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Traisrisilp K, Zheng Y, Choy KW, Chareonkwan P. Thalassemia screening by third-generation sequencing: Pilot study in a Thai population. Obstet Med 2024; 17:101-107. [PMID: 38784187 PMCID: PMC11110746 DOI: 10.1177/1753495x231207676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/27/2023] [Indexed: 05/25/2024] Open
Abstract
Background Conventional thalassemia screening takes a stepwise approach and has limitations in comprehensively identifying all spectrums of mutations. This study aimed to investigate the performance of third-generation sequencing (TGS) compared to conventional molecular testing. Methods TGS was applied to validate all known variants detected by conventional testing and to detect missing variants in undiagnosed cases. The study was conducted at Maharaj Nakorn Chiang Mai Hospital between December 2021 and April 2022. Results In total, 19 cases were included in this study, among which 52.6% (10/19) had known thalassemia variants, while 47.7% (9/19) cases were undiagnosed by conventional methods. All 16 variants previously detected were validated by TGS, and TGS additionally detected 43.8% (7/16) thalassemia variants for 36.8% (7/19) cases. Conclusion TGS could provide additional genetic diagnoses compared with conventional methods. Further cost-effectiveness studies with a larger sample size are needed to explore the role of TGS in clinical practices.
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Affiliation(s)
- Kuntharee Traisrisilp
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yu Zheng
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kwong Wai Choy
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Pimlak Chareonkwan
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Shojaei Z, Abiri M, Zafarghandi Motlagh F, Amini M, Dabbagh Bagheri S, Asnavandi S, Asadi S, Bagherian H, Zeinali S. First report of a patient with homozygous hemoglobin Ernz: Evidence to support a non-pathogenic variant. Blood Cells Mol Dis 2024; 104:102797. [PMID: 37826942 DOI: 10.1016/j.bcmd.2023.102797] [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: 03/30/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Abstract
Hemoglobin Ernz (Hb Ernz) is a missense variant in β-globin caused by a Threonine to Asparagine substitution at the 123rd amino acid position and HBB c.371C > A in gene level. Hb Ernz has been classified as Uncertain Significance (VUS) by ACMG due to limited reports and the absence of any homozygote genotypes. In our study, we found eight cases of Hb Ernz by DNA sequencing of the β-globin gene during >20 years of Thalassemia Screening in individuals with borderline hematological parameters who were possible carriers of thalassemia or their spouses. We also report the first homozygote variant of Hb Ernz. Our findings suggest that the changes in hematological parameters observed in individuals with Hb Ernz are likely due to α-globin gene mutations rather than Hb Ernz itself. These findings support the reclassification of Hb Ernz as a benign variant in variant classification.
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Affiliation(s)
- Zohreh Shojaei
- Dr. Zeinali's Medical Genetics Laboratory, Kawsar Human Genetics Research Center, 41 IRNA St., Vali Asr St., Tehran 1595645513, Iran
| | - Maryam Abiri
- Department of Medical Genetics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Fatemeh Zafarghandi Motlagh
- Dr. Zeinali's Medical Genetics Laboratory, Kawsar Human Genetics Research Center, 41 IRNA St., Vali Asr St., Tehran 1595645513, Iran
| | - Masoume Amini
- Dr. Zeinali's Medical Genetics Laboratory, Kawsar Human Genetics Research Center, 41 IRNA St., Vali Asr St., Tehran 1595645513, Iran
| | - Samira Dabbagh Bagheri
- Dr. Zeinali's Medical Genetics Laboratory, Kawsar Human Genetics Research Center, 41 IRNA St., Vali Asr St., Tehran 1595645513, Iran
| | - Sadaf Asnavandi
- Dr. Zeinali's Medical Genetics Laboratory, Kawsar Human Genetics Research Center, 41 IRNA St., Vali Asr St., Tehran 1595645513, Iran
| | - Sedighe Asadi
- Dr. Zeinali's Medical Genetics Laboratory, Kawsar Human Genetics Research Center, 41 IRNA St., Vali Asr St., Tehran 1595645513, Iran
| | - Hamideh Bagherian
- Dr. Zeinali's Medical Genetics Laboratory, Kawsar Human Genetics Research Center, 41 IRNA St., Vali Asr St., Tehran 1595645513, Iran
| | - Sirous Zeinali
- Dr. Zeinali's Medical Genetics Laboratory, Kawsar Human Genetics Research Center, 41 IRNA St., Vali Asr St., Tehran 1595645513, Iran..
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3
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Zha G, Xiao X, Tian Y, Zhu H, Chen P, Zhang Q, Yu C, Li H, Wang Y, Cao C. An efficient isoelectric focusing of microcolumn array chip for screening of adult Beta-Thalassemia. Clin Chim Acta 2023; 538:124-130. [PMID: 36400321 DOI: 10.1016/j.cca.2022.10.021] [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: 09/15/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
Traditional capillary isoelectric focusing (cIEF), liquid chromatography (LC) and capillary zone electrophoresis (CZE) still suffered from low resolution for hemoglobinopathy screening. Herein, a 30-mm pH 5.2-7.8 microcolumn IEF (mIEF) array chip was developed for hemoglobinopathy screening. As a proof of concept, adult beta-thalassemia was chosen as a model disease. In the method, blood samples were hemolyzed via hemolysin solution and loaded into the microcolumn. The experiments showed that (i) the species of Hb A, F, A2 and variants were clearly separated in the chip, and the resolution was greatly higher than the ones of LC/CZE/cIEF; (ii) up to 24 samples could be simultaneously analyzed in 12-min run; (iii) the intraday and interday RSDs were respectively 3.32-4.91 % and 4.07-5.33 %. The assays of mIEF to total 634 samples were compared with the ones of LC (n = 327) and PCR (n = 307). The cutoff of 3.5 % HbA2 led to the sensitivity of 100 % and specificity of 89.1 % for the mIEF-based screening; and there was 96.7 % coincidence between the methods of mIEF and PCR if refer Hb A2 and F. The method had the merits of facility, efficiency, specificity and sensitivity in contrast to the currently-used methods, implying its potential to screening of beta-thalassemia and hemoglobinopathies.
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Affiliation(s)
- Genhan Zha
- School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Xuan Xiao
- NHC Key Laboratory of Thalassemia Medicine, Key Laboratory of Thalassemia Medicine, Chinese Academy of Medical Sciences, Guangxi Key Laboratory of Thalassemia Research, Guangxi Medical University, Nanning 530021, P. R. China
| | - Youli Tian
- School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China; School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Hengying Zhu
- NHC Key Laboratory of Thalassemia Medicine, Key Laboratory of Thalassemia Medicine, Chinese Academy of Medical Sciences, Guangxi Key Laboratory of Thalassemia Research, Guangxi Medical University, Nanning 530021, P. R. China
| | - Ping Chen
- NHC Key Laboratory of Thalassemia Medicine, Key Laboratory of Thalassemia Medicine, Chinese Academy of Medical Sciences, Guangxi Key Laboratory of Thalassemia Research, Guangxi Medical University, Nanning 530021, P. R. China.
| | - Qiang Zhang
- School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China.
| | - Changjie Yu
- School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Honggen Li
- School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China; School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Yuxing Wang
- School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China; School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Chengxi Cao
- School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China; School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
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4
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Nieuwenhuizen C, Netshidzivhani T, Potgieter J. Establishment of haemoglobin A2 reference intervals in Pretoria, South Africa: A retrospective secondary data analysis. Afr J Lab Med 2022; 11:1841. [PMID: 36091349 PMCID: PMC9453124 DOI: 10.4102/ajlm.v11i1.1841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/20/2022] [Indexed: 11/20/2022] Open
Abstract
Background Haemoglobinopathies are one of the most common inherited diseases worldwide. Quantification of haemoglobin A2 is necessary for the diagnosis of the beta thalassaemia trait. In this context, it is important to have a reliable reference interval for haemoglobin A2 and a local reference range for South Africa has not been established. Objective This study aimed to establish reference intervals for haemoglobin A2 using stored patient laboratory data. Methods This descriptive study used retrospective data to evaluate haemoglobin A2 levels determined using high-performance liquid chromatography at the National Health Laboratory Service haematology laboratory in Pretoria, South Africa. All tests performed from 01 October 2012 to 31 December 2020 were screened for inclusion; of these, 144 patients’ data met the selection criteria. The reference interval was calculated using descriptive statistics (mean and standard deviation) with a 95% confidence interval. Results Analysed data from enrolled patients showed a normal distribution. The mean age of the patients was 40 years (range: 3–84 years). The reference interval for haemoglobin A2 calculated from this data was 2.3% – 3.6%. The minimum haemoglobin A2 was 2.3% and the maximum was 3.9% with a mean of 2.95% and a standard deviation of 0.357%. Conclusion A normal reference interval has been established for the population served by the laboratory that will assist with accurate diagnosis of the beta thalassaemia trait. This reference interval may also be useful to other laboratories that employ the same technology, especially smaller laboratories where obtaining a sufficiently large number of normal controls may be challenging.
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Affiliation(s)
- Cailin Nieuwenhuizen
- Department of Haematology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Department of Haematology, Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
| | - Tshiphiri Netshidzivhani
- Department of Haematology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Department of Haematology, Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
| | - Johan Potgieter
- Department of Haematology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Department of Haematology, Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
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5
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Saadatifar H, Niayeshfar A, Mard-Soltani M, Bahrampour E, Khalili S, Alinezhad Dezfuli D, Pouriamehr S. The correlation of cardiac biomarkers and myocardial iron overload based on T2* MRI in major beta-thalassemia. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:833-840. [PMID: 34727252 DOI: 10.1007/s10554-021-02458-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
Cardiac hemosiderosis is the primary factor to derive the pathogenesis of cardiac dysfunction in patients with transfusion dependent thalassemia. Biomarkers assessment along with T2 * MRI study could be employed to evaluate the severity of iron deposition-related damage and determination of the diagnostic and prognostic value of these inflammatory factors. The study was conducted on 62 patients (12-44 years old) with major thalassemia. The patients were under regular blood transfusion and they had no signs of cardiac defects, and chronic diseases. The serum levels of inflammatory factors (NT-proBNP, CRP, Copeptin HS) were determined before routine transfusion. Cardiac iron overload was assessed by T2* MRI (within the last three months), and T2* lower than 20 ms was considered as cardiac siderosis. The obtained results were analyzed using statistical methods. 92% of patients showed an increased level of hs-CRP (> 2 µg/dL). All cases showed increased levels of NT-proBNP (> 150 pg/mL). Only 29% of subjects showed high level of Copeptin, 25.8% of patients demonstrated cardiac siderosis based on the T2* MRI (< 20 ms) results. The serum levels of inflammatory factors were not significantly correlated with cardiac siderosis. Given the obtained results, it could be deduced that the serum levels of inflammatory factors could not be exploited for early detection of cardiac siderosis in major beta-thalassemia patients.
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Affiliation(s)
- Hakimeh Saadatifar
- Department of Echocardiography, Dezful University of Medical Sciences, Dezful, Iran
| | - Arezoo Niayeshfar
- Department of Echocardiography, Dezful University of Medical Sciences, Dezful, Iran
| | - Maysam Mard-Soltani
- Department of Laboratory Sciences, Student Research Committee, Dezful University of Medical Sciences, Dezful, Iran.
| | - Ehsan Bahrampour
- Department of Epidemiology, Dezful University of Medical Sciences, Dezful, Iran
| | - Saeed Khalili
- Department of Biology Sciences, Shahid Rajaee Teacher Training University, Tehran, Iran
| | | | - Somayeh Pouriamehr
- Department of Laboratory Sciences, Dezful University of Medical Sciences, Dezful, Iran
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6
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Moradi K, Alibakhshi R, Shafieenia S, Azimi A. Problem of borderline hemoglobin A2 levels in an Iranian population with a high prevalence of α- and β-thalassemia carriers. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2022. [DOI: 10.1186/s43042-022-00279-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
It is difficult to classify a small fraction of α- and β-thalassemia (α- and β-thal) carriers based on their Hb A2 levels. Here, we report the results of a molecular investigation in a cohort of thalassemia carriers with borderline Hb A2 levels originated from western Iran.
Results
The documents of 5956 α- or β-thal carriers were reviewed. The frequency of individuals with borderline Hb A2 levels in this cohort was 436 (7.32%). A total of 12 different α-thal and 27 different β-thal variants were identified in this study.
Conclusions
Our data showed that individuals with borderline Hb A2 are not uncommon in our population. Moreover, preselection of α- and β-thal carriers with borderline Hb A2 levels based on Hb A2, mean corpuscular volume (MCV), and mean cell hemoglobin (MCH) is not advisable in our population. Therefore, it is necessary to investigate both α- and β-globin genes in cases with borderline Hb A2 levels, especially if the partner is a carrier of β-thal or α0-thal.
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Mahmud N, Maffei M, Mogni M, Forni GL, Pinto VM, Barberio G, Ungari S, Maffè A, Curcio C, Zanolli F, Paventa R, Carta M, Caleffi A, Mercadanti M, Maoggi S, Ivaldi G, Coviello D. Hemoglobin A 2 and Heterogeneous Diagnostic Relevance Observed in Eight New Variants of the Delta Globin Gene. Genes (Basel) 2021; 12:genes12111821. [PMID: 34828427 PMCID: PMC8625798 DOI: 10.3390/genes12111821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hemoglobin A (Hb A) (α2β2) in the normal adult subject constitutes 96-98% of hemoglobin, and Hb F is normally less than 1%, while for hemoglobin A2 (Hb A2) (α2δ2), the normal reference values are between 2.0 and 3.3%. It is important to evaluate the presence of possible delta gene mutations in a population at high risk for globin gene defects in order to correctly diagnose the β-thalassemia carrier. METHODS The most used methods for the quantification of Hb A2 are based on automated high performance liquid chromatography (HPLC) or capillary electrophoresis (CE). In particular Hb analyses were performed by HPLC on three dedicated devices. DNA analyses were performed according to local standard protocols. RESULTS Here, we described eight new δ-globin gene variants discovered and characterized in some laboratories in Northern Italy in recent years. These new variants were added to the many already known Hb A2 variants that were found with an estimated frequency of about 1-2% during the screening tests in our laboratories. CONCLUSIONS The knowledge recognition of the delta variant on Hb analysis and accurate molecular characterization is crucial to provide an accurate definitive thalassemia diagnosis, particularly in young subjects who would like to ask for a prenatal diagnosis or preimplantation genetic diagnosis.
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Affiliation(s)
- Noraesah Mahmud
- Laboratorio Genetica Umana, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (N.M.); (M.M.); (D.C.)
- Department of Pathology, Hospital Kuala Lumpur, Kuala Lumpur 50586, Malaysia
| | - Massimo Maffei
- Laboratorio Genetica Umana, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (N.M.); (M.M.); (D.C.)
- Correspondence:
| | - Massimo Mogni
- Laboratorio Genetica Umana, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (N.M.); (M.M.); (D.C.)
| | - Gian Luca Forni
- Centro Microcitemia e Anemie Congenite, Ospedali Galliera, 16128 Genova, Italy; (G.L.F.); (V.M.P.)
| | - Valeria Maria Pinto
- Centro Microcitemia e Anemie Congenite, Ospedali Galliera, 16128 Genova, Italy; (G.L.F.); (V.M.P.)
| | - Giuseppina Barberio
- Medicina di Laboratorio, Azienda ULSS 2 Marca Trevigiana, 31100 Treviso, Italy;
| | - Silvana Ungari
- Genetica e Biologia Molecolare ASO S. Croce e Carle, 12100 Cuneo, Italy; (S.U.); (A.M.)
| | - Antonella Maffè
- Genetica e Biologia Molecolare ASO S. Croce e Carle, 12100 Cuneo, Italy; (S.U.); (A.M.)
| | - Cristina Curcio
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy;
| | - Francesco Zanolli
- Formerly, Servizio di Immunoematologia e Medicina Trasfusionale, A.O. Santa Maria degli Angeli, 33170 Pordenone, Italy;
| | | | - Mariarosa Carta
- Medicina di Laboratorio, Ospedale S. Bortolo, AULSS 8 Berica, 36100 Vicenza, Italy;
| | - Alberta Caleffi
- U.O. Diagnostica Ematochimica, Azienda Ospedaliero-Universitaria, 43126 Parma, Italy; (A.C.); (M.M.)
| | - Mariella Mercadanti
- U.O. Diagnostica Ematochimica, Azienda Ospedaliero-Universitaria, 43126 Parma, Italy; (A.C.); (M.M.)
| | - Sauro Maoggi
- Sebia-Italia S.r.l., 50012 Bagno a Ripoli, Italy;
| | - Giovanni Ivaldi
- Formerly, Laboratorio Genetica Umana, Galliera Hospital, 16128 Genova, Italy;
| | - Domenico Coviello
- Laboratorio Genetica Umana, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (N.M.); (M.M.); (D.C.)
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Satthakarn S, Panyasai S, Pornprasert S. Molecular Characterization of β- and α-Globin Gene Mutations in Individuals with Borderline Hb A 2 Levels. Hemoglobin 2020; 44:349-353. [PMID: 33023363 DOI: 10.1080/03630269.2020.1826327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Elevated Hb A2 level (≥4.0%) is considered to be reliable parameter to identify β-thalassemia (β-thal) carriers. However, some β-thal carriers have been misdiagnosed as their Hb A2 levels are below 4.0%. In addition, coinheritance of α-thalassemia (α-thal) and β-thal might affect Hb A2 levels. Therefore, the aim of this study was to investigate the mutations of β- and α-globin genes in individuals with borderline Hb A2 levels in Thailand. Three hundred samples from individuals with Hb A2 levels of 3.5-3.9% were collected for molecular diagnosis of β-globin gene mutations. In addition, the α0-thal, α+-thal, Hb Constant Spring (Hb CS, HBA2: c.427T>C), and Hb Paksé (HBA2: c.429A>T) diagnostics were also performed. Sixteen samples (5.33%) had β-globin gene mutations, and codon 41/42 (-TTCT) (HBB: c.126_129delCTTT) was the most prevalent mutation. Ninety-eight samples (32.67%) had α-globin gene mutations including four Hb H (β4)-Hb CS disease, two Hb H disease, 13 heterozygous α0-thal, 11 homozygous α+-thal, two α+-thal/Hb CS, one α+-thal/Hb Paksé, 61 heterozygous α+-thal, and four Hb CS. Furthermore, seven cases of β-thal carriers coinheriting α-thal were observed, and five of them carried Hb H disease. High prevalence of both α- and β-thal in subjects with borderline Hb A2 levels suggested that molecular diagnosis of α- and β-thal should be performed, especially in a high prevalence area of thalasssemia carriers, for accurate diagnosis and genetic counseling to prevent and control new severe thalassemia cases. Moreover, β-thal carriers who coinherited Hb H disease might have reduced Hb A2 levels, leading to a misdiagnosis of β-thal in analysis programs.
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Affiliation(s)
- Surada Satthakarn
- Department of Medical Technology, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
| | - Sitthichai Panyasai
- Department of Medical Technology, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
| | - Sakorn Pornprasert
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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9
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Guastini A, Rizzi L, Santoni F, Mogni M, Maffei M, Vinci S, Barberio G, Coviello D, Ivaldi G. Hb A 2-Pistoia [δ89(F5)Ser→Asn, HBD: c.269G>a]: a Novel Mutation on the δ-Globin Gene in an Italian Child. Hemoglobin 2020; 44:368-370. [PMID: 32912024 DOI: 10.1080/03630269.2020.1815766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We describe a new hemoglobin (Hb) variant, found in a 6-year-old Italian male living in Pistoia, Italy. An abnormal pattern compatible with a Hb A2 variant was observed on capillary electrophoresis (CE); direct sequencing revealed a transition at codon 89 of the δ gene (HBD: c.269G>A) changing serine into asparagine. The variant was also identified as Hb A2-Pistoia according to the traditional nomenclature and no other globin defect was present. The observation and description of this Hb A2 variant contributes to the number and heterogeneity of mutations of the δ-globin gene in the Mediterranean Area.
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Affiliation(s)
| | - Leonardo Rizzi
- Laboratorio Analisi, Ospedale San Jacopo, Pistoia, Italia
| | | | - Massimo Mogni
- Laboratorio Genetica Umana, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Giannina Gaslini, Genova, Italia
| | - Massimo Maffei
- Laboratorio Genetica Umana, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Giannina Gaslini, Genova, Italia
| | - Santina Vinci
- Sebia-Italia Società a Responsabilità Limita (S.r.l.), Firenze, Italia
| | - Giuseppina Barberio
- Medicina di Laboratorio, Ospedale di Treviso, Azienda Unità Locale Socio-Sanitaria (ULSS No. 9), Treviso, Italia
| | - Domenico Coviello
- Laboratorio Genetica Umana, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Giannina Gaslini, Genova, Italia
| | - Giovanni Ivaldi
- Laboratorio Genetica Umana, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Giannina Gaslini, Genova, Italia
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10
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Ai S, Cliffe C, Kidson-Gerber G. Antenatal haemoglobinopathy screening - Experiences of a large Australian Centre. Obstet Med 2020; 14:89-94. [PMID: 34394717 DOI: 10.1177/1753495x20944708] [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: 04/06/2020] [Revised: 06/10/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background Antenatal screening is vital to identifying couples at risk of having children with a clinically significant haemoglobinopathy. In Australia, immigration is increasing carrier incidence. Methods A retrospective analysis was performed of full blood count, high-performance liquid chromatography and haemoglobin electrophoresis of women and their partners who underwent antenatal haemoglobinopathy screening over three years at a major NSW laboratory. Genetic testing results were included where available. Results One thousand six hundred and twenty-eight women and 729 male partners were screened at a median gestation of 14 weeks. 8.2% of women had a clinically significant result, with a median 16-day interval to partner testing. In 35% of couples screened simultaneously, the partner did not require testing. Genetic confirmatory testing was performed in 65% of high risk couples. Conclusion There was a significant delay to antenatal haemoglobinopathy screening for mothers, limiting time for genetic diagnosis, prenatal diagnosis and management of affected pregnancies. Screening should be performed earlier. Simultaneous couple testing is not cost-effective.
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Affiliation(s)
- Sylvia Ai
- Department of Haematology, NSW Health Pathology, Randwick, Australia
| | - Corrina Cliffe
- Department of Molecular Genetics, NSW Health Pathology, Randwick, Australia
| | - Giselle Kidson-Gerber
- Department of Haematology, NSW Health Pathology, Randwick, Australia.,■, University of NSW, Kensington, Australia
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11
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Warghade S, Britto J, Haryan R, Dalvi T, Bendre R, Chheda P, Matkar S, Salunkhe Y, Chanekar M, Shah N. Prevalence of hemoglobin variants and hemoglobinopathies using cation-exchange high-performance liquid chromatography in central reference laboratory of India: A report of 65779 cases. J Lab Physicians 2020; 10:73-79. [PMID: 29403210 PMCID: PMC5784299 DOI: 10.4103/jlp.jlp_57_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT: Hemoglobinopathies constitute the world's most common genetically inherited red blood cell disorder. Screening and accurate identification of hemoglobin (Hb) variants have become increasingly important in antenatal diagnosis and prevention of Hb disorders. AIM: The aim of this study was to screen and identify Hb fractions prevalent in the Central Reference Laboratory of India. MATERIALS AND METHODS: A total of 65,779 cases were screened for hemoglobinopathies on the bio-rad variant high-performance liquid chromatography (HPLC) system by beta-thalassemia short program. The retention times, proportion of the hemoglobin (%) and the peak characteristics for all hemoglobin fractions were recorded. Molecular analysis of the beta-globin gene was carried out by DNA sequencing on eight cases. RESULTS: Total number of abnormal Hb fractions on cation exchange-HPLC (CE-HPLC) was seen in 12,131 (18.44%) cases. Beta-thalassemia trait was the predominant genetic Hb disorder accounting for 7377 cases (11.21%) of the total cases. This was followed by sickle cell trait (2.01%), sickle cell disease (1.59%), beta-thalassemia syndrome (0.80%), HbE trait (0.79%), and borderline HbA2 (0.51%). Molecular characterization of eight rare cases of hemoglobin variants by beta-globin gene sequencing identified three cases of Hb Beth Israel, two cases of Hb Hofu trait, and one case each of Hb J Cambridge, Hb Mizunami, and Hb Sherwood Forest. CONCLUSION: Superior resolution, rapid assay time, and accurate quantification make CE-HPLC suitable for the routine investigation of hemoglobinopathies.
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Affiliation(s)
- Sandeep Warghade
- Department of Hematology, Metropolis Healthcare Ltd, Mumbai, Maharashtra, India
| | - Jyothi Britto
- Department of Hematology, Metropolis Healthcare Ltd, Mumbai, Maharashtra, India
| | - Reshma Haryan
- Department of Hematology, Metropolis Healthcare Ltd, Mumbai, Maharashtra, India
| | - Tejaswi Dalvi
- Department of Hematology, Metropolis Healthcare Ltd, Mumbai, Maharashtra, India
| | - Rajesh Bendre
- Department of Hematology, Metropolis Healthcare Ltd, Mumbai, Maharashtra, India
| | - Pratiksha Chheda
- Department of Molecular Pathology, Metropolis Healthcare Ltd, Mumbai, Maharashtra, India
| | - Sunmeet Matkar
- Department of Molecular Pathology, Metropolis Healthcare Ltd, Mumbai, Maharashtra, India
| | - Yogita Salunkhe
- Department of Molecular Pathology, Metropolis Healthcare Ltd, Mumbai, Maharashtra, India
| | - Milind Chanekar
- Department of Molecular Pathology, Metropolis Healthcare Ltd, Mumbai, Maharashtra, India
| | - Nilesh Shah
- Department of Molecular Pathology, Metropolis Healthcare Ltd, Mumbai, Maharashtra, India
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12
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Chaweephisal P, Phusua A, Fanhchaksai K, Sirichotiyakul S, Charoenkwan P. Borderline hemoglobin A2 levels in northern Thai population: HBB genotypes and effects of coinherited alpha-thalassemia. Blood Cells Mol Dis 2019; 74:13-17. [DOI: 10.1016/j.bcmd.2018.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 01/13/2023]
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13
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Arsene CG, Kaiser P, Paleari R, Henrion A, Spannagl M, Mosca A. Determination of HbA2 by quantitative bottom-up proteomics and isotope dilution mass spectrometry. Clin Chim Acta 2018; 487:318-324. [DOI: 10.1016/j.cca.2018.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 10/16/2018] [Indexed: 10/28/2022]
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14
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Tripathi P, Kumar R, Agarwal S. Spectrum and hematological profile of hereditary anemia in North Indians: SGPGI experience. Intractable Rare Dis Res 2018; 7:258-263. [PMID: 30560018 PMCID: PMC6290850 DOI: 10.5582/irdr.2018.01093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Thalassemia and other hemoglobinopathies together with red cell enzymopathies are a common cause of anemia, which can be prevented by population screening and genetic counseling. This study was designed to screen the anemic patients for thalassemia, structural hemoglobin variants and red cell enzymopathies. A total of 17047 cases were evaluated from 2009 to 2018 for thalassemia, hemoglobin variants, glucose 6 phosphate dehydrogenase deficiency, pyruvate kinase deficiency and hereditary spherocytosis. Patients' records were entered in a Microsoft excel sheet and a spectrum of disorders was evaluated. Year wise spectrum was also analyzed to see the difference in incidence at different time periods. Incidence of beta thalassemia trait and thalassemia major was found in 11.0% and 3.4% respectively, whereas other hemoglobinopathies were observed in 3.2% of the cases. G6PD deficient cases were 0.2 % and 0.4% had hereditary spherocytosis. No significant difference was observed in incidence of thalassemia and other hemoglobinopathies at different time points. This study provided a health burden and detailed spectrum and prevalence of hemoglobinopathies in North Indians high risk population which contribute toward the development of prevention strategies for better management of hemoglobinopathies. In view of high incidence of thalassemia a routine hematological screening at a primary health center may be introduced as a prospective premarital screening under a thalassemia control program. Moreover rapid and easy quantification of hemoglobin variants (Hb variants) make Cation exchange - High Performance Liquid Chromatography (CE-HPLC) a suitable diagnostic test for the routine investigation of genetic causes of anemia.
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Affiliation(s)
| | | | - Sarita Agarwal
- Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
- Address correspondence to:Dr. Sarita Agarwal, Department of Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India. E-mail:
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Jiang F, Chen GL, Li J, Zhou JY, Liao C, Li DZ. Analysis of the Genotypes in a Chinese Population with Increased Hb A2and Low Hematological Indices. Hemoglobin 2018; 42:154-158. [DOI: 10.1080/03630269.2018.1509869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Fan Jiang
- Southern Medical University, Guangzhou Women and Children’s Medical Center affiliated to Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China
- Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center affiliated to Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Gui-Lan Chen
- Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center affiliated to Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jian Li
- Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center affiliated to Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jian-Ying Zhou
- Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center affiliated to Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Can Liao
- Southern Medical University, Guangzhou Women and Children’s Medical Center affiliated to Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China
- Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center affiliated to Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Dong-Zhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center affiliated to Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China
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Jiang F, Qu YX, Chen GL, Li J, Zhou JY, Zuo LD, Liao C, Li DZ. KFL1 Gene Variants in α-Thalassemia Individuals with Increased Fetal Hemoglobin in a Chinese Population. Hemoglobin 2018; 42:161-165. [PMID: 30205725 DOI: 10.1080/03630269.2018.1486325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Krüppel-like factor 1 (KLF1) is a pleiotropic erythroid transcription factor that is a regulator of definitive erythropoiesis. The aim of this study was to detect KLF1 gene variants in α-thalassemia (α-thal) carriers with an increased Hb F level in a Chinese population, and determine the changes of hematological parameters as a result of interactions between KLF1 gene mutations and α-thal. Subjects with α-thal and Hb F levels of ≥1.0% were selected for further investigation. Direct sequencing was used to detect KLF1 gene mutations. Hematological parameters of subjects with α-thal and concomitant KLF1 gene mutations and those with α-thal alone were compared. The KLF1 gene variants were detected in 46 of 275 (16.7%) individuals with α-thal and Hb F levels of ≥1.0%. The detection rate of KLF1 gene mutations rose correspondingly when the Hb F level increased. For α0-thal carriers, significantly lower mean corpuscular volume (MCV) and mean corpuscular hemoglobin (Hb) (MCH) values were observed in KLF1 gene mutation-positive carriers than that in KLF1 gene mutation-free carriers; conversely, significantly higher Hb A2 and Hb F levels were observed in the former condition rather than in the latter condition. The results of this study indicate that KLF1 gene variants are common in Chinese subjects with α-thal and increased Hb F levels, and KLF1 gene mutations decreased the red blood cell (RBC) indices in α-thal carriers as that in normal adults.
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Affiliation(s)
- Fan Jiang
- a Guangzhou Women and Children's Medical Center , Guangzhou Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Yan-Xia Qu
- a Guangzhou Women and Children's Medical Center , Guangzhou Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Gui-Lan Chen
- a Guangzhou Women and Children's Medical Center , Guangzhou Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Jian Li
- a Guangzhou Women and Children's Medical Center , Guangzhou Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Jian-Ying Zhou
- a Guangzhou Women and Children's Medical Center , Guangzhou Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Lian-Dong Zuo
- a Guangzhou Women and Children's Medical Center , Guangzhou Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Can Liao
- a Guangzhou Women and Children's Medical Center , Guangzhou Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Dong-Zhi Li
- a Guangzhou Women and Children's Medical Center , Guangzhou Medical University , Guangzhou , Guangdong Province , People's Republic of China
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17
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Borgio JF, AbdulAzeez S, Al-Muslami AM, Naserullah ZA, Al-Jarrash S, Al-Suliman AM, Al-Madan MS, Al-Ali AK. KLF1 gene and borderline hemoglobin A 2 in Saudi population. Arch Med Sci 2018; 14:230-236. [PMID: 29379553 PMCID: PMC5778434 DOI: 10.5114/aoms.2018.72245] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/29/2017] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Elevated HbA2 (hemoglobin A2) level is considered the most reliable hematological parameter for the detection of β-thalassemia carriers. However, some carriers are difficult to recognize because the level of HbA2 is not in the distinctive carrier range, i.e. 4.0-6.0%; instead, some carriers have HbA2 levels between normal and carrier levels, i.e. borderline HbA2 (HbA2 = 3.1-3.9%). Studies have shown that variations in the erythroid Krüppel-like factor (KLF1) gene lead to borderline HbA2 in β-thalassemia carriers from various populations. The incidence of borderline HbA2 in Saudis is high. MATERIAL AND METHODS To confirm the influence of variations in KLF1, HBA1, HBA2 and HBB genes for the reduction of the level of HbA2 in Saudi β-thalassemia carriers, we performed a direct sequence analysis of KLF1, HBA1, HBA2 and HBB genes from 212 healthy Saudis (88 subjects: HbA2 < 3; 72 subjects: HbA2 = 3.1 to 3.9; 52 subjects HbA2 > 4.3). RESULTS The presence of the borderline HbA2 level is not specific to any type of β-thalassemia variation or β+-thalassemia variations in Saudis. Two exonic (c.304T>C and c.544T>C) and two 3' untranslated region (3'UTR) (c.*296G>A and c.*277C>G) variations have been identified in the KLF1 gene for the first time from an Arab population. None of these four variations in KLF1 genes are significantly associated with the Saudis with borderline HbA2. α Globin genotype, -α23.7/α1α2, is found to be the most frequent (55.55%) among healthy Saudis with borderline HbA2 compared with the other groups (HbA2 < 3 = 20.45%; HbA2 > 4.3 = 13.51%). CONCLUSIONS Further studies are necessary to determine the influence of other factors on the presence of borderline HbA2 in 41.67% of Saudis.
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Affiliation(s)
- J. Francis Borgio
- Department of Genetic Research, Institute for Research and Medical Consultation (IRMC), University of Dammam, Dammam, Saudi Arabia
| | - Sayed AbdulAzeez
- Department of Genetic Research, Institute for Research and Medical Consultation (IRMC), University of Dammam, Dammam, Saudi Arabia
| | - Ahmed M. Al-Muslami
- Department of Genetic Research, Institute for Research and Medical Consultation (IRMC), University of Dammam, Dammam, Saudi Arabia
| | | | | | - Ahmed M. Al-Suliman
- Al-Omran Scientific Chair for Hematological Diseases Prevalent in the Al-Ahssa Area, King Faisal University, Al-Ahssa, Saudi Arabia
| | - Mohammed S. Al-Madan
- Department of Pediatrics, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Amein K. Al-Ali
- Department of Biochemistry, University of Dammam, Dammam, Saudi Arabia
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Vinciguerra M, Cannata M, Cassarà F, Passarello C, Leto F, Calvaruso G, Renda D, Maggio A, Giambona A. HBB: c.316-125A>G and HBB: c.316-42delC: Phenotypic Evaluations of Two Rare Changes in the Second Intron of the HBB Gene. Hemoglobin 2017; 41:234-238. [DOI: 10.1080/03630269.2017.1397014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Margherita Vinciguerra
- Department of Hematology for Rare Diseases of Blood and Blood-Forming Organs, Laboratory for Molecular Diagnosis of Rare Diseases, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Monica Cannata
- Department of Hematology for Rare Diseases of Blood and Blood-Forming Organs, Laboratory for Molecular Diagnosis of Rare Diseases, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Filippo Cassarà
- Department of Hematology for Rare Diseases of Blood and Blood-Forming Organs, Laboratory for Molecular Diagnosis of Rare Diseases, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Cristina Passarello
- Department of Hematology for Rare Diseases of Blood and Blood-Forming Organs, Laboratory for Molecular Diagnosis of Rare Diseases, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Filippo Leto
- Department of Hematology for Rare Diseases of Blood and Blood-Forming Organs, Laboratory for Molecular Diagnosis of Rare Diseases, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Giuseppina Calvaruso
- Department of Hematology for Rare Diseases of Blood and Blood-Forming Organs, Laboratory for Molecular Diagnosis of Rare Diseases, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Disma Renda
- Department of Hematology for Rare Diseases of Blood and Blood-Forming Organs, Laboratory for Molecular Diagnosis of Rare Diseases, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Aurelio Maggio
- Department of Hematology for Rare Diseases of Blood and Blood-Forming Organs, Laboratory for Molecular Diagnosis of Rare Diseases, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Antonino Giambona
- Department of Hematology for Rare Diseases of Blood and Blood-Forming Organs, Laboratory for Molecular Diagnosis of Rare Diseases, Villa Sofia-Cervello Hospital, Palermo, Italy
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19
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Borgio JF, Abdulazeez S, Almandil NB, Naserullah ZA, Al-Jarrash S, Al-Suliman AM, Elfakharay HI, Qaw FS, Alabdrabalnabi FI, Alkhalifah MA, Shakil Akhtar M, Qutub H, Al-Ali AK. The ‑α3.7 deletion in α‑globin genes increases the concentration of fetal hemoglobin and hemoglobin A2 in a Saudi Arabian population. Mol Med Rep 2017; 17:1879-1884. [PMID: 29138844 DOI: 10.3892/mmr.2017.8033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/29/2017] [Indexed: 11/06/2022] Open
Abstract
The regions of Al‑Qatif and Al‑Ahssa in the Eastern Province of Saudi Arabia are known for their high prevalence of hemoglobinopathies, including β‑thalassemia and sickle cell anemia. Previously, the α‑gene deletion has been demonstrated as highly prevalent among populations residing in these two regions. The present study was conducted in order to investigate the implications of the α‑globin gene deletion on fetal hemoglobin (HbF) and hemoglobin α2 (HbA2) concentrations in patients with transfusion‑dependent β‑thalassemia. A total of 166 Saudi patients with transfusion‑dependent β‑thalassemia and 337 healthy Saudi patients were included in the study. The ‑α3.7, ‑α4.2, -‑FIL, -‑SEA, -‑MED and -‑(20.5) gene deletions were identified using multiplex α‑globin deletion polymerase chain reaction. The present study revealed that the ‑α3.7 gene deletion is the most prevalent (43.5%) in the Saudi populations that were analyzed and is characterized by the deletion of 3,804 base pairs. Numerous genotypes, namely ‑3.7α2/α1α2, ‑3.7α2/α1α12, ‑3.7α2/‑3.7α2, ‑3.7α2HphI/α1α2HphI, ‑3.7α2/α1‑4.2, ‑3.7α2/α1polyA‑1α2, ‑3.7α12/α1α12, ‑‑FIL/‑3.7α2 and ‑3.7α2/‑3.7α2Hb Villiers le Bel were also identified in the investigated population. Furthermore, a gradual increase in the concentration of HbF and HbA2 in patients with β‑thalassemia and the number of α‑gene deletions was demonstrated; whereas in healthy patients the level of HbA2 was demonstrated to decrease as the number of α‑gene deletions increased. Therefore, it can be concluded that the high HbF concentration in the present study is predominantly associated with other mutations associated with β‑thalassemia rather than α‑globin deletions. Furthermore, the results of the present study also revealed novel α‑gene deletion genotypes prevalent in the population studied, namely α1α2/α1α2HphI, α1α2HphI/α1α2HphI, α1α2/α1α2Hb Handsworth, ‑3.7α2HphI/α1α2HphI, ‑3.7α2/‑3.7α2Hb Villiers le Bel and ‑-MED/α1α2HphI.
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Affiliation(s)
- J Francis Borgio
- Department of Genetic Research, Institute for Research and Medical Consultation, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Sayed Abdulazeez
- Department of Genetic Research, Institute for Research and Medical Consultation, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Noor B Almandil
- Department of Clinical Pharmacy Research, Institute for Research and Medical Consultation, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | | | - Sana Al-Jarrash
- Dammam Maternity and Child Hospital, Dammam 32253, Saudi Arabia
| | - Ahmed M Al-Suliman
- Al‑Omran Scientific Chair for Hematological Diseases Prevalent in The Al‑Ahssa Area, King Faisal University, Al‑Ahssa 31982, Saudi Arabia
| | | | - Fuad S Qaw
- Department of Biochemistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | | | | | - Mohammed Shakil Akhtar
- Department of Biochemistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Hatem Qutub
- King Fahd Hospital of The University, Al‑Khobar 34445, Saudi Arabia
| | - Amein K Al-Ali
- Al‑Omran Scientific Chair for Hematological Diseases Prevalent in The Al‑Ahssa Area, King Faisal University, Al‑Ahssa 31982, Saudi Arabia
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Uaprasert N, Settapiboon R, Amornsiriwat S, Sutcharitchan P, Rojnuckarin P. The first validated criteria for effective screening and a new simplified method for α-globin gene sequencing for diagnosis of uncommon α-globin mutations. Int J Hematol 2017; 105:819-827. [PMID: 28168416 DOI: 10.1007/s12185-017-2186-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
No well-defined phenotypes that distinguish between unknown α- and β-globin mutations have been reported to date. Direct DNA sequencing of α-globin genes can be technically challenging, as α1- and α2-globin genes are nearly indistinguishable. To detect hemoglobin variants (HbXs) on Hb analysis, the entire β- and α-globin genes were directly sequenced using a newly developed sequencing protocol for α-globin genes. An algorithm to distinguish between α- and β-HbXs was constructed and subsequently validated in the independent validation group. Distinctive characteristics that can distinguish 39 α-HbXs from 24 β-HbXs were the presence of unidentifiable variants of HbA2 and/or HbX of <37% on isoelectric focusing and <31% on high-performance liquid chromatography. Another set of 67 HbXs was employed to validate our algorithm. This accurately predicted 33 α-HbXs with 100% sensitivity and 97.1% specificity. Our sequencing protocol for α-globin genes was able to identify 11 rare mutations among all exons of both α-globin genes from 72 subjects. Six of these variants were first discovered in Thais. This is the first well-characterized algorithm for distinguishing unknown Hb variants in a large cohort. Our validated criteria and DNA sequencing procedure are highly efficient for molecular characterization of rare Hb mutations.
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Affiliation(s)
- Noppacharn Uaprasert
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand.
| | - Rung Settapiboon
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Supaporn Amornsiriwat
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Pranee Sutcharitchan
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Ponlapat Rojnuckarin
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
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Zhang J, He J, Mao X, Zeng X, Chen H, Su J, Zhu B. Haematological and electrophoretic characterisation of β-thalassaemia in Yunnan province of Southwestern China. BMJ Open 2017; 7:e013367. [PMID: 28143837 PMCID: PMC5293871 DOI: 10.1136/bmjopen-2016-013367] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES β-Thalassaemia is widely found in Southwestern China. Characterisation of β-thalassaemia can improve screening and prenatal diagnosis for at-risk populations. DESIGN A retrospective study. METHODS In this study, the levels of haemoglobin alpha 2 (HbA2) and haemoglobin alpha (HbA) were analysed by gender for a total of 15 067 subjects screened by capillary electrophoresis. The cut-off value with the highest accuracy was established to identify β-thalassaemia in 723 patients suspected to have this disease. Haematological and electrophoretic characterisation of eight common types of β-thalassaemia were analysed in 486 β-thalassaemia subjects. RESULTS HbA levels were significantly higher in men than in women, but there was no significant difference on HbA2 levels. A new cut-off value for the diagnosis of β-thalassaemia (HbA2≥4.0%) with the highest accuracy was proposed for the studied populations. Haemoglobin (Hb) was significantly higher in men compared with women (p<0.05), whereas no statistically significant differences were found for mean cell volume (MCV), mean cell haemoglobin (MCH), HbA and HbA2. The haemoglobin E (HbE) group showed comparatively higher values for haematological indices (Hb, MCV and MCH) than the other genotypes in heterozygous β-thalassaemia groups (p<0.05), and -28 (A>G) (HBB (β-globin):c.-78A>C) had significantly higher HbA2 values compared with other β-thalassaemia. CONCLUSIONS Ethnic groups have diversified β-globin gene mutations and considerable haematological variations. Our study will lay the foundation for screening programmes and clinical management of thalassaemia in Southwestern China.
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Affiliation(s)
- Jie Zhang
- Yunnan Provincial Key Laboratory For Birth Defects and Genetic Diseases, Genetic Diagnosis Center, the First People's Hospital of Yunnan Province, Kunming, China
- Genetics Department, Kunming University of Science and Technology
| | - Jing He
- Yunnan Provincial Key Laboratory For Birth Defects and Genetic Diseases, Genetic Diagnosis Center, the First People's Hospital of Yunnan Province, Kunming, China
- Genetics Department, Kunming University of Science and Technology
| | - Xiaoqin Mao
- Department of Clinical Laboratory, The First People's Hospital of Yunnan Province, Kunming, China
| | - Xiaohong Zeng
- Yunnan Provincial Key Laboratory For Birth Defects and Genetic Diseases, Genetic Diagnosis Center, the First People's Hospital of Yunnan Province, Kunming, China
- Genetics Department, Kunming University of Science and Technology
| | - Hong Chen
- Yunnan Provincial Key Laboratory For Birth Defects and Genetic Diseases, Genetic Diagnosis Center, the First People's Hospital of Yunnan Province, Kunming, China
- Genetics Department, Kunming University of Science and Technology
| | - Jie Su
- Yunnan Provincial Key Laboratory For Birth Defects and Genetic Diseases, Genetic Diagnosis Center, the First People's Hospital of Yunnan Province, Kunming, China
- Genetics Department, Kunming University of Science and Technology
| | - Baosheng Zhu
- Yunnan Provincial Key Laboratory For Birth Defects and Genetic Diseases, Genetic Diagnosis Center, the First People's Hospital of Yunnan Province, Kunming, China
- Genetics Department, Kunming University of Science and Technology
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Rungsee P, Kongthai K, Pornprasert S. Detection of the common South-East Asian β0-thalassemia mutations in samples with borderline HbA2 levels. Clin Chem Lab Med 2017; 55:e17-e20. [PMID: 27394049 DOI: 10.1515/cclm-2016-0470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 06/13/2016] [Indexed: 11/15/2022]
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Turner A, Sasse J, Varadi A. Rapid detection of pathological mutations and deletions of the haemoglobin beta gene (HBB) by High Resolution Melting (HRM) analysis and Gene Ratio Analysis Copy Enumeration PCR (GRACE-PCR). BMC MEDICAL GENETICS 2016; 17:75. [PMID: 27756326 PMCID: PMC5070150 DOI: 10.1186/s12881-016-0334-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 09/29/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Inherited disorders of haemoglobin are the world's most common genetic diseases, resulting in significant morbidity and mortality. The large number of mutations associated with the haemoglobin beta gene (HBB) makes gene scanning by High Resolution Melting (HRM) PCR an attractive diagnostic approach. However, existing HRM-PCR assays are not able to detect all common point mutations and have only a very limited ability to detect larger gene rearrangements. The aim of the current study was to develop a HBB assay, which can be used as a screening test in highly heterogeneous populations, for detection of both point mutations and larger gene rearrangements. METHODS The assay is based on a combination of conventional HRM-PCR and a novel Gene Ratio Analysis Copy Enumeration (GRACE) PCR method. HRM-PCR was extensively optimised, which included the use of an unlabelled probe and incorporation of universal bases into primers to prevent interference from common non-pathological polymorphisms. GRACE-PCR was employed to determine HBB gene copy numbers relative to a reference gene using melt curve analysis to detect rearrangements in the HBB gene. The performance of the assay was evaluated by analysing 410 samples. RESULTS A total of 44 distinct pathological genotypes were detected. In comparison with reference methods, the assay has a sensitivity of 100 % and a specificity of 98 %. CONCLUSION We have developed an assay that detects both point mutations and larger rearrangements of the HBB gene. This assay is quick, sensitive, specific and cost effective making it suitable as an initial screening test that can be used for highly heterogeneous cohorts.
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Affiliation(s)
- Andrew Turner
- Department of Pathology and Laboratory Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
| | - Jurgen Sasse
- Department of Pathology and Laboratory Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Aniko Varadi
- Department of Applied Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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Vinciguerra M, Passarello C, Leto F, Crivello A, Fustaneo M, Cassarà F, Cannata M, Maggio A, Giambona A. Coinheritance of a Rare Nucleotide Substitution on theβ-Globin Gene and Other Known Mutations in the Globin Clusters: Management in Genetic Counseling. Hemoglobin 2016; 40:231-5. [DOI: 10.1080/03630269.2016.1188400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Paglietti ME, Satta S, Sollaino MC, Barella S, Ventrella A, Desogus MF, Demartis FR, Manunza L, Origa R. The Problem of Borderline Hemoglobin A2 Levels in the Screening for β-Thalassemia Carriers in Sardinia. Acta Haematol 2016; 135:193-9. [PMID: 26794457 DOI: 10.1159/000442194] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/04/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND The increase in HbA2 is the most important parameter for the identification of thalassemia carriers. However, in routine screening for hemoglobinopathies, some cases are difficult to classify because the level of HbA2 is not typically elevated. In this work, we report the results of a molecular investigation on a cohort of subjects with borderline HbA2. METHODS All subjects with a β-thalassemia carrier partner and a borderline percentage level of HbA2 were investigated for the presence of a pathological mutation in the β-globin gene. All negative subjects were screened for both the KLF1 mutation and the presence of ααα/ or αααα/ alleles. The subjects with reduced MCV and/or MCH were also screened for deletional and nondeletional α-globin gene defects. RESULTS Various β-globin mutations and KLF1 gene defects are the most common genetic determinants responsible for this phenotype in our population. CONCLUSION KLF1 mutations are important in a screening program for hemoglobinopathies. An increase in HbF in association with borderline HbA2 levels is a useful but not exclusive marker that suggests the investigation of this gene. On the basis of our findings, we are able to suggest the molecular procedure to use in a population characterized by a high prevalence of thalassemia carriers.
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Affiliation(s)
- Maria Elisabetta Paglietti
- Dipartimento di Sanitx00E0; Pubblica, Medicina Clinica e Molecolare, Universitx00E0; degli Studi di Cagliari, Ospedale Microcitemico, Cagliari, Italy
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Gorivale M, Sawant P, Mehta P, Nadkarni A, Ghosh K, Colah R. Challenges in prenatal diagnosis of beta thalassaemia: couples with normal HbA2
in one partner. Prenat Diagn 2015; 35:1353-7. [DOI: 10.1002/pd.4706] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/25/2015] [Accepted: 10/05/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Manju Gorivale
- National Institute of Immunohaematology; Indian Council of Medical Research; 13 Floor, New MS Building, KEM Hospital Campus, Parel Mumbai 400012 India
| | - Pratibha Sawant
- National Institute of Immunohaematology; Indian Council of Medical Research; 13 Floor, New MS Building, KEM Hospital Campus, Parel Mumbai 400012 India
| | - Pallavi Mehta
- National Institute of Immunohaematology; Indian Council of Medical Research; 13 Floor, New MS Building, KEM Hospital Campus, Parel Mumbai 400012 India
| | - Anita Nadkarni
- National Institute of Immunohaematology; Indian Council of Medical Research; 13 Floor, New MS Building, KEM Hospital Campus, Parel Mumbai 400012 India
| | - Kanjaksha Ghosh
- National Institute of Immunohaematology; Indian Council of Medical Research; 13 Floor, New MS Building, KEM Hospital Campus, Parel Mumbai 400012 India
| | - Roshan Colah
- National Institute of Immunohaematology; Indian Council of Medical Research; 13 Floor, New MS Building, KEM Hospital Campus, Parel Mumbai 400012 India
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Panyasai S, Jaiping K, Pornprasert S. Elevated Hb A 2Levels in a Patient with a Compound Heterozygosity for the (β+) −31 (A > G) and ( β0) Codon 17 (A > T) Mutations Together with a Single α-Globin Gene. Hemoglobin 2015; 39:292-5. [DOI: 10.3109/03630269.2015.1047513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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28
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Steinberg MH, Rodgers GP. HbA2: biology, clinical relevance and a possible target for ameliorating sickle cell disease. Br J Haematol 2015; 170:781-7. [DOI: 10.1111/bjh.13570] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
| | - Griffin P. Rodgers
- National Institute of Diabetes and Digestive and Kidney Diseases; National Institutes of Health; Bethesda MD USA
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29
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Waye JS, Eng B. Krüppel-like factor 1: hematologic phenotypes associated withKLF1gene mutations. Int J Lab Hematol 2015; 37 Suppl 1:78-84. [DOI: 10.1111/ijlh.12356] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/18/2015] [Indexed: 11/30/2022]
Affiliation(s)
- J. S. Waye
- Hamilton Regional Laboratory Medicine Program; Hamilton Health Sciences; Hamilton Ontario L8N 3Z5 Canada
- Department of Pathology and Molecular Medicine; McMaster University; Hamilton Ontario L8N 3Z5 Canada
| | - B. Eng
- Hamilton Regional Laboratory Medicine Program; Hamilton Health Sciences; Hamilton Ontario L8N 3Z5 Canada
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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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Lou JW, Li DZ, Zhang Y, He Y, Sun MN, Ye WL, Liu YH. Delineation of the molecular basis of borderline hemoglobin A2 in Chinese individuals. Blood Cells Mol Dis 2014; 53:261-4. [DOI: 10.1016/j.bcmd.2014.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 04/17/2014] [Accepted: 04/20/2014] [Indexed: 11/29/2022]
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Detection of Abnormal Hemoglobin Variants by HPLC Method: Common Problems with Suggested Solutions. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:257805. [PMID: 27351019 PMCID: PMC4897512 DOI: 10.1155/2014/257805] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 07/16/2014] [Indexed: 11/18/2022]
Abstract
Thalassemia and thalassemic hemoglobinopathies pose serious health problem leading to severe morbidity and mortality in Indian population. Plethora of hemoglobin variants is prevalent in multiethnic Indian population. The aim of the present study was to analyze laboratory aspects, namely, hematological profile and HPLC findings of the hemoglobin variants detected, and to discuss problems that we faced in diagnosis in a routine clinical laboratory. We screened a total of 4800 cases in a hospital based population of North India in a 2-years period of by automated HPLC method using the Variant Hemoglobin Testing System (Variant II Beta Thalassemia Short Program, Bio-Rad Laboratories) under the experimental conditions specified by the manufacturer. Whole blood in EDTA was used and red cell indices were determined using automated hematology analyzer. We detected 290 cases with abnormal variants in which beta thalassemia was the most common followed by hemoglobin E. Here, we discuss the laboratory aspects of various hemoglobin disorders and diagnostic difficulties in cases like borderline HbA2 values, presence of silent mutation, alpha thalassemia gene, and few rare variants which at times require correlation with genetic study. Special attention was given to HbA2 level even in presence of a structural variant to rule out coinheritance of beta thalassemia gene.
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Yu LH, Liu D, Cai R, Shang X, Zhang XH, Ma XX, Yan SH, Fang P, Zheng CG, Wei XF, Liu YH, Zhou TB, Xu XM. Changes in hematological parameters in α-thalassemia individuals co-inherited with erythroid Krüppel-like factor mutations. Clin Genet 2014; 88:56-61. [PMID: 24930900 DOI: 10.1111/cge.12443] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 05/28/2014] [Accepted: 06/11/2014] [Indexed: 12/20/2022]
Abstract
Phenotypic variations in α-thalassemia mainly depend on the defective α-globin gene number. Genetic modifiers of the phenotype of Hemoglobin H (HbH) disease were poorly reported, apart from β-thalassemia allele that was identified ameliorating the severity of α-thalassemia. Because erythroid Krüppel-like factor (KLF1) mutations can modulate the red blood phenotype, we evaluated its effect on the α-thalassemia phenotype. Overall, we identified 72 subjects with five different KLF1 heterozygous mutations in 1468 individuals, including 65 out of 432 α-thalassemia carriers with fetal hemoglobin (HbF) levels ≥1%, 0 out of 310 carriers with HbF levels <1% and 7 out of 726 HbH disease patients. We firstly established the link between KLF1 mutations and relatively elevated hemoglobin A2 (HbA2 ) and HbF levels, along with lower mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) values in a group of α-thalassemia carriers. However, we concluded that KLF1 mutations were not significantly linked to HbH disease severity. On the basis of HBA or HBB genotype and gender, clinical severity of patients with HbH disease was correctly predicted in 73.3% cases. It may improve the screening and diagnostic assessment of α-thalassemia.
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Affiliation(s)
- L-H Yu
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, P.R.China
| | - D Liu
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, P.R.China
| | - R Cai
- Department of Birth Health and Heredity, Liuzhou Women and Children Care Hospital, Liuzhou, Guangxi, P.R.China
| | - X Shang
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, P.R.China
| | - X-H Zhang
- Department of Hematology, 303rd Hospital of the People's Liberation Army, Nanning, Guangxi, P.R.China
| | - X-X Ma
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, P.R.China
| | - S-H Yan
- Laboratory of Medical Genetics, Maternal and Child Health Care Hospital of Qinzhou, Qinzhou, Guangxi, P.R.China
| | - P Fang
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, P.R.China
| | - C-G Zheng
- Prenatal Diagnostic Center, Guangxi Zhuang Autonomous Region Women and Children Care Hospital, Nanning, Guangxi, P.R.China
| | - X-F Wei
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, P.R.China
| | - Y-H Liu
- Prenatal Diagnosis Center, Maternal and Child Health Hospital, Dongguan, Guangdong, P.R.China
| | - T-B Zhou
- Clinical Laboratory, Yunnan Women and Children Care Hospital, Kunming, Yunnan, P.R.China
| | - X-M Xu
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, P.R.China
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Alkindi S, AlZadjali S, Daar S, Ambusaidi R, Gravell D, Al Haddabi H, Krishnamoorthy R, Pathare A. First report of the spectrum of δ-globin gene mutations in Omani subjects - identification of novel mutations. Int J Lab Hematol 2014; 37:238-43. [DOI: 10.1111/ijlh.12272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 06/02/2014] [Indexed: 11/28/2022]
Affiliation(s)
- S. Alkindi
- College of Medicine & Health Sciences; Sultan Qaboos University; Muscat Oman
| | | | - S. Daar
- College of Medicine & Health Sciences; Sultan Qaboos University; Muscat Oman
| | | | - D. Gravell
- Sultan Qaboos University Hospital; Muscat Oman
| | | | - R. Krishnamoorthy
- INSERM, U665; Paris France
- Laboratoire d'Excellence GR-EX; Paris France
| | - A. Pathare
- Sultan Qaboos University Hospital; Muscat Oman
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Vinciguerra M, Passarello C, Leto F, Cassarà F, Cannata M, Maggio A, Giambona A. Identification of three new nucleotide substitutions in the β-globin gene: laboratoristic approach and impact on genetic counselling for beta-thalassaemia. Eur J Haematol 2014; 92:444-9. [PMID: 24401016 DOI: 10.1111/ejh.12267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Over the past two decades, a wide range of available methods for DNA analysis have allowed us to identify defects in globin genes associated with haemoglobin disorders and to correlate specific mutations with phenotypic expression. The purpose of this study was to evaluate the nature of three new nucleotide changes, mutation or single nucleotide polymorphism, found in the beta-globin gene, to conduct an appropriate genetic counselling. PATIENTS AND METHODS We report the molecular study performed in three probands and their families, sampling during the screening programme conducted at the Laboratory for Molecular Prenatal Diagnosis of Hemoglobinopathies at Villa Sofia-Cervello Hospital in Palermo, Italy. RESULTS This work allowed us to report three new nucleotide substitutions of the β-globin gene: a substitution of the nucleotide 16 in the CAP site area (HBB: c.-35 A>G), a substitution of the nucleotide 478 in the second intron (HBB: c.316-373) in association with β-haemoglobin variant Hb G Copenhagen (HBB:c.142G>A) and a substitution of the nucleotide 1656 within the 3' UTR (HBB: c.*+182 G>A) in association with the 1393-bp deletion (NG_000007.3:g.70060_71452del1393). CONCLUSION The present work emphasizes the importance of reporting the observed nucleotide changes to the Haemoglobin Variant Database, especially in the case of new or rare undefined mutations, to facilitate the determination of their phenotypic expression and the possible interactions with known molecular defects and to formulate an appropriate genetic counselling for couples at risk.
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Affiliation(s)
- Margherita Vinciguerra
- Department of Haematology for Rare Diseases of Blood and Blood-forming Organs, Regional Reference Laboratory for Screening and Prenatal Diagnosis of Haemoglobinopathies, Villa Sofia-Cervello Hospital, Palermo, Italy
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Al Zadjali S, Bashir W, Gravell D, Al Riyami AZ, Wali Y, Daar S. First reported case of compound heterozygosity for HbA2-Yialousa (HBD: c.82 G>C) and HbA2-Wrens (HBD: c.295 G>A) in Oman. Int J Hematol 2013; 98:240-2. [DOI: 10.1007/s12185-013-1388-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 06/11/2013] [Accepted: 06/16/2013] [Indexed: 11/24/2022]
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Belhoul KM, Abdulrahman M, Alraei RF. Hemoglobinopathy Carrier Prevalence in The United Arab Emirates: First Analysis of The Dubai Health Authority Premarital Screening Program Results. Hemoglobin 2013; 37:359-68. [DOI: 10.3109/03630269.2013.791627] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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38
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Sahli CA, Bibi A, Ouali F, Fredj SH, Dakhlaoui B, Othmani R, Laaouini N, Jouini L, Ouenniche F, Siala H, Touhami I, Becher M, Fattoum S, El Houda Toumi N, Messaoud T. Red cell indices: differentiation between β-thalassemia trait and iron deficiency anemia and application to sickle cell disease and sickle cell thalassemia. Clin Chem Lab Med 2013; 51:1595-603. [PMID: 23492565 DOI: 10.1515/cclm-2012-0842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 02/08/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND In Tunisia, thalassemia and sickle cell disease (SS) represent the most prevalent monogenic hemoglobin disorders with 2.21% and 1.89% of carriers, respectively. This study aims to evaluate the diagnosis reliability of 12 red blood cell (RBC) indices in differentiation of β-thalassemia trait (β-TT) from iron deficiency anemia (IDA) and between homozygous SS and sickle cell thalassemia (ST). METHODS The study covered 384 patients divided into three groups. The first one is composed of 145 control group, the second consists of 57 β-TT and 52 IDA subjects and the last one with 88 SS and 42 ST patients. We calculated sensitivity, specificity, positive-predictive values, negative-predictive values, percentage of correctly identified patients and Youden's Index (YI) for each indice. We also established new cut-off values by receiver operating characteristic curves for each indice. An evaluation study was performed on another population composed of 106 β-TT, 125 IDA, 31 SS, and 17 ST patients. RESULTS Srivastava Index (SI) shows the highest reliability in discriminating β-TT from IDA at 5.17 as a cut-off and also SS from ST with 7.7 as another threshold. Mentzer Index (MI) and RBC appear also useful in both groups with new cut-offs slightly different from those described in literature for β-TT and IDA. CONCLUSIONS The effectiveness and the simplicity of calculation of these indices make them acceptable and easy to use. They can be relied on for differential diagnosis and even for diagnosis of β-TT with atypical HbA₂ levels.
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Affiliation(s)
- Chaima A Sahli
- Biochemistry Laboratory, Research Laboratory LR00SP03, Children's Hospital, Tunis, Tunisia
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Hemoglobin A2 Lowered by Iron Deficiency and α -Thalassemia: Should Screening Recommendation for β -Thalassemia Change? ISRN HEMATOLOGY 2013; 2013:858294. [PMID: 23577263 PMCID: PMC3610360 DOI: 10.1155/2013/858294] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 02/18/2013] [Indexed: 01/29/2023]
Abstract
Screening for β-thalassemia trait (BTT) relies on measuring hemoglobin (Hb) A2. Since multiple factors can affect HbA2 levels, the screening can become unreliable. In 1356 healthy Arabs enrolled into a federally funded premarital BTT screening program, the effects of iron deficiency (ID), α+-thalassemia trait, gender, smoking, and tribalism on HbA2 were studied. The complete blood count and hemoglobin fractions were determined on the entire cohort; serum ferritin (<15 μg/L) in 391 subjects was used to determine ID. BTT was present in 29 (2.1%) subjects (HbA2 > 3.5%). Among 77(20.3%) subjects with ID, the mean HbA2 (2.30 ± 0.23%) was 0.2% lower than in subjects without iron deficiency (2.50 ± 0.24%, P < 0.0001). In 65 (38%)/172 subjects with phenotypic α+-thalassemia trait, the mean HbA2 (2.43 ± 0.24%) was 0.13% lower than in subjects without α+-thalassemia trait, P < 0.0001. The mean HbA2 did not differ between males and females, smokers and nonsmokers, and between the tribes. Thus, 35 (2.6%) subjects with HbA2 between 3.2 and 3.5% were at a risk of false negative diagnosis of BTT. Since iron deficiency and α+-thalassemia are both common and both lower HbA2, modifications in screening recommendations for BTT are proposed.
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Red cell indices: differentiation between β-thalassemia trait and iron deficiency anemia and application to sickle-cell disease and sickle-cell thalassemia. Clin Chem Lab Med 2013; 51:2115-24. [DOI: 10.1515/cclm-2013-0354] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 05/26/2013] [Indexed: 11/15/2022]
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Passarello C, Giambona A, Cannata M, Vinciguerra M, Renda D, Maggio A. Iron deficiency does not compromise the diagnosis of high HbA(2) β thalassemia trait. Haematologica 2011; 97:472-3. [PMID: 22102712 DOI: 10.3324/haematol.2011.052357] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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STEPHENS AD, ANGASTINIOTIS M, BAYSAL E, CHAN V, FUCHAROEN S, GIORDANO PC, HOYER JD, MOSCA A, WILD B. ICSH recommendations for the measurement of Haemoglobin A2. Int J Lab Hematol 2011; 34:1-13. [DOI: 10.1111/j.1751-553x.2011.01368.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Al Zadjali S, Wali Y, Al Lawatiya F, Gravell D, Alkindi S, Al Falahi K, Krishnamoorthy R, Daar S. The β-globin promoter -71 C>T mutation is a β+ thalassemic allele. Eur J Haematol 2011; 87:457-60. [PMID: 21801233 DOI: 10.1111/j.1600-0609.2011.01687.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A novel β-globin gene promoter (-71 C>T) nucleotide change was recently posted to the HbVar database (ID 2701) without precision on phenotype and ethnicity. We found the same change in compound heterozygosity with Hb S [β6(A3)Glu>Val] in an Omani family with almost equal expression of Hb A and Hb S. This suggested that the -71 C to T mutation may be a mild β-thalassemic allele. Subsequent search found three other independent cases with the same atypical Hb A:Hb S ratio, further confirming the mild thalassemic feature of this mutation. In addition, molecular screening of a set of subjects (with only Hb A) with borderline Hb A(2) or MCV values revealed the presence of -71 C>T change in heterozygous state, altogether assigning the mutation as a mild β(+) thalassemic allele. In a region such as Oman, where several genetic conditions of the red blood cell coexist (α- and β-thalassemia, Hb S, Hb D, Hb E) in significant frequencies, it is crucial to decipher the molecular basis of these atypical forms of β(+) thalassemias, especially in a genetic counseling setting.
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Rangan A, Sharma P, Dadu T, Saxena R, Verma IC, Bhargava M. β-Thalassemia mutations in subjects with borderline HbA₂ values: a pilot study in North India. Clin Chem Lab Med 2011; 49:2069-72. [PMID: 21892914 DOI: 10.1515/cclm.2011.696] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND Interpreting hemoglobin high performance liquid chromatograms with borderline HbA₂ values is often problematic, especially in antenatal cases if the partner is a known thalassemia trait. METHODS We tested for underlying β-thalassemia mutations in 25 subjects with borderline HbA₂ values (between 3.0%-4.0%). Amplification refractory mutation system (ARMS-PCR) was used to detect the five common Indian β-thalassemia mutations: (IVS-I-5 (G>C), IVS-I-1 (G>T), codons 8/9 (+G), codons 41/42 (-TTCT) and 619 bp deletion). β-Globin gene sequencing was performed if no mutation was detected. RESULTS A β-globin gene defect was identified in 8 (32%) of the 25 cases with HbA₂ levels ranging from 3.5%-3.9%. ARMS-PCR revealed IVS-I-5 (G>C) in three, 619 bp deletion in two and codons 41/42 (-TTCT) in one case. Two cases had CAP +1 (A>C) mutation on gene sequencing. IVS-I-1 (G>T) and codons 8/9 (+G) were not found in this small cohort. CONCLUSIONS Mutation analysis should be offered to all at-risk couples with borderline HbA₂, especially those with values between 3.5% and 4.0% and microcytic hypochromic indices. Significant mutations different from those in other ethnic populations were seen in this small institution-based study.
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Affiliation(s)
- Aruna Rangan
- Department of Hematology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India.
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Abstract
Increased hemoglobin A(2) (HbA(2); ie, levels > 3.9%) is the most important feature of β-thalassemia carriers. However, it is not uncommon to find persons with borderline HbA(2) (levels, 3.3%-3.8%), who pose a relevant screening problem. Several genotypes have been associated with borderline HbA(2), but sometimes the reasons for this unusual phenotype are unknown. In this paper, we report, for the first time, that mutations of KLF1 result in HbA(2) levels in the borderline range. Six different KLF1 mutations were identified in 52 of 145 subjects with borderline HbA(2) and normal mean corpuscular volume and mean corpuscular hemoglobin. Two mutations (T327S and T280_H283del) are here reported for the first time. The prevalent mutation in Sardinians is S270X, which accounts for 80.8% of the total. The frequent discovery of KLF1 mutations in these atypical carriers may contribute significantly to the thalassemia screening programs aimed at identification of at risk couples.
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Akhavan-Niaki H, Derakhshandeh-Peykar P, Banihashemi A, Mostafazadeh A, Asghari B, Ahmadifard MR, Azizi M, Youssefi A, Elmi MM. A comprehensive molecular characterization of beta thalassemia in a highly heterogeneous population. Blood Cells Mol Dis 2011; 47:29-32. [PMID: 21493114 DOI: 10.1016/j.bcmd.2011.03.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 03/13/2011] [Accepted: 03/16/2011] [Indexed: 10/18/2022]
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The genetic heterogeneity of β-globin gene defects in Sicily reflects the historic population migrations of the island. Blood Cells Mol Dis 2011; 46:282-7. [DOI: 10.1016/j.bcmd.2011.01.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 01/17/2011] [Accepted: 01/18/2011] [Indexed: 11/23/2022]
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Rao S, Kar R, Gupta SK, Chopra A, Saxena R. Spectrum of haemoglobinopathies diagnosed by cation exchange-HPLC & modulating effects of nutritional deficiency anaemias from north India. Indian J Med Res 2011; 132:513-9. [PMID: 21150000 PMCID: PMC3028946 DOI: 10.4103/0971-5916.73390] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background & objectives: The usefulness of cation exchange high performance liquid chromatography (CE-HPLC) as a tool for detection of thalassaemia/haemoglobin variants was evaluated in a prospective study in a tertiary care centre in north India. We also tried to evaluate the effect of concurrent nutritional deficiency on the HPLC pattern in the local ethnic population. Methods: A total of 800 blood samples were analyzed on the Bio-Rad Variant HPLC system by β-thal short program. The retention times, proportion of the haemoglobin (%), and the peak characteristics for all haemoglobin fractions were recorded. Alkaline and acid haemoglobin electrophoresis was performed to document the identities of the haemoglobin variants, wherever necessary. Many cases were subjected to family studies for a definitive diagnosis. Results: Among 800 samples tested, 553 (69.1%) were found to have normal HPLC pattern. Apart from β- thalassaemia, nine additional variants were encountered; HbS (2.8%), HbE (2.5%) and HbD (1.1%) being the most common variants present. Other variants included Hb Q-India, Hb-Lepore, δβ-thalassemia/ HPFH, HbD-Iran, HbJ-Meerut and HbH disease. There was a significant decrease in the level of HbA2 associated with iron deficiency anaemia (IDA) (P=0.004) and increase in megaloblastic anaemia (P<0.001) among subjects with normal HPLC pattern. Interpretation & conclusions: HPLC was found to be a simple, rapid and reliable method for the detection of hemoglobin variants. An accurate diagnosis can be provided in majority of cases by use of retention time, proportion of total haemoglobin, and peak characteristics of HPLC. Haemoglobin electrophoresis and family studies play a valuable role in difficult cases. Concurrent nutritional deficiency also has an effect on HbA2 levels.
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Affiliation(s)
- Seema Rao
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.
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Colah R, Gorakshakar A, Nadkarni A. Global burden, distribution and prevention of β-thalassemias and hemoglobin E disorders. Expert Rev Hematol 2011; 3:103-17. [PMID: 21082937 DOI: 10.1586/ehm.09.74] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The β-thalassemias, including the hemoglobin E disorders, are not only common in the Mediterranean region, South-East Asia, the Indian subcontinent and the Middle East but have now become a global problem, spreading to much of Europe, the Americas and Australia owing to migration of people from these regions. Approximately 1.5% of the global population are heterozygotes or carriers of the β-thalassemias. While the overall frequencies of carriers of these disorders are known in most countries, there have been few attempts at micromapping and wherever this has been done, significant variations are seen even within small geographic regions. Thus, the figures for the estimated numbers of births each year of homozygous β-thalassemia and the severe compound states involving other hemoglobin disorders may be an underestimate. Screening strategies have varied from premarital to antenatal in different countries depending on socio-cultural and religious customs in different populations. Prenatal diagnosis programs are ongoing in many countries and the knowledge of the distribution of mutations has facilitated the establishment of successful control programs. Many of these were through North-South partnerships and networking. Yet, there are many countries in Asia where they are lacking, and South-South partnerships are now being developed in South-East Asia and the Indian subcontinent to link centers with expertise to centers where expertise needs to be developed. Although the carrier frequencies will remain unaltered, this will eventually help to bring down the burden of the birth of affected children with β-thalassemias and hemoglobin E disorders in Asia.
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Affiliation(s)
- Roshan Colah
- National Institute of Immunohaematology, Indian Council of Medical Research ,KEM Hospital Campus, Parel, Mumbai, India.
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Lacerra G, Scarano C, Lagona LF, Testa R, Caruso DG, Medulla E, Friscia MG, Mastrullo L, Caldora M, Prezioso R, Gaudiano C, Magnano C, Romeo MA, Musollino G, Di Noce F, Carestia C. Genotype-phenotype relationship of the δ-thalassemia and Hb A(2) variants: observation of 52 genotypes. Hemoglobin 2011; 34:407-23. [PMID: 20854114 DOI: 10.3109/03630269.2010.511586] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The increase of Hb A(2) (α2δ2) beyond the upper limit [2.0-2.2/3.3-3.4% of the total hemoglobin (Hb)] is an invaluable tool in the hematological screening of β-thalassemia (β-thal) carriers. Factors decreasing Hb A(2) percentages can hinder correct diagnosis. In order to analyze the genotype-phenotype relationship, we characterized δ-, β- and α-globin genotypes in 190 families where the probands had Hb A(2) values of ≤2.0% or were β-thal heterozygotes with normal Hb A(2) levels. Hb A(2) was measured with cation exchange high performance liquid chromatography (HPLC). Mutations were detected with allele-specific methods or DNA sequencing; two multiplex-ARMS (amplification refractory mutation system) assays were set up. The molecular basis underlying the decrease in Hb A(2) was extremely heterogeneous. Nineteen δ-globin alleles (Hb A(2)-S.N. Garganico was new) were detected; their interaction with α- or β-globin alleles (10 and eight, respectively) led us to observe 52 genotypes in 261 carriers. The type of δ-globin mutations, the relative genotypes, the interaction with α(0)-thal traits, are the most important factors in decreasing the Hb A(2) percentage. These results are extremely useful in addressing the molecular diagnosis of hemoglobinopathies and thalassemias.
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Affiliation(s)
- Giuseppina Lacerra
- Istituto di Genetica e Biofisica Adriano Buzzati-Traverso, CNR, Napoli, Italia.
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