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Ma S, Tang L, Wu C, Tang H, Pu X, Niu J. Study on Management of Blood Transfusion Therapy in Patients with Hereditary Spherocytosis. Appl Bionics Biomech 2022; 2022:6228965. [PMID: 35126660 PMCID: PMC8816590 DOI: 10.1155/2022/6228965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 12/17/2022] Open
Abstract
Hereditary spherocytosis (HS) is a chronic hemolytic disorder caused by inherited defects in the red blood cell membrane. This study discusses the treatment strategy for the decline in hemoglobin level in three HS probands with moderately severe or severe hemolysis and summarizes the appropriate laboratory tests that help improve clinical management of blood transfusion in HS patients. Three probands who were diagnosed with HS in our hospital and their family members were included in this study. Clinical data of the three families were reviewed to summarize their hematopoietic characteristics. DNA from all family members of the 3 HS probands was amplified by polymerase chain reaction (PCR) and sequenced by the Sanger method to assess genetic relation for HS. Based on the sequencing results, the type of mutated membrane protein in each proband was analyzed using the eosin-5'-maleimide (EMA) binding test and sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The hemoglobin level was reduced in all 3 probands after different levels of infection. The fluorescence of EMA-labeled red blood cell (RBC) was decreased. DNA sequencing showed that His54Pro, Leu1858Val, and 6531-12C>T compound heterozygous mutations were present in the SPTA1 gene of patient I-1, Arg344Gln and c.609+86G>A heterozygous mutations were present in the SLC4A1 gene of patient II-1, and Leu2032Pro homozygous mutation was present in the SPTB gene of patient III-1. SDS-PAGE results demonstrated that the concentration of band 3 was reduced in II-1, whereas the levels of the corresponding mutant proteins in the other probands were unchanged. The family members of the respective patients presented mutations in major genes causing HS. The Leu2032Pro mutation identified in patient III-1 is a new missense mutation of the SPTB gene in the Chinese population that has never been reported in literature previously. The presence or absence of acute or chronic infections is a critical deciding factor for the treatment and clinical management of HS patient via blood transfusion. For patients with infections, hemoglobin concentration can be restored once the infection is controlled, thus obviating the need for proper infection control before blood transfusion.
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Affiliation(s)
- Shiyue Ma
- Department of Laboratory Medicine, Affiliated Hospital of Guilin Medical University, Guilin City 541001, Guangxi Zhuang Autonomous Region, China
| | - Lingjian Tang
- Department of Rehabilitation Medicine, Affiliated Hospital of Guilin Medical University, Guilin City 541001, Guangxi Zhuang Autonomous Region, China
| | - Chaoli Wu
- Department of Laboratory Medicine, Affiliated Hospital of Guilin Medical University, Guilin City 541001, Guangxi Zhuang Autonomous Region, China
| | - Hui Tang
- Department of Laboratory Medicine, Affiliated Hospital of Guilin Medical University, Guilin City 541001, Guangxi Zhuang Autonomous Region, China
| | - Xue Pu
- Department of Laboratory Medicine, Affiliated Hospital of Guilin Medical University, Guilin City 541001, Guangxi Zhuang Autonomous Region, China
| | - Jinhong Niu
- Department of Medical Administration, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin City 541002, Guangxi Zhuang Autonomous Region, China
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Zaidi AU, Buck S, Gadgeel M, Herrera-Martinez M, Mohan A, Johnson K, Bagla S, Johnson RM, Ravindranath Y. Clinical Diagnosis of Red Cell Membrane Disorders: Comparison of Osmotic Gradient Ektacytometry and Eosin Maleimide (EMA) Fluorescence Test for Red Cell Band 3 (AE1, SLC4A1) Content for Clinical Diagnosis. Front Physiol 2020; 11:636. [PMID: 32636758 PMCID: PMC7318840 DOI: 10.3389/fphys.2020.00636] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
The measurement of band 3 (AE1, SLC4A1, CD233) content of red cells by eosin-5- maleimide (EMA) staining is swiftly replacing conventional osmotic fragility (OF) test as a tool for laboratory confirmation of hereditary spherocytosis across the globe. Our group has systematically evaluated the EMA test as a method to screen for a variety of anemias in the last 10 years, and compared these results to those obtained with the osmotic gradient ektacytometry (osmoscans) which we have used over three decades. Our overall experience allowed us to characterize the distinctive patterns with the two tests in several congenital erythrocyte membrane disorders, such as hereditary spherocytosis (HS), hereditary elliptocytosis (HE), Southeast Asian Ovalocytosis (SAO), hereditary pyropoikilocytosis (HPP) variants, erythrocyte volume disorders, various red cell enzymopathies, and hemoglobinopathies. A crucial difference between the two methodologies is that osmoscans measure red blood cell deformability of the entire sample of RBCs, while the EMA test examines the band 3 content of individual RBCs. EMA content is influenced by cell size as smaller red cells have lower amount of total membrane than larger cells. The SAO mutation alters the EMA binding site resulting in a lower EMA MCF even as the band 3 content itself is unchanged. Thus, EMA scan results should be interpreted with caution and both the histograms and dot plots should be analyzed in the context of the clinical picture and morphology.
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Affiliation(s)
| | - Steven Buck
- Children's Hospital of Michigan, Detroit, MI, United States.,Wayne State University School of Medicine, Detroit, MI, United States
| | - Manisha Gadgeel
- Wayne State University School of Medicine, Detroit, MI, United States
| | | | - Araathi Mohan
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Kenya Johnson
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Shruti Bagla
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Robert M Johnson
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Yaddanapudi Ravindranath
- Children's Hospital of Michigan, Detroit, MI, United States.,Wayne State University School of Medicine, Detroit, MI, United States
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Jamwal M, Sharma P, Das R. Laboratory Approach to Hemolytic Anemia. Indian J Pediatr 2020; 87:66-74. [PMID: 31823208 DOI: 10.1007/s12098-019-03119-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022]
Abstract
Hemolytic anemias are a group of disorders with varied clinical and molecular heterogeneity. They are characterized by decreased levels of circulating erythrocytes in blood. The pathognomic finding is a reduced red cell life span with severe anemia or, compensated hemolysis accompanied by reticulocytosis. The diagnostic workup or laboratory approach for hemolytic anemias is based on methodical step-wise testing which includes red blood cell morphology, hematological indices with increased reticulocyte count along with clinical features of hemolytic anemias. If conventional laboratory tests are unable to detect the underlying cause of hemolysis, genetic testing is recommended. Sanger sequencing along with conventional testing is the most efficient way to diagnose the underlying genetic causes, especially in thalassemias/hemoglobinopathies, if required. However, hemolytic anemias being highly heterogeneous disorders, next-generation sequencing-based screening is rapidly becoming an efficient way to decipher the etiologies where common causes have been excluded.
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Affiliation(s)
- Manu Jamwal
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Prashant Sharma
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Reena Das
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Abay A, Simionato G, Chachanidze R, Bogdanova A, Hertz L, Bianchi P, van den Akker E, von Lindern M, Leonetti M, Minetti G, Wagner C, Kaestner L. Glutaraldehyde - A Subtle Tool in the Investigation of Healthy and Pathologic Red Blood Cells. Front Physiol 2019; 10:514. [PMID: 31139090 PMCID: PMC6527840 DOI: 10.3389/fphys.2019.00514] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/11/2019] [Indexed: 01/03/2023] Open
Abstract
Glutaraldehyde is a well-known substance used in biomedical research to fix cells. Since hemolytic anemias are often associated with red blood cell shape changes deviating from the biconcave disk shape, conservation of these shapes for imaging in general and 3D-imaging in particular, like confocal microscopy, scanning electron microscopy or scanning probe microscopy is a common desire. Along with the fixation comes an increase in the stiffness of the cells. In the context of red blood cells this increased rigidity is often used to mimic malaria infected red blood cells because they are also stiffer than healthy red blood cells. However, the use of glutaraldehyde is associated with numerous pitfalls: (i) while the increase in rigidity by an application of increasing concentrations of glutaraldehyde is an analog process, the fixation is a rather digital event (all or none); (ii) addition of glutaraldehyde massively changes osmolality in a concentration dependent manner and hence cell shapes can be distorted; (iii) glutaraldehyde batches differ in their properties especially in the ratio of monomers and polymers; (iv) handling pitfalls, like inducing shear artifacts of red blood cell shapes or cell density changes that needs to be considered, e.g., when working with cells in flow; (v) staining glutaraldehyde treated red blood cells need different approaches compared to living cells, for instance, because glutaraldehyde itself induces a strong fluorescence. Within this paper we provide documentation about the subtle use of glutaraldehyde on healthy and pathologic red blood cells and how to deal with or circumvent pitfalls.
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Affiliation(s)
- Asena Abay
- Dynamics of Fluids, Department of Experimental Physics, Saarland University, Saarbrücken, Germany.,Landsteiner Laboratory, Sanquin, Amsterdam, Netherlands
| | - Greta Simionato
- Dynamics of Fluids, Department of Experimental Physics, Saarland University, Saarbrücken, Germany.,Theoretical Medicine and Biosciences, Saarland University, Homburg, Germany
| | - Revaz Chachanidze
- Dynamics of Fluids, Department of Experimental Physics, Saarland University, Saarbrücken, Germany.,Université Grenoble Alpes, CNRS, Grenoble INP, LRP, Grenoble, France
| | - Anna Bogdanova
- Red Blood Cell Research Group, Institute of Veterinary Physiology, Vetsuisse Faculty and the Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Laura Hertz
- Dynamics of Fluids, Department of Experimental Physics, Saarland University, Saarbrücken, Germany.,Theoretical Medicine and Biosciences, Saarland University, Homburg, Germany
| | - Paola Bianchi
- UOC Ematologia, UOS Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Marc Leonetti
- Université Grenoble Alpes, CNRS, Grenoble INP, LRP, Grenoble, France
| | - Giampaolo Minetti
- Laboratory of Biochemistry, Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - Christian Wagner
- Dynamics of Fluids, Department of Experimental Physics, Saarland University, Saarbrücken, Germany.,Physics and Materials Science Research Unit, University of Luxembourg, Luxembourg City, Luxembourg
| | - Lars Kaestner
- Dynamics of Fluids, Department of Experimental Physics, Saarland University, Saarbrücken, Germany.,Theoretical Medicine and Biosciences, Saarland University, Homburg, Germany
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Ma S, Qin J, Wei A, Li X, Qin Y, Liao L, Lin F. Novel compound heterozygous SPTA1 mutations in a patient with hereditary elliptocytosis. Mol Med Rep 2018; 17:5903-5911. [PMID: 29484404 PMCID: PMC5866036 DOI: 10.3892/mmr.2018.8632] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 01/24/2018] [Indexed: 12/19/2022] Open
Abstract
Hereditaryelliptocytosis (HE) is a hereditary hemolytic disease, characterized by the presence of many elliptical erythrocytes in the peripheral blood that is caused by abnormal cytoskeletal proteins in the erythrocyte membrane. In the present study, a novel, causal HE mutation was reported. Routine blood examinations were performed on the proband and their family, and the fluorescence intensity of eosin‑5‑maleimide (EMA)‑labeled erythrocytes was determined via flow cytometry. Subsequently, DNA was extracted from the peripheral blood of the proband and their family members, and amplified by quantitative polymerase chain reaction. The Sanger sequencing approach was used to determine and identify gene mutations, which were verified by matrix‑assisted laser desorption‑ionization time of flight (MALDI‑TOF) mass spectrometry. To exclude genetic polymorphisms, newly identified mutations were subjected to large‑scale gene screening using high‑resolution melt analysis. Protein expression levels in the erythrocyte membrane of the proband were determined via SDS‑PAGE, which demonstrated that, compared with healthy controls, the proband exhibited a reduction in EMA‑labeled erythrocytes. In addition, DNA analysis demonstrated that the proband carried three mutations in the spectrin α chain erythrocytic 1 (SPTA1) gene: c.161A>C, c.5572C>G and 6531‑12C>T. The corresponding mutant polypeptides were also analyzed by MALDI‑TOF mass spectroscopy. SDS‑PAGE analysis indicated that the proband exhibited normal levels of erythrocyte membrane proteins. In the present study, a novel HE case with a His54Pro mutation in the SPTA1 gene was reported. The results suggested that the His54Pro mutation influenced the role of erythrocyte membrane proteins without reducing its level of expression.
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Affiliation(s)
- Shiyue Ma
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Jinqiu Qin
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Aiqiu Wei
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Xiaohong Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Yuanyuan Qin
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Lin Liao
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Faquan Lin
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
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Arora RD, Dass J, Maydeo S, Arya V, Radhakrishnan N, Sachdeva A, Kotwal J, Bhargava M. Flow cytometric osmotic fragility test and eosin-5’-maleimide dye-binding tests are better than conventional osmotic fragility tests for the diagnosis of hereditary spherocytosis. Int J Lab Hematol 2018; 40:335-342. [DOI: 10.1111/ijlh.12794] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/24/2018] [Indexed: 11/27/2022]
Affiliation(s)
- R. D. Arora
- Department of Hematology; Sir Ganga Ram Hospital; New Delhi India
| | - J. Dass
- Department of Hematology; Sir Ganga Ram Hospital; New Delhi India
| | - S. Maydeo
- Department of Hematology; Sir Ganga Ram Hospital; New Delhi India
| | - V. Arya
- Department of Hematology; Sir Ganga Ram Hospital; New Delhi India
| | - N. Radhakrishnan
- Department of Pediatric Hematology-Oncology; Sir Ganga Ram Hospital; New Delhi India
| | - A. Sachdeva
- Department of Pediatric Hematology-Oncology; Sir Ganga Ram Hospital; New Delhi India
| | - J. Kotwal
- Department of Hematology; Sir Ganga Ram Hospital; New Delhi India
| | - M. Bhargava
- Department of Hematology; Sir Ganga Ram Hospital; New Delhi India
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