (α-thal) in the Republic of Macedonia have identified the following genetic defects: -α3.7 (rightward), -(α)20.5 and - -MED I deletions and Hb Icaria [α142, Term→Lys (α2), HBA2: c.427T>A] and polyadenylation signal (polyA) [AATAAA>AATGAA (α2), HBA2: c.*92A>G] point mutations. Here, we report two unrelated patients from the Romani population in the Republic of Macedonia, homozygotes for the α2-globin gene variant Hb Agrinio [α29(B10)Leu→Pro; HBA2: c.89T>C]. To date, Hb Agrinio has been described only in individuals of Greek, Cypriot and Spanish origin. Both of our patients had early presentation of the disease (3.5 years and 2 months, respectively) with frequent blood transfusions from early infancy. They have a severe intermediate phenotype of thalassemia (Hb H disease) with hemoglobin (Hb) levels of 7.8 and 7.7 g/dL, respectively. Although the HBA2: c.89T>C mutation results in an α+ allele, the severe phenotype of the homozygotes is due to the production of hyperunstable α chains that undergo post translational precipitation. This leads to a greater degree of red cell damage and hemolytic anemia. The detection of Hb Agrinio in two unrelated families of Romani ethnic origin, may suggest it is a founder mutation in this population living in the Republic of Macedonia. Considering the severity of the clinical presentation of the homozygotes or compound heterozygotes for this rare Hb variant, a targeted molecular screening for Hb Agrinio mutation carriers should be considered in all patients of Romani ethnic origin with manifested microcytosis.
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Affiliation(s)
- Marija Dimishkovska
- a Research Centre for Genetic Engineering and Biotechnology 'Georgi D. Efremov , ' Macedonian Academy of Science and Arts , Skopje , Republic of Macedonia
| | - Maja Kuzmanovska
- a Research Centre for Genetic Engineering and Biotechnology 'Georgi D. Efremov , ' Macedonian Academy of Science and Arts , Skopje , Republic of Macedonia
| | - Svetlana Kocheva
- b University Pediatric Clinic, Medical Faculty , Skopje , Republic of Macedonia
| | - Kata Martinova
- b University Pediatric Clinic, Medical Faculty , Skopje , Republic of Macedonia
| | - Oliver Karanfilski
- c University Clinic for Hematology, Medical Faculty , Skopje , Republic of Macedonia
| | - Zlate Stojanoski
- c University Clinic for Hematology, Medical Faculty , Skopje , Republic of Macedonia
| | - Dijana Plaseska-Karanfilska
- a Research Centre for Genetic Engineering and Biotechnology 'Georgi D. Efremov , ' Macedonian Academy of Science and Arts , Skopje , Republic of Macedonia
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Incidence of alpha-globin gene defect in the Lebanese population: a pilot study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:517679. [PMID: 25834820 PMCID: PMC4365311 DOI: 10.1155/2015/517679] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 01/02/2015] [Accepted: 01/28/2015] [Indexed: 11/17/2022]
Abstract
Background. It is well established that the Mediterranean and Arab populations are at high risk for thalassemias in general and for alpha-thalassemia in particular. Yet, reports on alpha-thalassemia in Lebanon are still lacking. In this study, we aim at assessing the incidence of alpha-thalassemia in the Lebanese population. Methods. 230 newborns' dried blood cards remaining from routine neonatal screening at the American University of Beirut Medical Center were collected for DNA extraction. Samples were screened for the 21 most common α-globin deletions and point mutations reported worldwide, through multiplex Polymerase Chain Reaction (PCR) and Reverse-Hybridization technique. Results. Upon analyses, the carrier rate of α-thalassemia was found to be 8%. Two mutations detected the −α3,7 single gene deletion found in 75% of cases and the nongene deletion α2 IVS1 [−5nt] in the remaining samples. Conclusion. This study is the first dedicated to investigate α-thalassemia trait incidence in Lebanon. Data obtained demonstrates a high carrier rate in a relatively, highly consanguineous population; it also highlighted the presence of two common mutations. These results may be of an important impact on premarital and newborn screening policies in our country.
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Hamamy HA, Al-Allawi NAS. Epidemiological profile of common haemoglobinopathies in Arab countries. J Community Genet 2012; 4:147-67. [PMID: 23224852 DOI: 10.1007/s12687-012-0127-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 11/18/2012] [Indexed: 02/07/2023] Open
Abstract
Haemoglobinopathies including the thalassemias and sickle cell disease are known to be prevalent inherited disorders in most Arab countries with varying prevalence rates and molecular characterisation. β-thalassemia is encountered in polymorphic frequencies in almost all Arab countries with carrier rates of 1-11 % and a varying number of mutations. The most widespread mutation in Lebanon, Egypt, Syria, Jordan, Tunisia and Algeria is the IVS-I-110 (G>A). In the Eastern Arabian Peninsula, the Asian Indian mutations (IVS-I-5 (G>C), codons 8/9 (+G) and IVS-I (-25 bp del)) are more common. The α-thalassemias are encountered in the majority of Arab countries in frequencies ranging from 1 to 58 % with the highest frequencies reported from Gulf countries. The (-α(3.7)) mutation is the most frequent followed by the non-deletional α2 polyadenylation signal mutation (AATAAA>AATAAG) and the α2 IVS1 5-bp deletion. The rates of sickle cell trait in Arab countries range from 0.3 to 30 %, with the Benin, the Arab-Indian and the Bantu haplotypes constituting the bulk of the haplotypes, leading to two major phenotypes; a mild one associated with the Arab-Indian and a severe one with the Benin and Bantu haplotypes. Public health approaches targeting prevention of haemoglobinopathies in Arab countries include newborn screening for sickle cell disease, and premarital screening for carriers of β-thalassemia and sickle cell disease. These services are still patchy and inadequate in many Arab countries recommending the upgrade of these services with strengthening of the education and training of health care providers and raising public awareness on the feasibility of prevention and care for haemoglobinopathies.
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Affiliation(s)
- Hanan A Hamamy
- Department of Genetic Medicine and Development, University of Geneva, Geneva, Switzerland,
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Phylipsen M, Traeger-Synodinos J, van der Kraan M, van Delft P, Bakker G, Geerts M, Kanavakis E, Stamoulakatou A, Karagiorga M, Giordano PC, Harteveld CL. A novel α0-thalassemia deletion in a Greek patient with HbH disease and β-thalassemia trait. Eur J Haematol 2012; 88:356-62. [DOI: 10.1111/j.1600-0609.2012.01748.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
Alpha-thalassaemia is inherited as an autosomal recessive disorder characterised by a microcytic hypochromic anaemia, and a clinical phenotype varying from almost asymptomatic to a lethal haemolytic anaemia. It is probably the most common monogenic gene disorder in the world and is especially frequent in Mediterranean countries, South-East Asia, Africa, the Middle East and in the Indian subcontinent. During the last few decades the incidence of alpha thalassaemia in North-European countries and Northern America has increased because of demographic changes. Compound heterozygotes and some homozygotes have a moderate to severe form of alpha thalassaemia called HbH disease. Hb Bart's hydrops foetalis is a lethal form in which no alpha-globin is synthesized. Alpha thalassaemia most frequently results from deletion of one or both alpha genes from the chromosome and can be classified according to its genotype/phenotype correlation. The normal complement of four functional alpha-globin genes may be decreased by 1, 2, 3 or all 4 copies of the genes, explaining the clinical variation and increasing severity of the disease. All affected individuals have a variable degree of anaemia (low Hb), reduced mean corpuscular haemoglobin (MCH/pg), reduced mean corpuscular volume (MCV/fl) and a normal/slightly reduced level of HbA2. Molecular analysis is usually required to confirm the haematological observations (especially in silent alpha-thalassaemia and alpha-thalassaemia trait). The predominant features in HbH disease are anaemia with variable amounts of HbH (0.8-40%). The type of mutation influences the clinical severity of HbH disease. The distinguishing features of the haemoglobin Bart's hydrops foetalis syndrome are the presence of Hb Bart's and the total absence of HbF. The mode of transmission of alpha thalassaemia is autosomal recessive. Genetic counselling is offered to couples at risk for HbH disease or haemoglobin Bart's Hydrops Foetalis Syndrome. Carriers of alpha+- or alpha0-thalassaemia alleles generally do not need treatment. HbH patients may require intermittent transfusion therapy especially during intercurrent illness. Most pregnancies in which the foetus is known to have the haemoglobin Bart's hydrops foetalis syndrome are terminated due to the increased risk of both maternal and foetal morbidity.
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Affiliation(s)
- Cornelis L Harteveld
- 1Department of Human and Clinical Genetics, Leiden University Medical Center, Einthovenweg 20, 2333ZC Leiden, The Netherlands
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Nadkarni AH, Nair SB, Italia KY, Warang P, Dalvi M, Ghosh K, Colah RB. Molecular diversity of hemoglobin H disease in India. Am J Clin Pathol 2010; 133:491-4. [PMID: 20154289 DOI: 10.1309/ajcp70orbrurvsjm] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
This study was undertaken to evaluate the variable clinical expression of hemoglobin (Hb) H disease in India. For the study, alpha genotyping was done in 8 patients with Hb H disease using multiplex polymerase chain reaction and DNA sequencing. The study revealed that 4 genotypes (- -(SEA)/ -alpha(3.7), - -(SA)/-alpha(3.7), - -(SEA)/-alpha(3.7 Sallanches), - -alpha(3.7)/-alpha(3.7 Sallanches)) were responsible for Hb H disease, the alpha+ thalassemia mutation (-alpha(3.7) deletion) being the most common defect. The nondeletional mutation Hb Sallanches (alpha 2 codon 104 G --> A) was seen in 3 cases. Two unique and novel genotypes leading to Hb H disease were characterized (- -(SEA)/-alpha(3.7 Sallanches) and -alpha(3.7)/-alpha(3.7 Sallanches)). Because a majority of patients with Hb H disease do not have severe manifestations, prenatal diagnosis is usually unwarranted in India.
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Origa R, Sollaino MC, Giagu N, Barella S, Campus S, Mandas C, Bina P, Perseu L, Galanello R. Clinical and molecular analysis of haemoglobin H disease in Sardinia: haematological, obstetric and cardiac aspects in patients with different genotypes. Br J Haematol 2007; 136:326-32. [PMID: 17129226 DOI: 10.1111/j.1365-2141.2006.06423.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In this study, 251 Sardinian patients (187 adults and 64 children) with haemoglobin (Hb) H disease were evaluated. Two-hundred and sixteen patients (86%) had the deletional type (- -/-alpha) and 36 (14%) patients had the non-deletional type (- -/alpha(ND)alpha). A clear genotype-phenotype correlation was found, with the non-deletional type more severe than the deletional type. Diagnosis of Hb H disease was incidental in about 60% of cases. Aplastic crises due to B19 parvovirus infection were found in five patients (2.1%), while 23 patients (9.6%) experienced one or more haemolytic crises. Nineteen patients with Hb H received sporadic red blood cell transfusions and three patients were repeatedly transfused. Forty-seven of 61 married women (77%) had 82 pregnancies. In children, mean serum ferritin was 87 +/-92 mug/l and in adults, was 192 +/- 180 mug/l in females and 363 +/- 303 mug/l in males. For the 98 male patients, a significant correlation was found between ferritin values and age (r2 = 0.33, P < 0.0001). In the Sardinian population, Hb H disease needs regular monitoring for early detection and treatment of possible complications, such as worsening of anaemia that may require red cell transfusion, cholelithiasis and iron overload.
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Affiliation(s)
- R Origa
- Department of Biomedical and Biotechnological Sciences, Ospedale Regionale Microcitemie-ASL 8, University of Cagliari, Cagliari, Italy
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Puehringer H, Najmabadi H, Law HY, Krugluger W, Viprakasit V, Pissard S, Baysal E, Taher A, Farra C, Al-Ali A, Al-Ateeq S, Oberkanins C. Validation of a reverse-hybridization StripAssay for the simultaneous analysis of common α-thalassemia point mutations and deletions. Clin Chem Lab Med 2007; 45:605-10. [PMID: 17484620 DOI: 10.1515/cclm.2007.125] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND alpha-Thalassemia is a worldwide disease and considered to be a major public health problem in countries within the so-called thalassemia belt. The complex genetics of alpha-thalassemias requires diagnostic methods with the capacity to screen rapidly and accurately for common causative mutations. METHODS We developed and validated a reverse-hybridization assay (Alpha-Globin StripAssay) for the rapid and simultaneous detection of 21 alpha-globin mutations: two single gene deletions (-alpha(3.7); -alpha(4.2)), five double gene deletions [--(MED); --(SEA); --(THAI); --(FIL); -(alpha)(20.5)], alpha alpha alpha(anti-3.7) gene triplication, two point mutations in the alpha1 gene (cd 14 G>A; Hb Adana) and 11 point mutations in the alpha2 gene (initiation cd T>C; cd 19 -G; IVS1 -5nt; cd 59 G>A; Hb Quong Sze; Hb Constant Spring; Hb Icaria; Hb Pakse; Hb Koya Dora; polyA-1; polyA-2). RESULTS Reliable genotyping of recombinant mutant clones and reference DNA samples was achieved by means of two corresponding test strips presenting parallel arrays of allele-specific oligonucleotides. The entire procedure from blood sampling to the identification of mutations required less than 6 h, and hybridization/detection was manual or automated. The diagnostic potential of this Alpha-Globin StripAssay was carefully evaluated on 272 pre-typed samples in a multicenter validation study. In 96.14% of the cases, StripAssay typing was completely concordant with the reference methods. CONCLUSIONS The Alpha-Globin StripAssay proved to be a fast, easy-to-perform and reliable screening method to identify >90% of alpha-globin mutations in endemic areas worldwide.
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Papassotiriou I, Traeger-Synodinos J, Marden MC, Kister J, Liapi D, Prome D, Stamoulakatou A, Wajcman H, Kanavakis E. The homozygous state for Hb Crete [β129 (H7) Ala→Pro] is associated with a complex phenotype including erythrocytosis and functional anemia. Blood Cells Mol Dis 2005; 34:229-34. [PMID: 15885607 DOI: 10.1016/j.bcmd.2004.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Revised: 12/13/2004] [Accepted: 12/23/2004] [Indexed: 10/25/2022]
Abstract
Hb Crete, an electrophoretically neutral, unstable, high oxygen affinity variant, was characterized by protein and DNA analyses in the homozygous state in a 32-year-old woman from Crete, with erythrocytosis and microcytosis. The proband and members of her family over 3 generations, including 5 carriers of Hb Crete, were subject to clinical, hematological and biochemical investigations, and DNA, RNA and protein studies were carried out. The proband demonstrated features associated with disturbed hemoglobin (Hb) structure and function, including erythrocytosis and additionally a state of functional anemia, the latter reflected by increased erythropoetin levels and cardiac output. In addition, all the carriers surprisingly had hematological and biosynthetic findings more usually associated with thalassemia trait. The structural change in Hb Crete only partly explains all the pathological manifestations of this variant, and other mechanisms are discussed.
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Affiliation(s)
- Ioannis Papassotiriou
- Department of Clinical Biochemistry, Aghia Sophia Children's Hospital, 115 27 Athens, Greece.
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Boonsa S, Sanchaisuriya K, Fucharoen G, Wiangnon S, Jetsrisuparb A, Fucharoen S. The diverse molecular basis and hematological features of Hb H and AEBart's diseases in Northeast Thailand. Acta Haematol 2004; 111:149-54. [PMID: 15034236 DOI: 10.1159/000076523] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2003] [Accepted: 10/27/2003] [Indexed: 11/19/2022]
Abstract
We defined the molecular basis and correlated the hematological phenotypes with the globin genotypes in 52 patients with Hb H disease and 29 patients with AEBart's disease of northeast Thailand. Among the former group, the most prevalent molecular defect was found to be the interaction of alpha-thalassemia 1 (SEA type) with the Hb Constant Spring (Hb CS; 35 of 52 patients), followed by the deletion of three alpha-globin genes with the SEA type alpha-thalassemia 1 and the 3.7- or 4.2-kb deletion of alpha-thalassemia 2 (14 of 52 patients) and the interaction of the SEA alpha-thalassemia 1 with the Hb Paksé which was found in the remaining 3 patients. Among the 29 patients of the latter group, in 18 disease was caused by interactions of Hb E heterozygotes with the SEA alpha-thalassemia 1 and Hb CS. Interaction of Hb E heterozygotes with a deletional form of Hb H disease was detected in 7 patients and the Hb Paksé AEBart's disease was found in another 3 patients. A remaining patient with an unusually severe form of AEBart's disease with a lower Hb E level and observable Hb H was associated with a hitherto undescribed condition, the interaction of Hb E heterozygote with alpha-thalassemia 1 and an alpha2 codon 30 (GAG) deletion. Hematological characterization of the patients demonstrated that although disease in most of them was associated with thalassemia intermedia phenotypes, it was apparent that association with the nondeletional form of alpha-thalassemia 2 produced a more severe phenotype than that of the deletional one. Therefore, alpha-globin gene analysis of Hb H and AEBart's disease patients would be useful for predicting the clinical outcome and improving genetic counseling.
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Affiliation(s)
- Supap Boonsa
- Department of Clinical Chemistry, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
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Antonelou M, Papassideri IS, Karababa F, Gyparaki M, Loutradi A, Margaritis LH. A novel case of haemoglobin H disease associated with clinical and morphological characteristics of congenital dyserythropoietic anaemia type I. Eur J Haematol 2002; 68:247-52. [PMID: 12071943 DOI: 10.1034/j.1600-0609.2002.01590.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report, for the first time, an unusual case of congenital anaemia with the clinical diagnosis of haemoglobin H disease complicated by morphological features at the light and electron microscopy level very similar to those of CDA-I. The red cell indices and the globin chain biosynthetic ratio were not characteristic of the defective haemoglobin genotype. The haematological, clinical and morphological data strongly suggest the novel coexistence of the two defects in a patient. The disease is characterised by a unique dyserythropoietic phenotype of diagnostic importance, which possibly brings new data regarding the reciprocal interaction between the two diseases, especially concerning a specific abnormality in globin chain synthesis in CDA-I, as previously suggested.
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Affiliation(s)
- M Antonelou
- Department of Cell Biology and Biophysics, Faculty of Biology, University of Athens, Greece
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