Editorial: Frontiers in Hemoglobinopathies: New Insights and Methods

Significance of the mathematically calculated red cell indices in patients with qualitative and quantitative hemoglobinopathies

Background

Hemoglobinopathies represent a set of inherited red blood cell (RBCs) disorders, characterized by abnormal hemoglobin molecule. They include qualitative and quantitative hemoglobinopathies, with a structurally abnormal globin chain in the first and defective production in the later. This study assessed, for the first time, the significance of the mathematically calculated RBC indices to identify patients with hemoglobinopathies from normal subjects or iron deficiency anemia (IDA) and to differentiate various types of hemoglobinopathies from each other.

Subjects and methods

The study was a comparative hospital based and included 167 participants with hemoglobinopathies (group 1) and 49 participants with IDA (group 2) as an active comparator. Another 50 healthy volunteers (group 3) were also included. All participants were subjected to medical history, clinical examination, CBC, and HPLC. Next, 10 RBC indices were mathematically calculated from the CBC for each participant.

Results

Gender analysis shows that females represent 36.8% in thalassemia group, 42% in sickle cell disease (SCD) group, and 71.4% in IDA group. The receiver operating characteristic (ROC) curve shows that Ehsani index (EI) is the most reliable screening tool for thalassemics because of showing the highest Youden index and specificity of 41.88% and 88.89%, respectively, followed by Shine and Lal index (SL), with Youden index (YI) value, specificity, and sensitivity equal to 39.78%, 69.70%, and 70.09%, respectively. Similar results were found for IDA. For SCD, SL index is the most suitable screening tool. In conclusion, the mathematically calculated RBC indices are available, cheap, reliable, and sensitive tools for screening patients with hemoglobinopathies.

Applications of next generation sequencing in the screening and diagnosis of thalassemia: A mini-review

Thalassemias are a group of inherited blood disorders that affects 5-7% of the world population. Comprehensive screening strategies are essential for the management and prevention of this disorder. Today, many clinical and research laboratories have widely utilized next-generation sequencing (NGS) technologies to identify diseases, from germline and somatic disorders to infectious diseases. Yet, NGS application in thalassemia is limited and has just recently surfaced due to current demands in seeking alternative DNA screening tools that are more efficient, versatile, and cost-effective. This review aims to understand the several aspects of NGS technology, including its most current and expanding uses, advantages, and limitations, along with the issues and solutions related to its integration into routine screening and diagnosis of thalassemias. Hitherto, NGS has been a groundbreaking technology that offers tremendous improvements as a diagnostic tool for thalassemia in terms of its higher throughput, accuracy, and adaptability. The superiority of NGS in detecting rare variants, solving complex hematological problems, and providing non-invasive alternatives to neonatal diagnosis cannot be overlooked. However, several pitfalls still preclude its use as a stand-alone technique over conventional methods.