1
|
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.
Collapse
Affiliation(s)
| | | | | | | | | | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine and Department of Clinical Medicine, Aarhus University Hospital, Aarhus
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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
| |
Collapse
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
Recurrent nonbacterial thrombotic endocarditis: A novel therapeutic approach. J Cardiol Cases 2018; 17:175-177. [PMID: 30279885 DOI: 10.1016/j.jccase.2018.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/15/2017] [Accepted: 01/10/2018] [Indexed: 11/20/2022] Open
Abstract
We present the case of a 29-year-old male with a history of Mizuho hemolytic anemia, a rare form of unstable hemoglobinopathy, who presented with congestive heart failure secondary to recurrent valve thrombosis despite appropriate oral anticoagulation. He subsequently required mitral and aortic valve replacement. Pathologic examination revealed extensive nonbacterial thrombotic endocarditis. Due to recurrent thrombosis despite therapeutic anticoagulation, we elected to treat him with red blood cell exchange transfusions and hydroxyurea. He has remained free of symptoms for almost two years with this treatment regimen without side effects. <Learning objective: The management of nonbacterial thrombotic endocarditis (NBTE) is well described in the literature. However, the treatment for refractory NBTE in aggressive forms of unstable hemoglobinopathy remains difficult. The use of hydroxyurea and serial red blood cell exchange, in addition to the usual therapies, may be useful in the treatment of refractory NBTE.>.
Collapse
|
7
|
Perera PS, Silva I, Hapugoda M, Wickramarathne MN, Wijesiriwardena I, Efremov DG, Fisher CA, Weatherall DJ, Premawardhena A. Rare Hemoglobin Variants: Hb G-Szuhu (HBB: c.243C>G), Hb G-Coushatta (HBB: c.68A>C) and Hb Mizuho (HBB: c.206T>C) in Sri Lankan Families. Hemoglobin 2015; 39:62-5. [DOI: 10.3109/03630269.2014.992530] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
8
|
Abstract
We analyzed blood samples from more than 200 normal adults, and quantified their Hb F by cation-exchange high-performance liquid chromatography. In several subjects with slightly elevated Hb F (0.4-4.3%), we determined the Ggamma levels in the Hb F and DNA sequence variations in the locus control region II and in the Ggamma and Agamma promoters. About 25% of the approximately 200 normal teenaged high school students had elevated Hb F; detailed analyses of some 20 students, selected at random, identified most as females with a homozygosity for the C-->T variation at position -158 (Ggamma). One 11-year-old boy was heterozygous for the A-->G change at position -161 (Ggamma); he and two of his relatives had approximately 4% Hb F, high Ggamma values, and a high level of (mainly) Ggamma-mRNA. Nearly 40 normal adults from Macedonia and from Georgia (mostly Caucasians) were tentatively identified as Swiss HPFH heterozygotes because slightly elevated Hb F levels were observed at least once. Many of these persons were heterozygous or homozygous for the C-->T mutation at -158 (Ggamma), and a few carried a gamma-globin gene triplication. The C-->T change appears to be an important factor predisposing the adult to increased Hb F production. Evidence suggests a gene dose effect in (mildly) anemic adults; however, other factors besides the C-->T change at -158 (Ggamma), including factors not linked to the beta-globin region, may cause an increase in gamma-chain synthesis.
Collapse
|
9
|
Harthoorn-Lasthuizen EJ, Nabben FA, Kazanetz EG, Gu LH, Molchanova TP, Huisman TH. HB Mizuho or alpha 2 beta 2 68(E12)Leu-->Pro in a young Dutch boy. Hemoglobin 1995; 19:203-6. [PMID: 7558877 DOI: 10.3109/03630269509036941] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
10
|
Cürük MA, Dimovski AJ, Baysal E, Gu LH, Kutlar F, Molchanova TP, Webber BB, Altay C, Gürgey A, Huisman TH. Hb Adana or alpha 2(59)(E8)Gly-->Asp beta 2, a severely unstable alpha 1-globin variant, observed in combination with the -(alpha)20.5 Kb alpha-thal-1 deletion in two Turkish patients. Am J Hematol 1993; 44:270-5. [PMID: 8237999 DOI: 10.1002/ajh.2830440410] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We have identified a severely unstable hemoglobin variant through sequencing of amplified DNA involving the alpha 1-globin gene; the mutation is located in codon 59 (CCG CAG) and results in a Gly-->Asp replacement. This amino acid substitution concerns a glycine residue at an internal position in the E helix, which is in close contact with a glycine residue of the B helix; introduction of the larger and charged aspartic acid residue greatly affects the stability of the molecule. This variant was present in association with a common alpha-thalassemia-1 deletion [-(alpha)20.5 kb] in two adults and caused a severe type of Hb H disease with anemia, low levels of Hb A2, increased zeta chain, and Hb Bart's. In vitro chain synthesis in reticulocytes showed a high specific activity of the variant alpha chain. Only a minute quantity of Hb H was present but instead about 10% of Hb Bart's was observed. The increased synthesis of gamma chains was likely due to specific characteristics of a chromosome with haplotype #3, which was present in both patients. The same family was studied 18 years ago; the improved methodology presently available has led to a corrected diagnosis for these patients.
Collapse
Affiliation(s)
- M A Cürük
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta 30912-2100
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Beris P, Kitundu MN, Baysal E, Oner C, Lanclos KD, Dimovski AJ, Kutlar F, Huisman TH. Black beta-thalassemia homozygotes with specific sequence variations in the 5' hypersensitive site-2 of the locus control region have high levels of fetal hemoglobin. Am J Hematol 1992; 41:97-101. [PMID: 1384315 DOI: 10.1002/ajh.2830410206] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We have sequenced the 5' hypersensitive-2 (5'HS-2) site of the locus control region (LCR) and the promoters of the two gamma-globin genes located on chromosome 11 of a black patient with mild beta-thalassemia (beta-thal) major due to a homozygosity for the C----T mutation at position -88 of the beta promoter and with a high Hb F level. Sequence variations in the 5'HS-2 were the same as observed for the beta s chromosome with haplotype number 3, while most of the G gamma promoter and the A gamma promoter had sequences similar to that of the beta S chromosome with haplotype number 19. This atypical haplotype (number 19A) is apparently associated with an increased gamma chain production which is particularly evident during periods of severe hematopoietic stress. Additional studies on relatives of the proband and on 10 unrelated black beta-thal homozygotes with either the C----T mutation at -88 or the A----G mutation at -29, confirm the possible importance of the sequence differences in the 5'HS-2, and also suggest that at least two additional factors, namely a C----T mutation at position -158 of the G gamma promoter and a relative deficiency in alpha chain synthesis play a (perhaps less important) role in the increased Hb F synthesis in these patients.
Collapse
Affiliation(s)
- P Beris
- Division d'Hematologie, Centre de Transfusion Sanguine, Hopital Cantonal Universitaire de Geneve, Suisse
| | | | | | | | | | | | | | | |
Collapse
|