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Abstract
High oxygen affinity hemoglobins are responsible for rare and heterogeneous autosomic dominant genetic diseases. They cause pure erythrocytosis, sometimes accountable for hyperviscosity and thrombosis, or hemolysis. Differential diagnoses must be first ruled out. The diagnosis is based on the identification of a decreased P50, and their possible characterization by cation exchange-high performance liquid chromatography and capillary electrophoresis. Finally, genetic studies of the responsible globin chain gene will confirm the mutation. The prognosis mainly relies on the P50 decrease rate and on the hemoglobin cooperativity impairment. Disease management should be personalized, and it should primarily depend on smoking cessation and physical activity. Phlebotomy and platelet aggregation inhibitors' prescriptions can be discussed. There is no contraindication to flights, high-altitude conditions, or pregnancy. Nevertheless, blood donation must be prohibited.
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Affiliation(s)
- O Mangin
- Service de médecine interne, hôpital Cochin, 75014 Paris, France.
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Percy MJ, Butt NN, Crotty GM, Drummond MW, Harrison C, Jones GL, Turner M, Wallis J, McMullin MF. Identification of high oxygen affinity hemoglobin variants in the investigation of patients with erythrocytosis. Haematologica 2009; 94:1321-2. [PMID: 19734427 DOI: 10.3324/haematol.2009.008037] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Grace RJ, Gover PA, Treacher DF, Heard SE, Pearson TC. Venesection in haemoglobin Yakima, a high oxygen affinity haemoglobin. CLINICAL AND LABORATORY HAEMATOLOGY 2008; 14:195-9. [PMID: 1451399 DOI: 10.1111/j.1365-2257.1992.tb00365.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
High oxygen affinity haemoglobins result in polycythaemia and cardiovascular adaptation to maintain tissue oxygenation. The polycythaemia can cause symptoms of hyperviscosity and vaso-occlusive disease. We report a kindred with a high affinity haemoglobin (Haemoglobin Yakima) one of whose members gave birth to two infants with intra-uterine growth retardation and who suffered with symptoms of hyperviscosity which settled on reduction of the PCV by venesection.
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Affiliation(s)
- R J Grace
- Department of Haematology, St. Thomas' Hospital, London, UK
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Hoyer JD, Weinhold J, Mailhot E, Alter D, McCormick DJ, Snow K, Kubik KS, Holmes MW, Fairbanks VF. Three new hemoglobin variants with abnormal oxygen affinity: Hb Saratoga Springs [alpha40(C5)Lys --> Asn (alpha1)], Hb Santa Clara [beta97(FG4)His --> Asn], and Hb Sparta [beta103(G5)Phe --> Val]. Hemoglobin 2004; 27:235-41. [PMID: 14649314 DOI: 10.1081/hem-120026048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- James D Hoyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Beard ME, Potter HC, Spearing RL, Brennan SO. Haemoglobin Pierre-Benite--a high affinity variant associated with relative polycythaemia. CLINICAL AND LABORATORY HAEMATOLOGY 2001; 23:407-9. [PMID: 11843890 DOI: 10.1046/j.1365-2257.2001.00350.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This is the second reported example of Hb Pierre--Benite (beta90 Glu-->Asp). This mutation is associated with increased oxygen affinity and polycythaemia. No instability was found and there was no charge shift detected by cellulose acetate electrophoresis at pH 8.3. The mutation was however, clearly indicated by electrospray ionization mass spectrometry (ESI MS), which showed an abnormal beta chain with a 14 Da decrease in mass. Blood volume studies documented a relative rather than a true polycythaemia and this finding has been reported in at least two other high affinity haemoglobin variants--Hb Heathrow and Hb Rahere. This finding led to delay in diagnosis because high oxygen affinity variants are conventionally considered to cause a true polycythaemia.
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Affiliation(s)
- M E Beard
- The Department of Haematology, Christchurch Hospital, Canterbury Health, Christchurch, New Zealand.
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Ferranti P, Malorni A, Pucci P. Structural characterization of hemoglobin variants using capillary electrophoresis and fast atom bombardment mass spectrometry. Methods Enzymol 1994; 231:45-65. [PMID: 7518889 DOI: 10.1016/0076-6879(94)31006-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- P Ferranti
- Servizio di Spetrometria di Massa del C.N.R., Naples, Italy
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Wajcman H, Kister J, M'Rad A, Promé D, Milpied N, Rapp MJ, Harousseau JL, Riou J, Bardakdjian J, Galacteros F. Hb Saint Nazaire (beta 103[G5]Phe-->Ile): a new example of polycythemia due to a hemoglobin variant with increased oxygen affinity. Am J Hematol 1993; 44:16-21. [PMID: 8342560 DOI: 10.1002/ajh.2830440105] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Hb Saint Nazaire [beta 103 (G5) Phe-->Ile] was found in four apparently unrelated French families. The five patients carrying this hemoglobin have been detected because of a moderate erythrocytosis. The structural abnormality of Hb Saint Nazaire concerns the same residue as in Hb Heathrow [beta 103 (G5) Phe-->Leu). A comparative functional study between these two variants showed that the increase in oxygen affinity is much lower in Hb Saint Nazaire than in Hb Heathrow. The replacement of phenylalanine G5, which is localized within the heme pocket, by a leucine abolishes several contacts between the heme and the globin and leads to an environment of the heme having some similarities with that observed in myoglobin. In contrast, the replacement of G5 by an isoleucine is likely to introduce less structural modifications.
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Affiliation(s)
- H Wajcman
- INSERM U299, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
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Marsh G, Marino G, Pucci P, Ferranti P, Malorni A, Kaeda J, Marsh J, Luzzatto L. A third instance of the high oxygen affinity variant, Hb Heathrow [beta 103(G5)Phe- greater than Leu]: identification of the mutation by mass spectrometry and by DNA analysis. Hemoglobin 1991; 15:43-51. [PMID: 1917536 DOI: 10.3109/03630269109072483] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Hb. Heathrow [beta 103(G5)Phe- greater than Leu] was identified in an Englishman with a life-long history of polycythemia, his father had been similarly affected. A hemoglobin variant was suspected from the high oxygen affinity of the patient's blood. The Hb Heathrow abnormal beta chain was resolved from the normal beta chain by high performance liquid chromatography, and the abnormal peptide and the amino acid replacement were identified by mass spectrometry. The corresponding base change (C- greater than G at codon 103) was demonstrated by sequence analysis of the polymerase chain reaction amplified exon 2 of the genomic beta-globin gene. This is only the third known instance of Hb Heathrow.
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Affiliation(s)
- G Marsh
- Department of Haematology, North Middlesex Hospital, London, UK
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Abstract
The absolute polycythaemias include all patients who have a raised red cell mass. They may be divided by clinical and laboratory investigation into: primary proliferative polycythaemia (polycythaemia rubra vera), secondary polycythaemias, and idiopathic erythrocytosis. In vitro, the PCV is the single most important determinant of whole blood viscosity with the most marked effects at low shear rates. Yield stress is also dominantly influenced by PCV. Thus in the absolute polycythaemias, from whatever cause, whole blood viscosity and yield stress are high. However, flow conditions in vivo are much more complex than those usually used in in-vitro measurements. Under normal physiological conditions, whole blood viscosity probably does not determine flow in vivo. The observed in-vitro changes are only of relevance in vivo when local or general abnormalities of flow occur. In primary proliferative polycythaemia (PPP) and idiopathic erythrocytosis, presentation with ischaemia or thrombosis (either arterial or venous) is common, and the cerebral circulation is at particular risk. The incidence of vascular occlusion is positively correlated with the PCV. There is an inverse correlation between PCV and cerebral blood flow (CBF), with untreated patients having low CBF values. This is probably a 'physiological' change related to the increased oxygen carrying capacity at high PCV values. However, in many patients, cerebral oxygen carriage actually increases on reduction of the PCV to normal. This explains the improvement in cerebral ischaemic symptoms and mental performance which may be observed following treatment. Platelet contact and adhesion to the vessel wall are increased at high PCV values and, combined with the lower blood flow in both the arteries and veins, tend to favour thrombus formation. Ischaemia causes vessel dilatation but when this is maximal the high whole-blood viscosity demonstrated in vitro is a major determinant of flow. Hence in man and experimental animals, as demonstrated in the brain, the area of ischaemia or non-perfusion following arterial occlusion is greatest at high PCV values. Patients with polycythaemia due to hypoxic lung disease have a poor prognosis. The hypoxic pulmonary vasoconstriction combined with the high blood viscosity causes an increase in pulmonary vessel resistance. PCV reduction of 0.50-0.52 leads to an improvement in work performance and mental alertness, and reduction in pulmonary vascular resistance.(ABSTRACT TRUNCATED AT 400 WORDS)
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Steinberg MH, Adams JG. Thalassemic hemoglobinopathies. THE AMERICAN JOURNAL OF PATHOLOGY 1983; 113:396-409. [PMID: 6359893 PMCID: PMC1916350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hemoglobinopathies are due to changes in the normal amino acid sequence of globin. Thalassemias result from imbalance in the normal coordinated synthesis of the globin subunits that make up the hemoglobin tetramer. It is now apparent that a single globin gene can have coding region mutations which simultaneously produce a structural defect (hemoglobinopathy) and a biosynthetic defect (thalassemia). It is likely that two distinct mutations within the same gene can occur and produce a hemoglobinopathy with features of thalassemia. In this review the authors discuss such disorders and include the Hb Lepore and Constant Spring variants, hyper-unstable globins, mutations which create alternative sites for mRNA splicing, and amino acid substitutions likely to be associated with an additional thalassemia lesion within the same gene.
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Wada Y, Hayashi A, Fujita T, Matsuo T, Katakuse I, Matsuda H. Structural analysis of human hemoglobin variants with field desorption mass spectrometry. BIOCHIMICA ET BIOPHYSICA ACTA 1981; 667:233-41. [PMID: 7213803 DOI: 10.1016/0005-2795(81)90188-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Tryptic hydrolyzates of normal and abnormal human globin chains were analyzed with mass spectrometry, using field desorption ionization technique. All the peptides, including core peptides, were detected as protonated molecular ions in field desorption mass spectra. Since the technique makes it possible to determine the mass number of each peptide, it is very useful for structural analysis of human hemoglobin variants, even those with electrophoretically and chromatographically silent mutations.
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Beard ME, Hamer JW, Brennan SO, Jones JN, Sheat JM, Maclaurin JS. Familial relative polycythaemia due to haemoglobin Heathrow. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1979; 9:297-301. [PMID: 288399 DOI: 10.1111/j.1445-5994.1979.tb04143.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Eleven affected members of a New Zealand family carrying the high oxygen affinity haemoglobin Heathrow are described. The detection of high oxygen affinity abnormal haemoglobins may be difficult as haemoglobin and red cell mass may both fall within the normal range and no abnormality may be detected on haemoglobin electrophoresis or by haemoglobin stability tests. The importance of oxygen affinity studies to establish the diagnosis is emphasized.
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High affinity haemoglobins. BRITISH MEDICAL JOURNAL 1977; 2:1040-1. [PMID: 922410 PMCID: PMC1631832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Charache S. Homeostatic responses to increased oxygen affinity. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1977; 94:433-41. [PMID: 26175 DOI: 10.1007/978-1-4684-8890-6_58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Weatherall DJ, Clegg JB, Callender ST, Wells RM, Gale RE, Huehns ER, Perutz MF, Viggiano G, Ho C. Haemoglobin Radcliffe (alpha2beta299(Gi)Ala): a high oxygen-affinity variant causing familial polycythaemia. Br J Haematol 1977; 35:177-91. [PMID: 857849 DOI: 10.1111/j.1365-2141.1977.tb00575.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Three members of an Oxfordshire family have polycythaemia. In each case their whole-blood oxygen affinity is increased. This is due to a previously undescribed haemoglobin variant which has been named haemoglobin Radcliffe (alpha2beta299(Gl)Ala). In addition to having a high oxygen affinity haemoglobin Radcliffe shows virtually no haem-haem interaction and a diminished Bohr effect. It is synthesized at the same rate and is as stable as haemoglobin A. X-ray analysis indicates that crystals of deoxyhaemoglobin Radcliffe are isomorphous with those of deoxyhaemoglobin A. Solutions of haemoglobin Radcliffe were also studied by high-resolution proton nuclear magnetic resonance spectroscopy. The structure/function relationships of haemoglobin Radcliffe are discussed in the light of these studies.
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Abstract
This paper describes a method for isolating high oxygen affinity hemoglobins. It involves the selective derivatisation of the cysteine residue at position 93 in the beta chain. The iodoacetamide derivative of the high oxygen affinity hemoglobin was separated from the more negatively charged iodoacetic acid derivative of HbA on DEAE-Sephadex. The method was used to isolate two high oxygen affinity hemoglobins, one of which was subsequently identified as Hb Heathrow.
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Kirschenbaum DM. A compilation of amino acid analyses of proteins. IX. Residues per mole of protein--7. Hemoglobin, part A--human. Anal Biochem 1975; 65:466-99. [PMID: 1093450 DOI: 10.1016/0003-2697(75)90534-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Jensen M, Oski FA, Nathan DG, Bunn HF. Hemoglobin Syracuse (alpha2beta2-143(H21)His leads to Pro), a new high-affinity variant detected by special electrophoretic methods. Observations on the auto-oxidation of normal and variant hemoglobins. J Clin Invest 1975; 55:469-77. [PMID: 234980 PMCID: PMC301774 DOI: 10.1172/jci107953] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Family members from four generations were found to have polycythemia and increased whole blood O2 affinity (P50; 11 mm Hg; normal, 27 mm Hg). No abnormal hemoglobin bands were seen after electrophoresis on starch gel at pH 8.6 or agar gel at pH 6.0. Analysis of the oxygenated hemolysate by isoelectric focusing on polyacrylamide gel revealed two closely spaced bands. When deoxygenated hemolysate was analyzed in oxygen-free gels, the two components were more widely separated. About 40% of the patient's hemoglobin focused at a more acid pH than hemoglobin A, indicating a hemoglobin variant with impaired Bohr effect. Chromatography of globin in 8 M urea revealed two beta-chain peaks, the first of which was eluted at a lower buffer molarity than normal beta chain. Fingerprints of tryptic digests of the aminoethylated chains were done on silica gel thin-layer plates. Tp 14 from the abnormal beta chain had slower electrophoretic mobility and a greater Rf value. Amino acid analyses of this peptide gave values identical with those of betaTp 14, except that it contained one proline residue and no histidine. Since the one His in betaTp 14 is in position 143, hemoglobin Syracuse in alpha2beta2-143 His leads to Pro. Native Hb Syracuse could be separated from hemoglobin A on a carboxymethylcellulose column. The inclusion of 0.1 mM EDTA in the preparative buffers proved very useful in reducing the formation of methemoglobin. Oxygen equilibria of purified hemoglobin Syracuse showed high oxygen affinity (P50 value 12% that of hemoglobin A) and lack of cooperativity between subunits (Hill's n equals 1.1). The alkaline Bohr effect was about half that of hemoglobin A. The proline substitution at betaH21 disrupts the helical configuration and probably prevents the formation of salt bonds that are important in stabilizing the deoxy structure and contribute to the alkaline Bohr effect. Since beta143 His is a binding site for 2,3-diphosphoglycerate (2,3-DPG), it is not suprising that hemoglobin Syracuse had markedly impaired reactivity with 2,3-DPG. Hemoglobin Syracuse auto-oxidized more slowly than hemoglobin A, probably reflecting a slower rate of dissociation of oxygen from fully liganded hemoglobin.
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Lehmann H, Romero-Herrera AE, Joysey KA, Friday AE. Comparative structure of myoglobin: primates and tree-shrew. Ann N Y Acad Sci 1974; 241:380-91. [PMID: 4215355 DOI: 10.1111/j.1749-6632.1974.tb21894.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Harrison PM. Proceedings: Ferritin and haemosiderin. Br J Haematol 1974; 28:137-8. [PMID: 4415264 DOI: 10.1111/j.1365-2141.1974.tb06648.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Dacie JV. The hereditary haemolytic anaemias. JOURNAL OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON 1974; 8:206-19. [PMID: 4824998 PMCID: PMC5366534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
MESH Headings
- Adolescent
- Adult
- Anemia, Hemolytic, Congenital/blood
- Anemia, Hemolytic, Congenital/diagnosis
- Anemia, Hemolytic, Congenital/etiology
- Anemia, Hemolytic, Congenital/therapy
- Anemia, Hemolytic, Congenital Nonspherocytic/etiology
- Anemia, Sickle Cell/etiology
- Blood Proteins/metabolism
- Cell Membrane/metabolism
- Child
- Elliptocytosis, Hereditary/etiology
- Erythrocyte Aging
- Erythrocytes/metabolism
- Female
- Glucosephosphate Dehydrogenase Deficiency/complications
- Hemoglobinopathies/etiology
- Homozygote
- Humans
- Male
- Metabolism, Inborn Errors/complications
- Osmotic Fragility
- Postoperative Complications
- Pyruvate Kinase/metabolism
- Spherocytosis, Hereditary/etiology
- Splenectomy
- Thromboembolism/etiology
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Romero-Herrera AE, Lehmann H, Joysey KA, Friday AE. Molecular evolution of myoglobin and the fossil record: a phylogenetic synthesis. Nature 1973; 246:389-95. [PMID: 4202790 DOI: 10.1038/246389a0] [Citation(s) in RCA: 124] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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