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Gong Y, Zheng Q, Long S, Chen H, Liu W, Li C. The first Chinese with Hb Chile leading to chronic anemia and methemoglobinemia: a case report. BMC Pediatr 2023; 23:639. [PMID: 38110882 PMCID: PMC10726640 DOI: 10.1186/s12887-023-04462-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Hemoglobin (Hb) Chile [β28(B10) Leu > Met; HBB: c.85 C > A] is a rare hemoglobin variant caused by a missense mutation in the HBB gene. Only one case of Hb Chile has been reported worldwide so far. It is an unstable hemoglobin, characterized by cyanosis associated with chronic methemoglobinemia and hemolytic anemia induced by sulfonamides or methylene blue. CASE PRESENTATION A 9-year-3-month-old girl had mild anemia of unknown etiology for more than 6 years. She had a slight pallor without other symptoms or signs. The complete blood count revealed normocytic normochromic anemia with a sometimes-elevated reticulocyte count, and the bone marrow cytology showed marked erythroid hyperplasia, but the tests related to hemolysis were normal. Therefore, the whole exome sequencing was performed and showed a heterozygous mutation for HBB: c.85 C > A. With asymptomatic methemoglobinemia confirmed later, she was eventually diagnosed with Hb Chile. CONCLUSIONS This is the first report of Hb Chile in China and the second worldwide. This case shows that Hb Chile is clinically heterogeneous and difficult to diagnose and expands our understanding on the clinical and hematological traits of the disease.
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Affiliation(s)
- Yao Gong
- Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan, 646000, China
| | - Qinxin Zheng
- Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan, 646000, China
| | - Sili Long
- Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan, 646000, China
| | - Hongying Chen
- Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan, 646000, China
| | - Wenjun Liu
- Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan, 646000, China
| | - Cheng Li
- Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Luzhou, China.
- Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan, 646000, China.
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Colah RB, Nadkarni A, Gorakshakar A, Sawant P, Gorivale M, Mehta P, Sawant M, Ghosh K. Five Rare β Globin Chain Hemoglobin Variants in India. Indian J Hematol Blood Transfus 2016; 32:282-6. [PMID: 27408413 DOI: 10.1007/s12288-016-0676-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 04/05/2016] [Indexed: 11/24/2022] Open
Abstract
Thalassemias as well as structural hemoglobin (Hb) variants are common monogenic inherited disorders of Hb in India. In this paper we describe 5 rare β-chain Hb variants identified in the Indian population on the basis of high performance liquid chromatography (HPLC). Of these 3 were identified during antenatal screening of β-thalassemia while the other 2 cases were referred to us for a diagnostic work up. These 5 Hb variants were Hb British Columbia (β CD 101 GAG → AAG), Hb Saint Louis (β CD28 CTG → CAG), Hb G Coushatta (β CD 22 GAA → GCA), Hb Pyrgos (β CD 83 GGC → GAC) and Hb Agenogi (β CD 90 GAG → AAG). Hb Saint Louis and Hb G Coushatta eluted in the HbA2 window, Hb British Columbia and Hb Agenogi eluted in the Hb C window while Hb Pyrgos eluted in an unknown window on HPLC. They were all identified by DNA sequencing. The child having Hb St. Louis had hepatosplenomegaly and anemia while the individuals with the other 4 variants were asymptomatic. Rare Hb variants are diagnostic curiosities that may be encountered by laboratories. Correct identification requires the application of more than one technique to avoid misdiagnosing them as more common variants (e.g. St. Louis and G Coushatta as E or D Iran on HPLC. Some, like G Coushatta may interfere with HPLC-based HbA1c estimation).
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Affiliation(s)
- Roshan B Colah
- National Institute of Immunoheamatology, Indian Council of Medical Research (ICMR), 13th Floor, New MS Building, KEM Hospital Campus, Parel, Mumbai, 400012 India
| | - Anita Nadkarni
- National Institute of Immunoheamatology, Indian Council of Medical Research (ICMR), 13th Floor, New MS Building, KEM Hospital Campus, Parel, Mumbai, 400012 India
| | - Ajit Gorakshakar
- National Institute of Immunoheamatology, Indian Council of Medical Research (ICMR), 13th Floor, New MS Building, KEM Hospital Campus, Parel, Mumbai, 400012 India
| | - Pratibha Sawant
- National Institute of Immunoheamatology, Indian Council of Medical Research (ICMR), 13th Floor, New MS Building, KEM Hospital Campus, Parel, Mumbai, 400012 India
| | - Manju Gorivale
- National Institute of Immunoheamatology, Indian Council of Medical Research (ICMR), 13th Floor, New MS Building, KEM Hospital Campus, Parel, Mumbai, 400012 India
| | - Pallavi Mehta
- National Institute of Immunoheamatology, Indian Council of Medical Research (ICMR), 13th Floor, New MS Building, KEM Hospital Campus, Parel, Mumbai, 400012 India
| | - Madhavi Sawant
- National Institute of Immunoheamatology, Indian Council of Medical Research (ICMR), 13th Floor, New MS Building, KEM Hospital Campus, Parel, Mumbai, 400012 India
| | - Kanjaksha Ghosh
- National Institute of Immunoheamatology, Indian Council of Medical Research (ICMR), 13th Floor, New MS Building, KEM Hospital Campus, Parel, Mumbai, 400012 India
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Abstract
Neonatal cyanosis in healthy newborns can be associated either with methemoglobin due to cytochrome b5 reductase deficiency or to M-hemoglobin, a group of hemoglobin variants resulting from mutations in the globin chain genes. We report the clinical case of a neonate with cyanosis and normal cardiac and respiratory function. At birth the hematological parameters were normal; however, the methemoglobinemia was 16%. Spontaneously, the cyanosis gradually decreased and by the fifth month of age the methemoglobin level was normal. A heterozygous Gγ-globin gene (HBG2) missense mutation 87 C-A (Leu28Met) was identified. His father, with a history of transfusion in the neonatal period, is heterozygous for the same mutation. This hemoglobin variant, not previously described, was called Hb F Viseu and is the sixth Gγ-chain variant reported in association with neonatal cyanosis.
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Hojas-Bernal R, McNab-Martin P, Fairbanks VF, Holmes MW, Hoyer JD, McCormick DJ, Kubik KS. Hb Chile [beta28(B10)Leu-->Met]: an unstable hemoglobin associated with chronic methemoglobinemia and sulfonamide or methylene blue-induced hemolytic anemia. Hemoglobin 1999; 23:125-34. [PMID: 10335980 DOI: 10.3109/03630269908996157] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Among the causes of life-long cyanosis are congenital methemoglobinemia due to M hemoglobins, congenital methemoglobinemia due to methemoglobin reductase deficiency, a small number of low oxygen affinity hemoglobins, and a small number of unstable hemoglobins that spontaneously form methemoglobin in vivo at an accelerated rate. We report an unstable hemoglobin with these characteristics that was observed in a family of indigenous (native American) origin living near Santiago, Chile. This variant has the substitution beta28(B10)Leu-->Met, unambiguously corresponding to the DNA mutation of CTG-->ATG in beta-globin gene codon 28.
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Affiliation(s)
- R Hojas-Bernal
- Facultad de Medicina, Universidad de Chile, Departamento de Medicina Interna, Hospital Clinica San Borja-Arriaran, Santiago
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Brabec V, Indrák K, Fortová H, Suttnar J, Blazek B, Cermák J, Divoký V, Vepreková L, Zeman J. Hb Nottingham or alpha 2 beta 2 98 (FG5) Val-->Gly in a Czech child. Ann Hematol 1994; 69:93-5. [PMID: 8080886 DOI: 10.1007/bf01698489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report a fourth case of Hb Nottingham [alpha 2 beta 2 98 (FG5) Val-->Gly] observed in an 8-year-old girl in the Czech Republic with clinical and laboratory symptoms of severe hemolytic anemia. The unstable hemoglobin probably represents a de novo mutation, since the parents of the patient and the two siblings do not exhibit any hematological abnormalities. Splenectomy had a beneficial effect on the degree of hemolysis, as well as on the Hb level.
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Affiliation(s)
- V Brabec
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
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Fujisawa K, Yamashiro Y, Hattori Y, Ohha Y, Kajita T, Kageyama S, Arita J. Hb Higashitochigi (Hb Ht) [ beta 24(B6) or beta 25(B7) glycine deleted]: a new unstable variant expressing cyanosis. Hemoglobin 1993; 17:467-73. [PMID: 8294206 DOI: 10.3109/03630269308997502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- K Fujisawa
- School of Allied Medical Sciences, Yamaguchi University, Ube, Japan
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Indrak K, Brabec V, Indrakova J, Chrobak L, Sakalova A, Jarosova M, Cermak J, Fei YJ, Kutlar F, Gu YC. Molecular characterization of beta-thalassemia in Czechoslovakia. Hum Genet 1992; 88:399-404. [PMID: 1740317 DOI: 10.1007/bf00215673] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We have identified different beta-thalassemia mutations in 93 members of 34 families of Czech or Slovakian descent using gene amplification, hybridization with specific 32P-labeled oligonucleotide probes, sequencing of amplified DNA, and gene mapping. The G----A mutation at IVS-I-1 was found in 18 families; other Mediterranean mutations were IVS-II-1 (G----A), IVS-II-745 (C----G), IVS-I-110 (G----A), and codon 39 (C----T); these were present in 9 additional families. The G----T mutation at codon 121, known to cause Heinz-body beta-thalassemia, was present in 3 families, and the frameshift at codons 82/83 (-G), first described in the Azerbaijanian population, in 2 families. A newly discovered allele was a frameshift at codons 38/39 (-C). One beta-thalassemia allele was incompletely characterized. We observed in 2 families a T----C mutation at position +96 UTR (untranslated region) relative to the termination codon; this mutation likely is a rare polymorphism. alpha-Thalassemia was rare; only one person carried the -alpha 3.7 heterozygosity, and one other had a yet to be identified alpha-thalassemia-1, while seven had the alpha alpha alpha anti 3.7 triplication.
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Affiliation(s)
- K Indrak
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta 30912-2100
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Indrak K, Brabec V, Wilson JB, Webber BB, Huisman TH. Hb Köln or alpha 2 beta 2(98)(FG5)Val----Met in a Czechoslovakian family. Hemoglobin 1991; 15:133-5. [PMID: 1917535 DOI: 10.3109/03630269109072495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- K Indrak
- Department of Cell and Molecular Biology, Medical College of Georgia, Augusta 30912-2100
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Abstract
About 70 variants of Hb A with associated hemolytic disorders have been reported during the past 30 years. I have classified them according to four grades of severity of chronic hemolysis. Acute episodes of severe hemolysis may be seen in all classes. In addition, some 80 variants without overt hemolysis have given positive results with in vitro hemoglobin instability tests. The stereochemical bases for instability can be conjectured in most cases, although few unstable hemoglobins have actually been studied by X-ray crystallography. The mechanisms for denaturation of normal Hb A and its acceleration in unstable hemoglobins were proposed some 15 years ago. The alterations of membrane lipids and proteins leading to red cell senescence and the relevance of hemoglobin denaturation to this process are presently being investigated. Several "hyperunstable" variants are clinically silent, or equivalent to a thalassemia, probably because of very efficient degradation of the abnormal chains.
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Affiliation(s)
- Y Ohba
- Department of Clinical Laboratory Science, Yamaguchi University School of Medicine, Ube, Japan
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