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Agarwal AM, Rets AV. Advances in Hemoglobinopathies and Thalassemia Evaluation. Clin Lab Med 2024; 44:441-453. [PMID: 39089750 DOI: 10.1016/j.cll.2024.04.006] [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] [Indexed: 08/04/2024]
Abstract
Hemoglobin (Hb) disorders are among the most prevalent inherited diseases. Despite a limited number of involved genes, these conditions represent a broad clinical and prognostic spectrum. The menu of laboratory tests is extensive. From widely available modalities, for example, complete blood count to rather sophisticated molecular technologies, the investigation of Hb disorders recapitulates an increasing complexity of laboratory workup in other medical fields. This review highlights a current state of biochemical and molecular investigation of Hb disorders and offers a glimpse on technologies that are yet to be fully embraced in clinical practice.
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Affiliation(s)
- Archana M Agarwal
- Department of Pathology, University of Utah Health and ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT 84108, USA.
| | - Anton V Rets
- Department of Pathology, University of Utah Health and ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT 84108, USA
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Xu A, Li M, Ye Y, Li L, Ma M, Wu SY, Ji L. Mutational spectrum of HBD gene in the Chinese population: Description of 36 mutations including 11 novel variants. Int J Lab Hematol 2023; 45:961-968. [PMID: 37605839 DOI: 10.1111/ijlh.14155] [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] [Accepted: 08/09/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Mutations in the hemoglobin subunit delta (HBD) gene (MIM#142000) are associated with decreased levels of the Hemoglobin A2 (Hb A2 ) fraction. We aimed to examine the prevalence of HBD gene mutations and summarize their characteristics in the Chinese population. METHODS Individuals who exhibited Hb A2 levels below 1.8%, with or without Hb A2 variant peaks, were chosen for further investigation. Hemoglobin analysis was conducted using capillary electrophoresis. Common α and β-thalassemia in China were detected using gap-PCR and reverse dot blot hybridization. The presence of HBD gene mutations was confirmed by DNA sequencing. RESULTS A total of 188 patients were identified as carriers of the HBD gene mutation, with a prevalence of approximately 0.46%. We discovered 36 types of mutations, 30 of which resulted in δ-globin variants, while the remaining 6 resulted in δ-thalassemia. The most common mutation was HBD:c.-127 T > C, accounting for 87.2% of δ-thalassemia cases. In addition, we identified 11 novel HBD gene mutations and found 10 cases compounded with other common thalassemias. CONCLUSION We observed a high prevalence of HBD gene mutations in southern China. Our findings provide a genetic basis for screening for δ-thalassemia and enrich the spectrum of HBD gene mutations.
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Affiliation(s)
- Anping Xu
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Mingyang Li
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yinghui Ye
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Liping Li
- Department of Laboratory Medicine, Shenzhen University General Hospital, Shenzhen, China
| | - Minjing Ma
- Department of Laboratory Medicine, Shenzhen Longgang District Sixth People's Hospital, Shenzhen, China
| | - Shang Ying Wu
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Ling Ji
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, China
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Hanart C, Singha K, Changtrakul Y, Fucharoen S, Srivorakun H. Prospective screening for δ-hemoglobinopathies associated with decreased hemoglobin A 2 levels or hemoglobin A 2 variants: A single center experience. Clin Chim Acta 2023:117417. [PMID: 37276945 DOI: 10.1016/j.cca.2023.117417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/15/2023] [Accepted: 06/01/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND δ-hemoglobinopathies may lead to misdiagnosis of several thalassemia syndromes especially β-thalassaemia carrier, it is important to evaluate the δ-globin gene defects in areas with high prevalence of globin gene disorders. We describe a prospective screening for δ-hemoglobinopathies in a routine setting in Thailand. METHODS Study was done on a cohort of 8,471 subjects referred for thalassemia screening, 317 (3.7%) were suspected of having δ-globin gene defects due to reduced hemoglobin (Hb) A2 levels and/or appearance of Hb A2-variants on hemoglobin analysis. Hematologic and DNA analysis by PCR and related assays were carried out. RESULTS DNA analysis of δ-globin gene identified seven different δ-globin mutations in 24 of 317 subjects (7.6%). Both known mutations; δ-77(T>C) (n=3), δ-68(C>T) (n=1), δ-44(G>A) (n=8), Hb A2-Melbourne (n=5), δIVSII-897(A>C) (n=5), and Hb A2-Troodos (n=1) and a novel mutation; the Hb A2-Roi-Et (n=1) were identified. This Hb A2-Roi-Et, results from a double mutations in-cis, δCD82(AAG>AAT) and δCD133(GTG>ATG), was interestingly found in combination with an in trans, 12.6 kb deletional δβ0-thalassemia in an adult Thai woman who had no Hb A2 and elevated Hb F. A multiplex-allele-specific PCR was developed to detect these novel δ-globin gene defects. CONCLUSIONS The result confirms a diverse heterogeneity of δ-hemoglobinopathies in Thailand which should prove useful in a prevention and control program of thalassemia in the region.
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Affiliation(s)
- Chulikon Hanart
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Kritsada Singha
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand; Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand
| | - Yossombat Changtrakul
- Clinical Microscopy Unit, Srinagarind Hospital, 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
| | - Hataichanok Srivorakun
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.
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Lin Y, Agarwal AM, Anderson LC, Marshall AG. Discovery of a biomarker for β-Thalassemia by HPLC-MS and improvement from Proton Transfer Reaction - Parallel Ion Parking. J Mass Spectrom Adv Clin Lab 2023; 28:20-26. [PMID: 36814695 PMCID: PMC9939715 DOI: 10.1016/j.jmsacl.2023.01.004] [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: 08/07/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
β-thalassemia is a quantitative hemoglobin (Hb) disorder resulting in reduced production of Hb A and increased levels of Hb A2. Diagnosis of β-thalassemia can be problematic when combined with other structural Hb variants, so that the separation approaches in routine clinical centers are not sufficiently decisive to obtain accurate results. Here, we separate the intact Hb subunits by high-performance liquid chromatography, followed by top-down tandem mass spectrometry of intact subunits to distinguish Hb variants. Proton transfer reaction-parallel ion parking (PTR-PIP), in which a radical anion removes protons from multiply charged precursor ions and produces charge-reduced ions spanning a limited m/z range, was used to increase the signal-to-noise ratio of the subunits of interest. We demonstrate that the δ/β ratio can act as a biomarker to identify β-thalassemia in normal electrospray ionization MS1 and PTR-PIP MS1. The application of PTR-PIP significantly increases the sensitivity and specificity of the HPLC-MS method to identify δ/β ratio as a thalassemia biomarker.
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Key Words
- ACN, Acetonitrile
- AUC, Areas under the curve
- CID, Collision-induced dissociation
- ESI, Electrospray ionization
- ETD, Electron-transfer dissociation
- FA, Formic acid
- FN, False-negative
- FP, False-positive
- FT-ICR
- FT-ICR, MS Fourier transform ion cyclotron resonance mass spectrometer
- FTMS
- Fourier transform ion cyclotron resonance
- Hb A, Normal adult Hb
- Hb, Hemoglobin
- HbA1d, Hb β with glutathione
- IFCC, International Federation of Clinical Chemistry and Laboratory Medicine
- IQR, Interquartile range
- J, Youden Index
- MCW, Methanol/chloroform/water
- MS, Mass spectrometry
- PTM, Post-translational modification
- PTR-PIP, Proton transfer reaction-parallel ion parking
- ROC, Receiver operating characteristic
- S/N, Signal-to-noise ratios
- Se(c), Sensitivity, the probability of a true positive)
- Sp(c), Specificity, the probability of a true negative)
- TIC, Total ion chromatogram
- TN, True negative
- TP, True positive
- Top-down
- XIC, Extracted ion chromatograms
- m/z, Mass-to-charge ratios
- δ/β ratio
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Affiliation(s)
- Yuan Lin
- Department of Chemistry and Biochemistry, Florida State University, Tallahassee, FL 32308, United States
| | - Archana M. Agarwal
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT 84132, United States,ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT 84108, United States
| | - Lissa C. Anderson
- Ion Cyclotron Resonance Program, National High Magnetic Field Laboratory, Florida State University, Tallahassee, FL 32310, United States,Corresponding authors at: Department of Chemistry and Biochemistry, Florida State University, Tallahassee, FL 32308, United States (A.G. Marshall).
| | - Alan G. Marshall
- Department of Chemistry and Biochemistry, Florida State University, Tallahassee, FL 32308, United States,Ion Cyclotron Resonance Program, National High Magnetic Field Laboratory, Florida State University, Tallahassee, FL 32310, United States,Corresponding authors at: Department of Chemistry and Biochemistry, Florida State University, Tallahassee, FL 32308, United States (A.G. Marshall).
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A case of a novel hemoglobin variant, Hb A2-Karatsu, discovered following a falsely elevated HbA1c value. Clin Chim Acta 2022; 537:154-157. [DOI: 10.1016/j.cca.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 11/19/2022]
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Mahmud N, Maffei M, Mogni M, Forni GL, Pinto VM, Barberio G, Ungari S, Maffè A, Curcio C, Zanolli F, Paventa R, Carta M, Caleffi A, Mercadanti M, Maoggi S, Ivaldi G, Coviello D. Hemoglobin A 2 and Heterogeneous Diagnostic Relevance Observed in Eight New Variants of the Delta Globin Gene. Genes (Basel) 2021; 12:genes12111821. [PMID: 34828427 PMCID: PMC8625798 DOI: 10.3390/genes12111821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hemoglobin A (Hb A) (α2β2) in the normal adult subject constitutes 96-98% of hemoglobin, and Hb F is normally less than 1%, while for hemoglobin A2 (Hb A2) (α2δ2), the normal reference values are between 2.0 and 3.3%. It is important to evaluate the presence of possible delta gene mutations in a population at high risk for globin gene defects in order to correctly diagnose the β-thalassemia carrier. METHODS The most used methods for the quantification of Hb A2 are based on automated high performance liquid chromatography (HPLC) or capillary electrophoresis (CE). In particular Hb analyses were performed by HPLC on three dedicated devices. DNA analyses were performed according to local standard protocols. RESULTS Here, we described eight new δ-globin gene variants discovered and characterized in some laboratories in Northern Italy in recent years. These new variants were added to the many already known Hb A2 variants that were found with an estimated frequency of about 1-2% during the screening tests in our laboratories. CONCLUSIONS The knowledge recognition of the delta variant on Hb analysis and accurate molecular characterization is crucial to provide an accurate definitive thalassemia diagnosis, particularly in young subjects who would like to ask for a prenatal diagnosis or preimplantation genetic diagnosis.
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Affiliation(s)
- Noraesah Mahmud
- Laboratorio Genetica Umana, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (N.M.); (M.M.); (D.C.)
- Department of Pathology, Hospital Kuala Lumpur, Kuala Lumpur 50586, Malaysia
| | - Massimo Maffei
- Laboratorio Genetica Umana, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (N.M.); (M.M.); (D.C.)
- Correspondence:
| | - Massimo Mogni
- Laboratorio Genetica Umana, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (N.M.); (M.M.); (D.C.)
| | - Gian Luca Forni
- Centro Microcitemia e Anemie Congenite, Ospedali Galliera, 16128 Genova, Italy; (G.L.F.); (V.M.P.)
| | - Valeria Maria Pinto
- Centro Microcitemia e Anemie Congenite, Ospedali Galliera, 16128 Genova, Italy; (G.L.F.); (V.M.P.)
| | - Giuseppina Barberio
- Medicina di Laboratorio, Azienda ULSS 2 Marca Trevigiana, 31100 Treviso, Italy;
| | - Silvana Ungari
- Genetica e Biologia Molecolare ASO S. Croce e Carle, 12100 Cuneo, Italy; (S.U.); (A.M.)
| | - Antonella Maffè
- Genetica e Biologia Molecolare ASO S. Croce e Carle, 12100 Cuneo, Italy; (S.U.); (A.M.)
| | - Cristina Curcio
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy;
| | - Francesco Zanolli
- Formerly, Servizio di Immunoematologia e Medicina Trasfusionale, A.O. Santa Maria degli Angeli, 33170 Pordenone, Italy;
| | | | - Mariarosa Carta
- Medicina di Laboratorio, Ospedale S. Bortolo, AULSS 8 Berica, 36100 Vicenza, Italy;
| | - Alberta Caleffi
- U.O. Diagnostica Ematochimica, Azienda Ospedaliero-Universitaria, 43126 Parma, Italy; (A.C.); (M.M.)
| | - Mariella Mercadanti
- U.O. Diagnostica Ematochimica, Azienda Ospedaliero-Universitaria, 43126 Parma, Italy; (A.C.); (M.M.)
| | - Sauro Maoggi
- Sebia-Italia S.r.l., 50012 Bagno a Ripoli, Italy;
| | - Giovanni Ivaldi
- Formerly, Laboratorio Genetica Umana, Galliera Hospital, 16128 Genova, Italy;
| | - Domenico Coviello
- Laboratorio Genetica Umana, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (N.M.); (M.M.); (D.C.)
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