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Marchesani S, Di Mauro M, Ceglie G, Grassia G, Carletti M, Cristofaro RC, Cossutta M, Curcio C, Palumbo G. The blood count as a compass to navigate in the ever-changing landscape of the carrier state of hemoglobinopathies: a single-center Italian experience. Front Pediatr 2023; 11:1228443. [PMID: 37868262 PMCID: PMC10587575 DOI: 10.3389/fped.2023.1228443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Approximately 7% of the worldwide population exhibits variations in the globin genes. The recent migration of populations from countries where hemoglobin disorders are endemic has resulted in important epidemiological changes with the diffusion of newly discovered or poorly characterized genetic variants and new combinations and very heterogeneous clinical phenotypes. The aim of our study is to assess the parameters that are more significant in predicting a positive genetic testing outcome for hemoglobinopathies in a pediatric population of patients presenting with anemia or microcythemia, without a definite diagnosis. Methods and materials This study included patients evaluated in our hematological outpatient clinic for anemia and/or microcythemia despite normal ferritin levels. A screening of pathological hemoglobins using high-performance liquid chromatography (HPLC) was performed for the entire population of the study. Subsequently, patients with hemoglobin (Hb) S trait and patients with an HPLC profile compatible with beta thalassemia trait were excluded from the study. Genetic screening tests for hemoglobinopathies were performed on the remaining patients, which involved measuring the red blood cell (RBC) counts, red blood cells distribution width (RDW), reticulocyte count, and mean corpuscular volume of reticulocytes (MCVr). Results This study evaluated a total of 65 patients, consisting of nine patients with negative genetic analysis results and 56 patients with positive genetic analysis results. The Hb and RDW values in these two groups did not demonstrate statistical significance. On the other hand, there were statistically significant differences observed in the mean corpuscular volume (MCV), RBC count, reticulocyte count, and MCVr between the two groups. Furthermore, in the group of patients with positive genetic test results, specific genetic findings associated with different HPLC results were observed. In particular, 13 patients with positive genetic test results had normal HPLC findings. Discussion This study has demonstrated that HPLC, while serving as a valuable first-level test, has some limitations. Specifically, it has been observed that some patients may exhibit a negative HPLC result despite a positive genetic analysis. In addition to the presence of low levels of Hb and HPLC alterations, other parameters could potentially indicate the underlying mutations in the globin genes. Therefore, we propose that the complete blood cell count be utilized as a widely available parameter for conducting targeted genetic analyses to avoid the risk of overlooking rare hemoglobinopathies.
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Affiliation(s)
- Silvio Marchesani
- University Department of Pediatrics, Bambino Gesù Children’s Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Margherita Di Mauro
- University Department of Pediatrics, Bambino Gesù Children’s Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Giulia Ceglie
- Department of Pediatric Hematology and Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ginevra Grassia
- University Department of Pediatrics, Bambino Gesù Children’s Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Michaela Carletti
- Clinical Laboratory Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Matilde Cossutta
- University Department of Pediatrics, Bambino Gesù Children’s Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Cristina Curcio
- Medical Genetics Laboratory, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Palumbo
- University Department of Pediatrics, Bambino Gesù Children’s Hospital, University of Rome Tor Vergata, Rome, Italy
- Department of Pediatric Hematology and Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Capasso S, Cardiero G, Musollino G, Prezioso R, Testa R, Dembech S, Piluso G, Nigro V, Digilio FA, Lacerra G. Functional analysis of three new alpha-thalassemia deletions involving MCS-R2 reveals the presence of an additional enhancer element in the 5' boundary region. PLoS Genet 2023; 19:e1010727. [PMID: 37216374 DOI: 10.1371/journal.pgen.1010727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/31/2023] [Indexed: 05/24/2023] Open
Abstract
We report three novel deletions involving the Multispecies Conserved Sequences (MCS) R2, also known as the Major Regulative Element (MRE), in patients showing the α-thalassemia phenotype. The three new rearrangements showed peculiar positions of the breakpoints. 1) The (αα)ES is a telomeric 110 kb deletion ending inside the MCS-R3 element. 2) The (αα)FG, 984 bp-long, ends 51 bp upstream to MCS-R2; both are associated with a severe α-thalassemia phenotype. 3) The (αα)CT, 5058 bp-long starts at position +93 of MCS-R2 and is the only one associated to a mild α-thalassemia phenotype. To understand the specific role of different segments of the MCS-R2 element and of its boundary regions we carried out transcriptional and expression analysis. Transcriptional analysis of patients' reticulocytes showed that (αα)ES was unable to produce α2-globin mRNA, while a high level of expression of the α2-globin genes (56%) was detected in (αα)CT deletion, characterized by the presence of the first 93 bp of MCS-R2. Expression analysis of constructs containing breakpoints and boundary regions of the deletions (αα)CT and (αα)FG, showed comparable activity both for MCS-R2 and the boundary region (-682/-8). Considering that the (αα)CT deletion, almost entirely removing MCS-R2, has a less severe phenotype than the (αα)FG α0thalassemia deletion, removing both MCS-R2 almost entirely and an upstream 679 bp, we infer for the first time that an enhancer element must exist in this region that helps to increase the expression of the α-globin genes. The genotype-phenotype relationship of other previously published MCS-R2 deletions strengthened our hypothesis.
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Affiliation(s)
- Serena Capasso
- Institute of Genetics and Biophysics "Adriano Buzzati Traverso" (IGB-ABT), National Research Council (CNR), Naples, Italy
| | - Giovanna Cardiero
- Institute of Genetics and Biophysics "Adriano Buzzati Traverso" (IGB-ABT), National Research Council (CNR), Naples, Italy
| | - Gennaro Musollino
- Institute of Genetics and Biophysics "Adriano Buzzati Traverso" (IGB-ABT), National Research Council (CNR), Naples, Italy
| | - Romeo Prezioso
- Institute of Genetics and Biophysics "Adriano Buzzati Traverso" (IGB-ABT), National Research Council (CNR), Naples, Italy
| | - Rosario Testa
- A.O.U. Policlinico Rodolico-San Marco, University of Catania, Catania, Italy
| | - Sabrina Dembech
- Central analysis laboratory, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Foggia, Italy
| | - Giulio Piluso
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Vincenzo Nigro
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
| | - F Anna Digilio
- Research Institute on Terrestrial Ecosystems (IRET-CNR), National Research Council (CNR), Naples, Italy
| | - Giuseppina Lacerra
- Institute of Genetics and Biophysics "Adriano Buzzati Traverso" (IGB-ABT), National Research Council (CNR), Naples, Italy
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mRNA Analysis of Frameshift Mutations with Stop Codon in the Last Exon: The Case of Hemoglobins Campania [α1 cod95 (-C)] and Sciacca [α1 cod109 (-C)]. Biomedicines 2021; 9:biomedicines9101390. [PMID: 34680508 PMCID: PMC8533187 DOI: 10.3390/biomedicines9101390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/05/2022] Open
Abstract
An insertion or deletion of a nucleotide (nt) in the penultimate or the last exon can result in a frameshift and premature termination codon (PTC), giving rise to an unstable protein variant, showing a dominant phenotype. We described two α-globin mutants created by the deletion of a nucleotide in the penultimate or the last exon of the α1-globin gene: the Hb Campania or α1 cod95 (−C), causing a frameshift resulting in a PTC at codon 102, and the Hb Sciacca or α1 cod109 (−C), causing a frameshift and formation of a PTC at codon 133. The carriers showed α-thalassemia alterations (mild microcytosis with normal Hb A2) and lacked hemoglobin variants. The 3D model indicated the α-chain variants’ instability, due to the severe structural alterations with impairment of the chaperone alpha-hemoglobin stabilizing protein (AHSP) interaction. The qualitative and semiquantitative analyses of the α1mRNA from the reticulocytes of carriers highlighted a reduction in the variant cDNAs that constituted 34% (Hb Campania) and 15% (Hb Sciacca) of the total α1-globin cDNA, respectively. We developed a workflow for the in silico analysis of mechanisms triggering no-go decay, and its results suggested that the reduction in the variant mRNA was likely due to no-go decay caused by the presence of a rare triplet, and, in the case of Hb Sciacca, also by the mRNA’s secondary structure variation. It would be interesting to correlate the phenotype with the quantity of other frameshift mRNA variants, but very few data concerning α- and β-globin variants are available.
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Colaco S, Nadkarni A. Borderline HbA 2 levels: Dilemma in diagnosis of beta-thalassemia carriers. MUTATION RESEARCH. REVIEWS IN MUTATION RESEARCH 2021; 788:108387. [PMID: 34893152 DOI: 10.1016/j.mrrev.2021.108387] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 12/17/2022]
Abstract
There is inconsistency in the exact definition of diagnostic levels of HbA2 for β thalassemia trait. While many laboratories consider HbA2 ≥4.0 % diagnostic, still others consider HbA2 ≥3.3 % or HbA2 ≥3.5 % as the cut-off for establishing β thalassemia carrier diagnosis. This is because, over the years, studies have described β thalassemia carriers showing HbA2 levels that lie above the normal range of HbA2 but below the typical carrier range of β thalassemia. These, "borderline HbA2 levels", though not detrimental to health, are significant in β thalassemia carrier diagnosis because they can lead to misinterpretation of results. In this review, we have evaluated the prevalence of borderline HbA2 levels and discussed the causes of borderline HbA2 values. We have also compiled an extensive catalogue of β globin gene defects associated with borderline HbA2 levels and have discussed strategies to avoid misdiagnosing borderline HbA2 β thalassemia carriers. Our analysis of studies that have delineated the cause of borderline HbA2 levels in different populations shows that 35.4 % [626/1766] of all individuals with borderline HbA2 levels carry a molecular defect. Among the positive samples, 17 % [299/1766] show β globin gene defects, 7.7 % [137/1766] show α thalassemia defects, 2.7 % [49/1766] show KLF1 gene mutations, 2.3 % [41/1766] show the co-inheritance of β and α thalassemia, 2.0 % [37/1766] show the co-inheritance of β and δ thalassemia and 1.8 % [32/1766] show α globin gene triplication. It appears that a comprehensive molecular work up of the β globin gene is the only definite method to detect borderline HbA2 β thalassemia carriers, especially in populations with a high prevalence of the disease. The presence of associated genetic or acquired determinants may subsequently be assessed to identify the cause of borderline HbA2.
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Affiliation(s)
- Stacy Colaco
- Department of Hematogenetics, ICMR-National Institute of Immunohematology, 13th Floor, K.E.M. Hospital Campus, Parel, Mumbai, 400 012, India
| | - Anita Nadkarni
- Department of Hematogenetics, ICMR-National Institute of Immunohematology, 13th Floor, K.E.M. Hospital Campus, Parel, Mumbai, 400 012, India.
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Singha K, Fucharoen G, Fucharoen S. δ-Hemoglobinopathies in Thailand: screening, molecular basis, genotype-phenotype interaction, and implication for prevention and control of thalassemia. Ann Hematol 2021; 100:1953-1963. [PMID: 33834283 DOI: 10.1007/s00277-021-04510-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/03/2021] [Indexed: 11/30/2022]
Abstract
The δ-globin gene defects are clinically silent but interaction with β-thalassemia can lead to a misdiagnosis of β-thalassemia carrier. We report an extensive molecular characterization of δ-hemoglobinopathies in Thailand. Study was done on 32,108 subjects, encountered at the thalassemia screening. Six different approaches based on the reduced Hb A2 or appearance of Hb A2-derivative were established for selective recruitment of subjects. Among 32,108 subjects, a total of 296 subjects were suspected of having δ-globin gene defects. Of these 296 subjects, Hb and DNA analyses identified δ-hemoglobinopathies with 10 different mutations in 34 (0.11%) of them. These included a novel mutation, [δCD30(AGG>GGG) (n = 1)], 5 previously undescribed in Thailand, [δ-44(G>A) (n = 7), Hb A2-Troodos (n = 5), δIVSII-897(A>C) (n = 4), δ-68(C>T) (n = 2), and Hb A2-Indonesia (n = 1)], and 4 mutations previously found in Thailand, [Hb A2-Melbourne (n = 9), δ-77(T>C) (n = 3), Hb A2' (n = 1), and Hb A2-Kiriwong (n = 1)]. Genetic heterogeneities seen included interactions of δ-globin gene defects with heterozygous Hb E, β-thalassemia, α-thalassemia, and in cis locations of the Hb A2-Troodos and Hb E mutations found for the first time. Rapid identification methods of these δ-globin gene mutations were developed. The results should prove useful to a prevention and control program of hemoglobinopathies in the region.
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Affiliation(s)
- Kritsada Singha
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, 40002, Thailand.,Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand
| | - Goonnapa Fucharoen
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Supan Fucharoen
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, 40002, Thailand.
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Li Y, Huang T, Mao T, Zhang X, Liang L, Meng M. Detection of a Hb A 2 -Melbourne (HBD: c.130G>A) combined with β-thalassemia in a Chinese individual. J Clin Lab Anal 2020; 34:e23401. [PMID: 32770585 PMCID: PMC7521222 DOI: 10.1002/jcla.23401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thalassemia is common in Southeast Asian countries, including China. Hb A2 -Melbourne is a rare hemoglobin variant and has never been reported in China. Here, we report a Hb A2 -Melbourne combined with β-thalassemia in Chinese individuals which is the second case described in the published reports. METHODS Complete blood counts (CBC) of a 28-year-old female showed signs of thalassemia during a routine screening. Hemoglobin analysis was subsequently performed using capillary electrophoresis (CE) and high-performance liquid chromatography (HPLC). Four common deletional α-thalassemia detection was carried out using a gap-polymerase chain reaction (PCR). PCR and reverse dot-blot were used to detect three non-deletional α-thalassemia and 17 types of point mutations in β-thalassemia. Finally, it was identified by Sanger sequencing. Her husband also had CBC, hemoglobin analysis, and genetic diagnosis. RESULTS CBC of the couple showed Hb 103 and 139 g/L, mean corpuscular volume 58 and 63.1 fL, mean corpuscular hemoglobin 19.7 and 20.4 pg, respectively. Hemoglobin analysis revealed Hb X 2.4%, Hb A2 2.8% by CE and Hb X 2.9%, Hb A2 2.4% by HPLC in the female. The results of her husband were Hb A93.5%, Hb A2 5.7%, Hb F 0.8% by CE. Genetic analysis of both spouses detected the same CD 41/42 mutations in β-globin gene. Sanger sequencing of female identified a mutation of the δ-globin gene (HBD:c.130G>A), corresponding to Hb A2 -Melbourne. CONCLUSION Hb A2 -Melbourne can lead to misdiagnosis of β-thalassemia. δ-globin gene mutation must be carefully examined in routine thalassemia screening.
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Affiliation(s)
- Youqiong Li
- Center of Medical Genetics and Prenatal DiagnosisPeople’s Hospital of Guangxi Zhuang Autonomous RegionNanningChina
| | - Tongfeng Huang
- Department of Laboratory MedicineChongzuo Maternal and Child Health HospitalChongzuoChina
| | - Tian Mao
- Center of Medical Genetics and Prenatal DiagnosisPeople’s Hospital of Guangxi Zhuang Autonomous RegionNanningChina
| | - Xiuqun Zhang
- Center of Medical Genetics and Prenatal DiagnosisPeople’s Hospital of Guangxi Zhuang Autonomous RegionNanningChina
| | - Liang Liang
- Center of Medical Genetics and Prenatal DiagnosisPeople’s Hospital of Guangxi Zhuang Autonomous RegionNanningChina
| | - Menghui Meng
- Center of Medical Genetics and Prenatal DiagnosisPeople’s Hospital of Guangxi Zhuang Autonomous RegionNanningChina
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Cardiero G, Musollino G, Friscia MG, Testa R, Virruso L, Di Girgenti C, Caldora M, Colella Bisogno R, Gaudiano C, Manco G, Lacerra G. Effect of Mutations on mRNA and Globin Stability: The Cases of Hb Bernalda/Groene Hart and Hb Southern Italy. Genes (Basel) 2020; 11:genes11080870. [PMID: 32751969 PMCID: PMC7466077 DOI: 10.3390/genes11080870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
We identified two unstable variants in the third exon of α-globin genes: Hb Bernalda/Groene Hart (HBA1:c.358C>T), and Hb Caserta (HBA2:c.79G>A) in cis to Hb Sun Prairie (HBA2:c.391G>C), also named Hb Southern Italy. These mutations occurred in the H helix of the α-globin that is involved in heme contacting, specific recognition of α-hemoglobin-stabilizing protein (AHSP), and α1β1 interactions. The carriers showed α-thalassemia phenotype, but one also jaundice and cholelithiasis. Molecular identification of clusters of families in Southern Italy encouraged molecular characterization of mRNA, globin chain analyses, molecular modeling studies, and comparison with globin variants to understand the mechanisms causing the α-thalassemia phenotype. A normal amount of Hb Bernalda/Groene Hart mRNA were found, and molecular modeling highlighted additional H bonds with AHSP. For Hb Southern Italy, showing an unexpected α/β biosynthetic ratio typical of the β-thalassemia type, two different molecular mechanisms were shown: Reduction of the variant mRNA, likely due to the No-Go Decay for the presence of unused triplet ACG at cod 26, and protein instability due to the impairment of AHSP interaction. The UDP glucuronosyltransferase 1A (UGT1A1) genotyping was conclusive in the case of jaundice and cholelithiasis. Multiple approaches are needed to properly identify the mechanisms leading to unstable variants and the effect of a mutation.
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Affiliation(s)
- Giovanna Cardiero
- Institute of Genetics and Biophysics “Adriano Buzzati Traverso”, (IGB-ABT, CNR), National Research Council, 80131 Naples, Italy; (G.C.); (G.M.)
| | - Gennaro Musollino
- Institute of Genetics and Biophysics “Adriano Buzzati Traverso”, (IGB-ABT, CNR), National Research Council, 80131 Naples, Italy; (G.C.); (G.M.)
| | - Maria Grazia Friscia
- Azienda Ospedaliera Ospedali Civili Riuniti, Centro Trasfusionale e di Microcitemia, 92019 Sciacca, Italy;
| | - Rosario Testa
- Azienda Ospedaliero-Universitaria “Policlinico-Vittorio Emanuele”, Servizio di Talassemia ed Emoglobinopatie, 95123 Catania, Italy;
| | - Lucrezia Virruso
- ARNAS P.O. Civico e Di Cristina Benfratelli, U.O.s.d. Lab. Spec. Genetica Molecolare, 90127 Palermo, Italy; (L.V.); (C.D.G.)
| | - Caterina Di Girgenti
- ARNAS P.O. Civico e Di Cristina Benfratelli, U.O.s.d. Lab. Spec. Genetica Molecolare, 90127 Palermo, Italy; (L.V.); (C.D.G.)
| | | | - Rosario Colella Bisogno
- Azienda Ospedaliera Universitaria OO. RR. San Giovanni di Dio e Ruggi D’Aragona, Medicina Trasfusionale, 84131 Salerno, Italy;
| | - Carlo Gaudiano
- P.O. Madonna delle Grazie, Centro per la Lotta Contro le Microcitemie, ASL 4, 75100 Matera, Italy;
| | - Giuseppe Manco
- Institute of Biochemistry and Cell Biology (IBBC, CNR), National Research Council, 80131 Naples, Italy;
| | - Giuseppina Lacerra
- Institute of Genetics and Biophysics “Adriano Buzzati Traverso”, (IGB-ABT, CNR), National Research Council, 80131 Naples, Italy; (G.C.); (G.M.)
- Correspondence:
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Chen GL, Huang LY, Zhou JY, Li DZ. Hb A 2-Tianhe (HBD: c.323G>A): First Report in a Chinese Family with Normal Hb A 2-β-Thalassemia Trait. Hemoglobin 2017; 41:291-292. [PMID: 29251016 DOI: 10.1080/03630269.2017.1398170] [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] [Indexed: 10/18/2022]
Abstract
Coinheritance of δ-globin variants along with β-globin gene defects can interfere with correct diagnosis of β-thalassemia (β-thal) trait. In this report, we present the coinheritance of a δ-globin variant, Hb A2-Tianhe [δ107(G9)Gly→Asp; HBD: c.323G>A] and a heterozygous β-thal in a Chinese individual with microcytosis, hypochromia and a normal Hb A2 level.
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Affiliation(s)
- Gui-Lan Chen
- a Guangzhou Women and Children Medical Center affiliated to Guangzhou Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Lv-Yin Huang
- a Guangzhou Women and Children Medical Center affiliated to Guangzhou Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Jian-Ying Zhou
- a Guangzhou Women and Children Medical Center affiliated to Guangzhou Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Dong-Zhi Li
- a Guangzhou Women and Children Medical Center affiliated to Guangzhou Medical University , Guangzhou , Guangdong Province , People's Republic of China
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Wajcman H, Azimi M, Cui J, Hoppe C, Flamini M, Ho C, Reddy S. Hemoglobinopathy testing: the significance of accuracy and pitfalls in HbA 2 determination. Int J Lab Hematol 2016; 39:e23-e27. [PMID: 27976500 DOI: 10.1111/ijlh.12584] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H Wajcman
- Inserm U955, Team 2, CHU Henri Mondor, Créteil, France
| | - M Azimi
- Children's Hospital & Research Center, Oakland, CA, USA
| | - J Cui
- Children's Hospital & Research Center, Oakland, CA, USA
| | - C Hoppe
- Children's Hospital & Research Center, Oakland, CA, USA
| | - M Flamini
- Bio-Rad Laboratories Inc., Clinical Systems Division, Hercules, CA, USA
| | - C Ho
- Division of Hematology, Lifelabs Medical Laboratory Services, Burnaby, BC, Canada
| | - S Reddy
- Division of Hematology, Lifelabs Medical Laboratory Services, Burnaby, BC, Canada
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Cardiero G, Prezioso R, Dembech S, Del Vecchio Blanco F, Scarano C, Lacerra G. Identification and molecular characterization of a novel 163 kb deletion: The Italian (ϵγδβ)(0)-thalassemia. ACTA ACUST UNITED AC 2016; 21:317-24. [PMID: 27077761 DOI: 10.1080/10245332.2015.1133007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE AND IMPORTANCE To verify the presence of β-thalassemia in subjects showing hematologic phenotype of α-thalassemia, conduct normal molecular sequence analysis of the α-globin genes, and detect the absence of the most frequent α-thalassemia deletions. CLINICAL PRESENTATION A patient from Apulia (Southern Italy) was referred to our institution for the occasional founding of hypochromic polyglobulia and microcytic red blood cells associated with normal levels of Hb A2 and Hb F and normal iron parameters. INTERVENTION AND TECHNIQUE The patient has been investigated using Sanger sequencing, multiplex ligation-dependent probe amplification (MLPA), quantitative real-time PCR, restriction analysis, and gap-PCR. A novel deletion, the Italian (ϵγδβ)(0)-thalassemia, has been identified. The 5' breakpoint was within a LINE element of 80 kb 3' of the ε-globin gene, and the 3' breakpoint was within a 160-bp palindrome of about 30 kb 5' of the β-globin gene. The breakpoint region was characterized by the presence of a microhomology (5'-TCT-3') and of an insertion of 43 bp owing to the duplication of the 160-bp palindrome. Comparison of the Hb and Hb A2 values of (ϵγδβ)(0)-thalassemia from the literature with those of (molecularly known) thalassemia carriers indicated a higher level of Hb A2 with respect to α-thalassemia and a lower level of Hb with respect to β(0)-thalassemia carriers. CONCLUSION In this study, we report the first (ϵγδβ)(0)-thalassemia case identified in Italy. To avoid misdiagnosis of β-thalassemia, we suggest verifying the presence of large deletions of the β-globin gene cluster in subjects showing a higher border line level of Hb A2 and a lower level of Hb.
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Affiliation(s)
- Giovanna Cardiero
- a Istituto di Genetica e Biofisica "Adriano Buzzati-Traverso" - CNR , Napoli , Italy
| | - Romeo Prezioso
- a Istituto di Genetica e Biofisica "Adriano Buzzati-Traverso" - CNR , Napoli , Italy
| | - Sabrina Dembech
- b Azienda Ospedaliero-Universitaria , Ospedali Riuniti, Foggia , Italy
| | - Francesca Del Vecchio Blanco
- c Dipartimento di Biochimica, Biofisica e Patologia Generale , Seconda Università degli Studi di Napoli , Napoli , Italy
| | - Clelia Scarano
- b Azienda Ospedaliero-Universitaria , Ospedali Riuniti, Foggia , Italy
| | - Giuseppina Lacerra
- a Istituto di Genetica e Biofisica "Adriano Buzzati-Traverso" - CNR , Napoli , Italy
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González Borrachero ML, de la Fuente-Gonzalo F, González FA, Nieto JM, Villegas A, Ropero P. [Delta⁰-thalassemia by insertion of 27 base pairs in δ-globin gene with decreased hemoglobin A₂ levels]. Med Clin (Barc) 2015; 144:312-6. [PMID: 25579773 DOI: 10.1016/j.medcli.2014.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/16/2014] [Accepted: 10/23/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE We describe a novel delta-thalassemia mutation causing decreased hemoglobin (Hb) A2 levels associated with Hb Watts, variant Hb resulting from a trinucleotide deletion in Spain. PATIENTS AND METHOD Hb variant analysis was performed by cation-exchange high performance liquid chromatography (HPLC) and capillary zone electrophoresis. Polymerase chain reaction and DNA sequence analyses were used to identify mutations in the δ- and α-globin genes. RESULTS Abnormal Hb was observed on capillary zone electrophoresis in Z6 and by cation-exchange HPLC a slower peak than HbA was observed at an retention time of 4.19min. This variant Hb is called Hb Watts [α2 74(EF3)Asp->0 or α2 75(EF4)Asp->0; HBA2:c.226_228delGAC]. The decreased HbA2 percentage owes to an insertion of 27nt between nt 83 and 84 of IVS-I of the δ-globin gene. CONCLUSIONS When analyzing a chromatogram, the possibility of the existence of delta-thalassemia or an HbA2 variant should be considered, apart from alfa-, beta-thalassemia and structural haemoglobinopathies. To this end, each of the peaks and their percentages should be considered to allow for correct interpretation and to avoid misdiagnosis as much as possible.
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Affiliation(s)
| | | | | | - Jorge M Nieto
- Servicio de Hematología y Hemoterapia, Hospital Clínico San Carlos, Madrid, España
| | - Ana Villegas
- Servicio de Hematología y Hemoterapia, Hospital Clínico San Carlos, Madrid, España
| | - Paloma Ropero
- Servicio de Hematología y Hemoterapia, Hospital Clínico San Carlos, Madrid, España.
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Known and new hemoglobin A2 variants in Thailand and implication for β-thalassemia screening. Clin Chim Acta 2014; 438:226-30. [PMID: 25218786 DOI: 10.1016/j.cca.2014.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 09/02/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND We reported molecular and hematological characteristics of δ-globin chain variants and addressed diagnostic consideration of complex hemoglobinopathies caused by their interactions with α- and β-thalassemias. METHODS Study was done on four unrelated Thai subjects with second Hb A2 fractions. Hb analysis was carried out using automated HPLC and capillary electrophoresis. Mutations were identified by DNA analysis. Novel diagnostic methods based on PCR-RFLP and allele specific PCR were developed. RESULTS Hb analysis revealed Hb A2 variant in all cases. DNA analysis of δ-globin gene identified the Hb A2-Melbourne [δ43(CD2)Glu→Lys] in combination with α(+)-thalassemia, α(0)-thalassemia and β(0)-thalassemia in the first three cases, respectively. Analysis of the remaining case identified a novel δ-Hb variant namely the Hb A2-Lampang [δ47(CD6)GAT→AAT; Asp→Asn] found in association with Hb E and α(+)-thalassemia. These mutations could be identified using PCR-RFLP and allele specific PCR assays developed. CONCLUSIONS It is necessary to recognize the Hb A2 variant and to combine the amounts of Hb A2 and Hb A2-variant for a total Hb A2 value to make better diagnostic of these complex syndromes. Co-inheritance of these multiple globin gene defects could lead to complex hemoglobinopathies requiring comprehensive Hb and molecular assessments.
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Khalil MSM, Marouf S, Element D, Timbs A, Gallienne A, Schuh A, Old JM, Henderson S. A Study of δ-Globin Gene Mutations in the UK Population: Identification of Three Novel Variants and Development of a Novel DNA Test for Hb A′2. Hemoglobin 2014; 38:201-6. [DOI: 10.3109/03630269.2014.885908] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Moumni I, Zorai A, Mahjoub S, Mosbahi I, Chaouechi D, Benromdhane N, Abbes S. A New δ Chain Variant, Hb A2-Tunis [δ46(CD5)Gly → Glu;HBD: c.140G>A], Observed in a Tunisian Family in Association with a Compound Heterozygosity for Hb C [β6(A3)Glu → Lys;HBB: c.19G>A] β0-Thalassemia [IVS-I-1 (β143, G>A);HBB: c.92+1G>A]. Hemoglobin 2014; 38:88-90. [DOI: 10.3109/03630269.2013.872123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Chaibunruang A, Fucharoen G, Fucharoen S. First Description of a Hb A2Variant in Thailand. Identification of Hb A2-Melbourne [δ43(CD2)Glu→Lys] in Thai Individuals. Hemoglobin 2011; 36:80-4. [DOI: 10.3109/03630269.2011.599465] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Joly P, Lacan P, Garcia C, Meley R, Pondarré C, Francina A. A Novel Deletion/Insertion Caused by a Replication Error in the β-Globin Gene Locus Control Region. Hemoglobin 2011; 35:316-22. [DOI: 10.3109/03630269.2011.571331] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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