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Narvestad-Bøttger H, Winther-Larsen A, Haugbølle Bjerre J, Dziegiel MH, Hansen AT, Hasle H. Extreme Reticulocytosis After Splenectomy in a Patient With Hemoglobin Mizuho. J Pediatr Hematol Oncol 2024; 46:e111-e114. [PMID: 38011049 DOI: 10.1097/mph.0000000000002790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Patients with Hb Mizuho may be splenectomized at a young age to decrease their need for blood transfusions. OBSERVATIONS Transfusion-dependency decreased dramatically in a 4-year-old white boy with Hb Mizuho after splenectomy. Surprisingly, he developed reticulocytosis (>1000×10 9 /L) with a peak reticulocyte percentage of 49%, and erythrocyte abnormalities, including Heinz bodies, Howell-Jolly bodies, and basophilic stippling. Manual reticulocyte counting and flow cytometric measurement with anti-CD71 antibodies supported a truly elevated reticulocyte count. CONCLUSIONS We propose possible explanations for the extreme reticulocytosis that arose postsplenectomy and compare the reticulocyte count in the present case with previously published cases.
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Affiliation(s)
| | | | | | | | | | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine and Department of Clinical Medicine, Aarhus University Hospital, Aarhus
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2
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Elieff O, Rawlings L, Pham C, Mihalopoulos S, Henry D, Simons K, Tapp H. Hb Mizuho Case Report; Early Genomic Testing Facilitates a Life Changing Diagnosis. Hemoglobin 2024; 48:30-33. [PMID: 38198563 DOI: 10.1080/03630269.2023.2301028] [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] [Received: 11/02/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024]
Abstract
Unstable variant hemoglobinopathies are an uncommon cause of hemolysis in the pediatric patient and may cause a delay in diagnosis if there is not a high index of suspicion. Hemoglobin (Hb) Mizuho is a rare unstable hemoglobinopathy caused by a pathogenic variant of the HBB gene with a severe phenotype. Here we report on the first known case of Hb Mizuho in Australia, presenting with features of acute and chronic hemolysis. The morphological features on blood film review, in conjunction with biochemical findings and other clinical features, did not immediately suggest an alternative diagnosis and a Next Generation Sequencing gene analysis approach was taken to investigate genes associated with red blood cell disorders and atypical uremic syndrome. The HBB Mizuho variant was detected and established the diagnosis. This report highlights the challenge of diagnosing Hb Mizuho on conventional testing and the need for early genomic testing to clarify a diagnosis.
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Affiliation(s)
- Olivia Elieff
- Department of Haematology & Oncology, Women's & Children's Hospital, Adelaide, South Australia, Australia
| | - Lesley Rawlings
- Genetics & Molecular Pathology, SA Pathology, Women's & Children's Hospital, Adelaide, South Australia, Australia
| | - Cuong Pham
- Department Haematology, SA Pathology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Samantha Mihalopoulos
- Department Haematology, SA Pathology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Denae Henry
- Genetics & Molecular Pathology, SA Pathology, Women's & Children's Hospital, Adelaide, South Australia, Australia
| | - Keryn Simons
- Genetics & Molecular Pathology, SA Pathology, Women's & Children's Hospital, Adelaide, South Australia, Australia
| | - Heather Tapp
- Department of Haematology & Oncology, Women's & Children's Hospital, Adelaide, South Australia, Australia
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3
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Soozangar N, Abbaspour E, Mokaber H, Nematollahi Z, Davarnia B. A novel compound heterozygous of β-thalassemia with HbG-Coushatta: case report of Iran. Hum Genome Var 2023; 10:14. [PMID: 37188672 PMCID: PMC10185494 DOI: 10.1038/s41439-023-00243-y] [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: 11/15/2022] [Revised: 03/14/2023] [Accepted: 04/02/2023] [Indexed: 05/17/2023] Open
Abstract
A 30-year-old male couple from Ardabil city, Iran, were admitted for premarital screening. An abnormal band in HbS/D regions with high levels of HbF and HbA 2 led us to suspect the possibility of a compound heterozygous state of β-thalassemia in our affected proband. Therefore, beta globin chain sequencing of proband discovered a heterozygote combination of the Hb G-Coushatta [b22 (B4) Glu>Ala, HBB: c.68A>C) with HBB: IVS-II-1 (G>A) mutation as a compound heterozygote.
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Affiliation(s)
- Narges Soozangar
- Department of Medical Genetics and Pathology, Ardabil University of Medical Sciences, Ardabil, Iran
- Zoonoses Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Ehsan Abbaspour
- Department of Medical Genetics and Pathology, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Haleh Mokaber
- Department of Medical Genetics and Pathology, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Zahra Nematollahi
- Department of Medical Genetics and Pathology, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Behzad Davarnia
- Department of Medical Genetics and Pathology, Ardabil University of Medical Sciences, Ardabil, Iran.
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4
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Yadav DD, Jamwal M, Singh N, Sharma R, Das R, Trehan A, Bansal D, Chhabra S, Sharma P. Hb Mizuho ( HBB: c.206T>C): Pitfalls of Screening Tests in an Unstable Hemoglobin Variant Diagnosed after Targeted Next-Generation Sequencing. Hemoglobin 2022; 45:338-340. [PMID: 35144518 DOI: 10.1080/03630269.2022.2034642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Hyperunstable hemoglobins (Hbs) are challenging to diagnose and may be missed on conventional hemolytic anemia work-up. Here, we report the case of a 2-year-old Indian boy with infancy-onset severe hemolytic anemia. Its etiology was revealed by targeted next-generation sequencing (NGS) to be the rare Hb Mizuho (HBB: c.206T>C). This variant had been missed on the initial routine laboratory investigations (heat and isopropanol tests for unstable Hbs) owing to its hyperunstable nature.
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Affiliation(s)
- Diksha D Yadav
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manu Jamwal
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Namrata Singh
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritika Sharma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reena Das
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Department of Pediatric Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Department of Pediatric Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Chhabra
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prashant Sharma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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5
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Sarker TT, Delvadia B, Li S, Roback JD, Fasano RM, Broder KJ, Monsrud AL, Josephson CD. Mizuho hemoglobinopathy, presenting with severe hemolytic anemia and multisystem organ failure secondary to exertion. Transfusion 2021; 61:1996-1997. [PMID: 34196393 DOI: 10.1111/trf.16522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/17/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Tania T Sarker
- Department of Pathology & Laboratory Medicine, Emory Center for Transfusion and Cellular Therapies, Emory University, Atlanta, Georgia, USA
| | - Bhavesh Delvadia
- Department of Pathology & Laboratory Medicine, Emory Center for Transfusion and Cellular Therapies, Emory University, Atlanta, Georgia, USA
| | - Shiyong Li
- Department of Pathology & Laboratory Medicine, Emory Center for Transfusion and Cellular Therapies, Emory University, Atlanta, Georgia, USA
| | - John D Roback
- Department of Pathology & Laboratory Medicine, Emory Center for Transfusion and Cellular Therapies, Emory University, Atlanta, Georgia, USA
| | - Ross M Fasano
- Department of Pathology & Laboratory Medicine, Emory Center for Transfusion and Cellular Therapies, Emory University, Atlanta, Georgia, USA
| | - Kari J Broder
- Department of Pathology & Laboratory Medicine, Emory Center for Transfusion and Cellular Therapies, Emory University, Atlanta, Georgia, USA
| | - Ashley L Monsrud
- Department of Pathology & Laboratory Medicine, Emory Center for Transfusion and Cellular Therapies, Emory University, Atlanta, Georgia, USA
| | - Cassandra D Josephson
- Department of Pathology & Laboratory Medicine, Emory Center for Transfusion and Cellular Therapies, Emory University, Atlanta, Georgia, USA
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6
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Njue L, Medri C, Keller P, Diepold M, Taleghani BM, Rovó A. The rare hemoglobin variant Hb Mizuho: report of a Swiss family and literature review. Ann Hematol 2021; 100:1677-1683. [PMID: 33590291 PMCID: PMC8195896 DOI: 10.1007/s00277-021-04458-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 02/07/2021] [Indexed: 11/29/2022]
Abstract
Hb Mizuho is a very rare unstable hemoglobin; here, we describe the clinical history of three Swiss family members with Hb Mizuho together with a systematic review of the previously six published cases. The clinical history of the adult woman we report here is unique since this is the first Hb Mizuho presenting with Moyamoya complications and the first case reported with long-term erythrocyte exchange. The literature review showed that Hb Mizuho was mainly reported as a de novo mutation, with the exception of children descended from known cases. All published patients with this unstable hemoglobin showed severe hemolytic anemia with the exception of one; all were regularly transfused. Patients with higher HbF levels might require fewer transfusions. All patients underwent splenectomy at a median age of 4 years and had variable clinical improvement; some achieved complete resolution of transfusion dependency after splenectomy. Iron overload in Hb Mizuho patients seems to be mainly attributed to transfusions and has less to do with ineffective erythropoiesis. Diagnosis might be challenging; a normal hemoglobin electrophoresis should not rule out the diagnosis of unstable hemoglobin in patients with otherwise unexplained hemolytic anemia. This series shows the enormous utility of using molecular techniques for diagnosis.
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Affiliation(s)
- Linet Njue
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Cesare Medri
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Peter Keller
- Hematology, Spital Langenthal SRO AG, 4900, Langenthal, Switzerland
| | - Miriam Diepold
- Hematology and Oncology, Children's Hospital, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Behrouz Mansouri Taleghani
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Alicia Rovó
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
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7
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Perera S, Allen A, Silva I, Hapugoda M, Wickramarathne MN, Wijesiriwardena I, Allen S, Rees D, Efremov DG, Fisher CA, Weatherall DJ, Premawardhena A. Genotype-phenotype association analysis identifies the role of α globin genes in modulating disease severity of β thalassaemia intermedia in Sri Lanka. Sci Rep 2019; 9:10116. [PMID: 31300739 PMCID: PMC6625979 DOI: 10.1038/s41598-019-46674-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 06/28/2019] [Indexed: 01/14/2023] Open
Abstract
β thalassaemia intermedia (βTI) are a heterogeneous group of disorders known to be extremely phenotypically diverse. This group is more complex to manage as no definitive treatment guidelines exist unlike for β thalassaemia major (βTM). There are only a few studies looking at genotype phenotype associations of βTI outside the Mediterranean region. The reasons for the diverse clinical phenotype in βTI are unknown. We categorized fifty Sri Lankan patients diagnosed with βTI as mild, moderate or severe according to published criteria. DNA samples were genotyped for β thalassaemia mutations, α globin genotype and copy number and known genetic modifiers of haemoglobin F production. There were 26/50 (52.0%) in mild group and 12/50 (24.0%) each in moderate and sever categories. 18/26 (69.2%) classified as mild were β heterozygotes and 17/18 (94.4%) had excess α globin genes. 11/12 (91.6%) classified as moderate were β heterozygotes and 8/11 (72.2%) had excess α globin genes. In contrast, 8/12 (66.7%) classified as severe were β homozygotes and 7/8(87.5%) had α globin gene deletions. In Sri Lanka, co-inheritance of either excess α globin genes in β thalassaemia heterozygotes or α globin gene deletions in β thalassaemia homozygotes is a significant factor in modulating disease severity.
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Affiliation(s)
- Shiromi Perera
- Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.
| | - Angela Allen
- MRC Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
- Centre for Tropical and Infectious Disease, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ishari Silva
- Hemal's Thalassemia Care Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - Menaka Hapugoda
- Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | | | | | - Stephen Allen
- Centre for Tropical and Infectious Disease, Liverpool School of Tropical Medicine, Liverpool, UK
| | - David Rees
- Department of Paediatric Haematology, King's College Hospital, London, UK
| | - Dimitar G Efremov
- Molecular Hematology Unit, International Centre for Genetic Engineering and Biotechnology, Rome, Italy
| | - Christopher A Fisher
- MRC Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - David J Weatherall
- MRC Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Anuja Premawardhena
- Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
- Hemal's Thalassemia Care Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
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8
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Zhang J, Li P, Yang Y, Yan Y, Zeng X, Li D, Chen H, Su J, Zhu B. Molecular epidemiology, pathogenicity, and structural analysis of haemoglobin variants in the Yunnan province population of Southwestern China. Sci Rep 2019; 9:8264. [PMID: 31164695 PMCID: PMC6547717 DOI: 10.1038/s41598-019-44793-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 05/23/2019] [Indexed: 12/18/2022] Open
Abstract
Abnormal haemoglobin (Hb) variants result in the most commonly inherited disorders in humans worldwide. In this study, we investigated the molecular epidemiology characteristics of Hb variants, along with associated structural and functional predictions in the Yunnan province population of Southwestern China. A total of 41,933 subjects who sought haemoglobinopathy screening were included. Based on bioinformatics and structural analysis, as well as protein modeling, the pathogenesis and type of Hb genetic mutations were characterized. Among all individuals studied, 328 cases (0.78%) were confirmed as carriers of Hb variants, with 13 cases (0.03%) presenting α-globin variants, 313 (0.75%) β-globin variants, and two δ-globin variants. A total of 19 different mutations were identified, including three novel mutations. In addition, 48 cases of ααCS mutations and 14 cases of Hb H or Hb Bart’s were found. The isoelectric point, evolutionary conservation, and genotype-phenotype correlation for these mutations were predicted. Additionally, secondary and tertiary protein structure modeling were performed for three selected mutations. In conclusion, the prevalence of Hb variants in the Yunnan population is much higher than other regions of China. Complete characterization of these Hb variants is essential for generating a rational strategy to control the haemoglobinopathies in this region.
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Affiliation(s)
- Jie Zhang
- Genetic Diagnosis Center, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, The First People's Hospital of Yunnan Province, Yunnan Province, China. .,Department of Hematology, The First People's Hospital of Yunnan Province, Yunnan Province, China. .,Department of Pediatrics, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China.
| | - Peng Li
- Genetic Diagnosis Center, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, The First People's Hospital of Yunnan Province, Yunnan Province, China.,Department of Pediatrics, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yang Yang
- Genetic Diagnosis Center, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, The First People's Hospital of Yunnan Province, Yunnan Province, China.,Department of Pediatrics, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yuanlong Yan
- Genetic Diagnosis Center, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, The First People's Hospital of Yunnan Province, Yunnan Province, China
| | - Xiaohong Zeng
- Genetic Diagnosis Center, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, The First People's Hospital of Yunnan Province, Yunnan Province, China
| | - Dongmei Li
- Genetic Diagnosis Center, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, The First People's Hospital of Yunnan Province, Yunnan Province, China
| | - Hong Chen
- Genetic Diagnosis Center, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, The First People's Hospital of Yunnan Province, Yunnan Province, China
| | - Jie Su
- Genetic Diagnosis Center, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, The First People's Hospital of Yunnan Province, Yunnan Province, China
| | - Baosheng Zhu
- Genetic Diagnosis Center, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, The First People's Hospital of Yunnan Province, Yunnan Province, China. .,Department of Hematology, The First People's Hospital of Yunnan Province, Yunnan Province, China. .,Department of Pediatrics, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China.
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9
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Kurtoğlu AU, Eren E, Aslan V, Erkal Ö, Kurtoğlu E, Yilmaz N. Heterozygote Hemoglobin G-Coushatta as the Cause of a Falsely Decreased Hemoglobin A1C in an Ion-exchange HPLC Method. J Med Biochem 2017; 36:270-273. [PMID: 30568544 PMCID: PMC6287211 DOI: 10.1515/jomb-2017-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/20/2017] [Indexed: 11/28/2022] Open
Abstract
Glycated hemoglobin (HbA1c) is used for the assessment of glycemic control in patients with diabetes. The presence of genetic variants of hemoglobin can profoundly affect the accuracy of HbA1c measurement. Here, we report two cases of Hemoglobin G-Coushatta (HBB:c.68A>C) variant that interferes in the measurement of HbA1c by a cation-exchange HPLC (CE-HPLC) method. HbA1c was measured by a CE-HPLC method in a Tosoh HLC-723 G7 instrument. The HbA1c levels were 2.9% and 4%. These results alerted us to a possible presence of hemoglobinopathy. In the hemoglobin variant analysis, HbA2 levels were detected as 78.3% and 40.7% by HPLC using the short program for the Biorad Variant II. HbA1c levels were measured by an immunoturbidimetric assay in a Siemens Dimension instrument. HbA1c levels were reported as 5.5% and 5.3%. DNA mutation analysis was performed to detect the abnormal hemoglobin variant. Presence of Hemoglobin G-Coushatta variant was detected in the patients. The Hb G-Coushatta variants have an impact on the determination of glycated hemoglobin levels using CEHPLC resulting in a false low value. Therefore, it is necessary to use another measurement method.
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Affiliation(s)
- Ayşegül Uğur Kurtoğlu
- Department of Biochemistry, Sağlık Bilimleri Universiy Antalya Education and Research Hospital, Antalya, Turkey
| | - Esin Eren
- Department of Biochemistry, Sağlık Bilimleri Universiy Antalya Education and Research Hospital, Antalya, Turkey
| | - Vedat Aslan
- Department of Hematology, Sağlık Bilimleri University Antalya Education and Research Hospital, Antalya, Turkey
| | - Özgür Erkal
- Department of Genetics, Sağlık Bilimleri University Antalya Education and Research Hospital, Antalya, Turkey
| | - Erdal Kurtoğlu
- Department of Hematology, Sağlık Bilimleri University Antalya Education and Research Hospital, Antalya, Turkey
| | - Necat Yilmaz
- Department of Biochemistry, Sağlık Bilimleri Universiy Antalya Education and Research Hospital, Antalya, Turkey
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10
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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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