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Mosca A, Paleari R, Palazzi G, Pancaldi A, Iughetti L, Venturelli D, Rolla R, Pavanello E, Ceriotti F, Ammirabile M, Capri S, Piga A, Ivaldi G. Screening for sickle cell disease: focus on newborn investigations. Clin Chem Lab Med 2024; 62:1804-1813. [PMID: 38888156 DOI: 10.1515/cclm-2024-0478] [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: 04/17/2024] [Accepted: 06/04/2024] [Indexed: 06/20/2024]
Abstract
Drepanocytosis is a genetic disease relevant for its epidemiological, clinical and socio-economic aspects. In our country the prevalence is highly uneven with peaks in former malaria areas, but migration flows in recent years have led to significant changes. In this document we review the screening programs currently existing in Italy with particular emphasis on newborn screening, which in other countries around the world, including within Europe, is at most universal and mandatory. The essential laboratory issues are reviewed, from sampling aspects (cord blood or peripheral), to the analytical (analytical methods dedicated to neonatal screening and adult carrier detection) and post analytical (reporting, informative) ones. An economic analysis based on data collected in the province of Modena is also proposed, clearly showing that neonatal screening is also beneficial from an economic point of view.
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Affiliation(s)
- Andrea Mosca
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Renata Paleari
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Palazzi
- Pediatric Unit, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Alessia Pancaldi
- Pediatric Unit, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Donatella Venturelli
- Department of Transfusion Medicine, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Roberta Rolla
- Clinical Chemistry Laboratory, A.O.U. "Maggiore della carità", Università del Piemonte Orientale, Novara, Italy
| | - Enza Pavanello
- Department of Laboratory Medicine, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Ferruccio Ceriotti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
| | - Massimiliano Ammirabile
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
| | - Stefano Capri
- School of Economics and Management, Cattaneo-LIUC University, Varese, Italy
| | - Antonio Piga
- Department of Clinical and Biological Sciences, Università degli Studi di Torino, Torino, Italy
| | - Giovanni Ivaldi
- Formerly Laboratorio di Genetica Umana, Ospedali Galliera, Genova, Italy
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Mendez-Marti SR, Zik C, Alan S, Wang H, Ershler WB. Sickle Cell Screening in Adults: A Current Review of Point-of-Care Testing. J Hematol 2024; 13:53-60. [PMID: 38993742 PMCID: PMC11236353 DOI: 10.14740/jh1272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/10/2024] [Indexed: 07/13/2024] Open
Abstract
In adults, the sickle cell solubility test (SCST) is the most common screening test to determine the presence of hemoglobin S (HbS) within a blood sample. The assay is inexpensive, rapid, highly sensitive and specific. However, the SCST cannot accurately quantify the level of HbS in a test sample and requires confirmatory testing to distinguish between sickle trait and sickle cell disease. Despite these limitations, it remains the standard screening tool for HbS in a variety of settings such as screening in the US military or by the National Collegiate Athletic Association. With an increased awareness of the importance of screening for sickle cell in adults, we herein describe the current sensitivity, specificity, positive predictive value, and negative predictive value of this test. We also review overall clinical utility of this laboratory measure and briefly discuss new point-of-care techniques designed to overcome the SCST's shortcomings.
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Affiliation(s)
- Sebastian R. Mendez-Marti
- Adult Sickle Cell Center, Inova Schar Cancer Institute, Inova Fairfax Medical Campus, Fairfax, VA, USA
| | - Chad Zik
- Adult Sickle Cell Center, Inova Schar Cancer Institute, Inova Fairfax Medical Campus, Fairfax, VA, USA
| | - Sheinei Alan
- Adult Sickle Cell Center, Inova Schar Cancer Institute, Inova Fairfax Medical Campus, Fairfax, VA, USA
| | - Hongkun Wang
- Biostatics, Bioinformatics and Biomathematics Department, Georgetown University, Washington, DC, USA
| | - William B. Ershler
- Adult Sickle Cell Center, Inova Schar Cancer Institute, Inova Fairfax Medical Campus, Fairfax, VA, USA
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Ren M, Sambuughin N, Mungunshukh O, Edgeworth DB, Hupalo D, Zhang X, Wilkerson MD, Dalgard CL, O’Connor FG, Deuster PA. Genome-Wide Analysis of Exertional Rhabdomyolysis in Sickle Cell Trait Positive African Americans. Genes (Basel) 2024; 15:408. [PMID: 38674343 PMCID: PMC11049803 DOI: 10.3390/genes15040408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Sickle cell trait (SCT), although generally a benign carrier state of hemoglobin S (HbAS), is a risk factor for exertional rhabdomyolysis (ERM), a rare but potentially fatal consequence of highly intense physical exercise, particularly among active-duty military personnel and high-performance athletes. The association between SCT and ERM is poorly understood. The objective of this study was to elucidate the genetic basis of ERM in an SCT-positive African American cohort. SCT-positive African Americans with a personal history of ERM (cases, n = 30) and without history of ERM (controls, n = 53) were enrolled in this study. Whole-genome sequencing was performed on DNA samples isolated from peripheral white blood cells. Participants' demographic, behavioral, and medical history information was obtained. An additional 131 controls were extracted from SCT-positive subjects of African descent from the 1000 Genomes Project. SCT carriers with ERM were characterized by myotoxicity features, significant muscle involvement dominated by muscle weakness, and severe pain and substantial increase in serum creatine kinase, with a mean value of 50,480 U/L. A distinctive feature of the SCT individuals with ERM was exertional collapse, which was reported in 53.3% of the cases in the study cohort. An important factor for the development of ERM was the duration and frequency of strenuous physical activity in the cases compared to the controls. Whole-genome sequencing identified 79,696 protein-coding variants. Genome-wide association analysis revealed that the p.C477R, rs115958260 variant in the SLC44A3 gene was significantly associated with ERM event in SCT-positive African Americans. The study results suggest that a combination of vigorous exercise and a genetic predisposing factor is involved in ERM.
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Affiliation(s)
- Mingqiang Ren
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA (D.B.E.); (F.G.O.)
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Nyamkhishig Sambuughin
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA (D.B.E.); (F.G.O.)
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Ognoon Mungunshukh
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA (D.B.E.); (F.G.O.)
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Department of Anatomy, Physiology, and Genetics, Center for Military Precision Health, Uniformed Services University, Bethesda, MD 20814, USA
| | - Daniel Baxter Edgeworth
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA (D.B.E.); (F.G.O.)
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Daniel Hupalo
- Department of Anatomy, Physiology, and Genetics, Center for Military Precision Health, Uniformed Services University, Bethesda, MD 20814, USA
| | - Xijun Zhang
- Department of Anatomy, Physiology, and Genetics, Center for Military Precision Health, Uniformed Services University, Bethesda, MD 20814, USA
| | - Matthew D. Wilkerson
- Department of Anatomy, Physiology, and Genetics, Center for Military Precision Health, Uniformed Services University, Bethesda, MD 20814, USA
| | - Clifton L. Dalgard
- Department of Anatomy, Physiology, and Genetics, Center for Military Precision Health, Uniformed Services University, Bethesda, MD 20814, USA
| | - Francis G. O’Connor
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA (D.B.E.); (F.G.O.)
| | - Patricia A. Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA (D.B.E.); (F.G.O.)
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Mancini M, Buffet A, Porte B, Amar L, Lussey-Lepoutre C, Crinière L, Baudin E, Meatchi T, Gimenez-Roqueplo AP, Favier J, Burnichon N. EPAS1-mutated paragangliomas associated with haemoglobin disorders. Br J Haematol 2024; 204:1054-1060. [PMID: 38195958 DOI: 10.1111/bjh.19278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024]
Abstract
We report a large series of 40 patients presenting EPAS1-mutated paraganglioma (PGL) in whom we investigated a cause underlying chronic hypoxia. Four patients suffered from hypoxaemic heart disease. In patients with available haemoglobin electrophoresis results, 59% presented with a haemoglobin disorder, including six with sickle cell disease, five with sickle cell trait and two with heterozygous haemoglobin C disease. Histological and transcriptomic characterization of EPAS1 tumours revealed increased angiogenesis and high similarities with pseudohypoxic PGLs caused by VHL gene mutations. Sickle haemoglobinopathy carriers could thus be at increased risk for developing EPAS1-PGLs, which should be taken into account in their management and surveillance.
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Affiliation(s)
- Maxence Mancini
- Université Paris Cité, Inserm, Paris Centre de Recherche Cardiovasculaire (PARCC), Equipe Labellisée Ligue contre le Cancer, Paris, France
| | - Alexandre Buffet
- Université Paris Cité, Inserm, Paris Centre de Recherche Cardiovasculaire (PARCC), Equipe Labellisée Ligue contre le Cancer, Paris, France
- Département de Médecine Génomique des Tumeurs et des Cancers, Fédération de Génétique et de Médecine Génomique, Assistance Publique-Hôpitaux de Paris (AP-HP) Centre, Hôpital Européen Georges Pompidou, Paris, France
| | - Baptiste Porte
- Université Paris Cité, Inserm, Paris Centre de Recherche Cardiovasculaire (PARCC), Equipe Labellisée Ligue contre le Cancer, Paris, France
| | - Laurence Amar
- Université Paris Cité, Inserm, Paris Centre de Recherche Cardiovasculaire (PARCC), Equipe Labellisée Ligue contre le Cancer, Paris, France
- Service d'Hypertension artérielle, Assistance Publique-Hôpitaux de Paris (AP-HP) Centre, Hôpital Européen Georges Pompidou, Paris, France
| | - Charlotte Lussey-Lepoutre
- Université Paris Cité, Inserm, Paris Centre de Recherche Cardiovasculaire (PARCC), Equipe Labellisée Ligue contre le Cancer, Paris, France
- Service de Médecine Nucléaire, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Lise Crinière
- Service d'endocrinologie, CHRU Bretonneau, Tours, France
| | - Eric Baudin
- Service de Médecine Nucléaire, Gustave Roussy, Villejuif, France
| | - Tchao Meatchi
- Service d'anatomie pathologique, Assistance Publique-Hôpitaux de Paris (AP-HP) Centre, Hôpital Européen Georges Pompidou, Paris, France
| | - Anne-Paule Gimenez-Roqueplo
- Université Paris Cité, Inserm, Paris Centre de Recherche Cardiovasculaire (PARCC), Equipe Labellisée Ligue contre le Cancer, Paris, France
- Département de Médecine Génomique des Tumeurs et des Cancers, Fédération de Génétique et de Médecine Génomique, Assistance Publique-Hôpitaux de Paris (AP-HP) Centre, Hôpital Européen Georges Pompidou, Paris, France
| | - Judith Favier
- Université Paris Cité, Inserm, Paris Centre de Recherche Cardiovasculaire (PARCC), Equipe Labellisée Ligue contre le Cancer, Paris, France
| | - Nelly Burnichon
- Université Paris Cité, Inserm, Paris Centre de Recherche Cardiovasculaire (PARCC), Equipe Labellisée Ligue contre le Cancer, Paris, France
- Département de Médecine Génomique des Tumeurs et des Cancers, Fédération de Génétique et de Médecine Génomique, Assistance Publique-Hôpitaux de Paris (AP-HP) Centre, Hôpital Européen Georges Pompidou, Paris, France
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Elenga N. Genetic Information to Share with Parents when Newborn Screening Reveals the Presence of Sickle Cell Trait. Int J Pediatr 2024; 2024:8910397. [PMID: 38433874 PMCID: PMC10904677 DOI: 10.1155/2024/8910397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
The primary purpose of newborn screening for sickle cell disease is to diagnose the disease before the appearance of symptoms and to initiate early treatment. To answer the question "What genetic information needs to be communicated to parents when newborn screening reveals the presence of a sickle cell trait," we conducted a survey using a self-administered online questionnaire. We received responses from 122 healthcare workers and members of sickle cell disease associations, in France and French overseas departments. Our results showed similar positions on this issue. The information conveyed is not consistent and is the result of grassroots initiatives. The negative consequences generated by this information could be reduced when this information is delivered by a multidisciplinary team, within the framework of a dedicated consultation. This information on sickle cell trait status should be given in at least three key periods: the neonatal period, early adolescence, and later adolescence, when reproductive implications become important. Neonatal screening programs should develop systems that allow referring physicians to easily access the results of neonatal screening electronically. Harmonization of practices should allow a better analysis of the consequences of this counselling on family projects.
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Affiliation(s)
- Narcisse Elenga
- Pediatric Medicine and Surgery, Hôpital Andrée Rosemon, Rue des flamboyants, BP 6006, 97306 Cayenne Cedex, French Guiana
- Sickle Cell Reference Center, Pediatric Medicine and Surgery, Centre Hospitalier de Cayenne “Andrée Rosemon” Rue de Flamboyants, BP 6006, 97306 Cayenne Cedex, French Guiana
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