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Thilakarathne S, Jayaweera UP, Premawardhena A. Unresolved laboratory issues of the heterozygous state of β-thalassemia: a literature review. Haematologica 2024; 109:23-32. [PMID: 37259577 PMCID: PMC10772521 DOI: 10.3324/haematol.2022.282667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/19/2023] [Indexed: 06/02/2023] Open
Abstract
Although considered a mild clinical condition, many laboratory issues of the carrier state of β-thalassemia remain unresolved. Accurate laboratory screening of β-thalassemia traits is crucial for preventing the birth of a β-thalassemia major child. Identification of carriers in the laboratory is affected by factors that influence red cell indices and HbA2 quantification. Silent mutations and co-inheriting genetic and non-genetic factors affect red cell indices which decreases the effectiveness of the conventional approach. Similarly, the type of β mutation, co-inheriting genetic and non-genetic factors, and technical aspects, including the analytical method used and variations in the HbA2 cut-off values, affect the HbA2 results, leading to further confusion. However, the combination of mean corpuscular volume, mean corpuscular hemoglobin, and hemoglobin analysis increases the diagnostic accuracy. Diagnostic problems arising from non-genetic factors can be eliminated by carefully screening the patient's clinical history. However, issues due to certain genetic factors, such as Krüppel-like factor 1 gene mutations and α triplication still remain unresolved. Each laboratory should determine the population-specific reference ranges and be wary of machine-related variations of HbA2 levels, the prevalence of silent mutations in the community.
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Affiliation(s)
- Shyamali Thilakarathne
- Faculty of Graduate Studies, University of Kelaniya, Dalugama, Sri Lanka; Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya.
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Sumedha D, Anita K. Prevalence of beta thalassemia carriers in India: a systematic review and meta-analysis. J Community Genet 2023; 14:527-541. [PMID: 37861936 PMCID: PMC10725409 DOI: 10.1007/s12687-023-00683-7] [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: 07/10/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
A large number of studies have reported that the prevalence of beta thalassemia carriers in India varies by ethnic groups. The objective of this study was to conduct a systematic review of the published studies and conduct a meta-analysis to determine the prevalence of beta thalassaemia carriers in India. A PubMed database search using keywords "beta thalassaemia AND India" identified 1088 articles of which 69 articles were included in the review. Studies using diagnostic tests and methods recommended by the International Council for Standardization in Haematology were used for calculation of pooled prevalence. Pooled prevalence was calculated using a random effects model using Review Manager version 5.3. Studies had screened five categories of populations, that is, the general population; tribal groups, communities not belonging to tribal groups, persons with anemia, and persons referred with a suspicion of hemoglobinopathy. This heterogeneity contributed to a high pooled prevalence of beta thalassemia carriers of 8.23% (95% CI 7.36-9.10). Sub-group analysis however yielded 3.74% (95% CI 2.52-4.97) pooled prevalence of beta thalassemia carriers in the general population. It was 4.6% (95% CI 3.2-6.2) among tribal groups. Quality of prevalence studies was limited by methodological issues including non-random sampling methods, heterogeneity of population types screened, and lack of use of recommended diagnostic cut-offs. Prevalence of beta thalassemia carriers was similar in tribal populations and the general population, indicating the need to further investigate the prevalence of beta thalassemia carriers in tribal groups.
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Affiliation(s)
- Dharmarajan Sumedha
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University (University of Pune), Pune, 411007, India
| | - Kar Anita
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University (University of Pune), Pune, 411007, India.
- Birth Defects Research Foundation, Pune, 411020, India.
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Spectrum of hemoglobin disorders in southern Odisha, India: a hospital based study. Porto Biomed J 2021; 6:e126. [PMID: 33884322 PMCID: PMC8055503 DOI: 10.1097/j.pbj.0000000000000126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/03/2021] [Indexed: 11/27/2022] Open
Abstract
Background: Hemoglobin disorders are the leading health concern in the world including India. There is a paucity of literature on the spectrum of hemoglobin disorders in southern districts of Odisha state. This study was undertaken to elucidate the occurrence of different hemoglobin disorders in a tertiary health care facility of Odisha state, India. Methods: The study cases were suspected patients of all age groups advised for screening of different hemoglobin disorders. Hemoglobin disorders were screened by sickling slide test and high-performance liquid chromatography (HPLC) using the Variant-II hemoglobin testing system as per the manufacturer's guidelines. Results: Over 2 years, 2332 blood samples (including 1102 pediatric and 1230 adult cases) were investigated, out of which, 1380 (59.2%) of cases had abnormal hemoglobin disorders. The most common was sickle cell disorders (48.67%, 1135/2332) followed by β-thalassemia (11.32%, 264/2332). Some rare variants were detected as hemoglobin D-Punjab, hemoglobin E, hemoglobin Lepore, hereditary persistence of fetal hemoglobin, hemoglobin with high P2 window, hemoglobin with high P3 window etc, Among the cases with abnormal hemoglobin disorders, 744 (53.9%), 545 (39.5%) and, 91 (6.6%) cases were found to have the heterozygous, homozygous and, double heterozygous state. Of the 188 ante-natal cases screened, 31.4% of cases had abnormal hemoglobin variants with sickle cell disorders being the most prevalent one. Conclusion: Along with the high occurrence of sickle cell disorders in the study area, some other rare hemoglobin disorders are also prevalent which calls for a large community-based cohort study.
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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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Harrison A, Mashon RS, Kakkar N, Das S. Clinico-Hematological Profile of Hb Q India: An Uncommon Hemoglobin Variant. Indian J Hematol Blood Transfus 2017; 34:299-303. [PMID: 29622873 DOI: 10.1007/s12288-017-0864-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/08/2017] [Indexed: 11/29/2022] Open
Abstract
Inherited hemoglobin disorders include thalassemias and structural variants like HbS, HbE, and HbD, Hb Lepore, HbD-Iran, Hb-H disease and HbQ India. HbQ India is an uncommon alpha-chain structural hemoglobin variant seen in North and West India. Patients are mostly asymptomatic and often present in the heterozygous state or co-inherited with beta-thalassaemia. This study was done in a tertiary care teaching hospital in North India over a period of 7 years among patients referred from antenatal and other clinics for screening of hemoglobin disorders. Complete blood count, peripheral blood smear examination and cation exchange high performance liquid chromatography (HPLC) was done to quantify various hemoglobins. HbQ India was diagnosed if the unknown variant hemoglobin was detected within the characteristic retention window. Of a total of 7530 patients screened, 31 (0.4%) were detected to have HbQ India. Of these, 25 (0.3%) patients had HbQ India trait and 6 (0.1%) patients had compound heterozygosity for HbQ India and Beta Thalassemia trait (HbQ India-BTT). All patients were clinically asymptomatic and were detected as part of the screening for hemoglobin disorders. Only two patients with HbQ India-BTT had hemoglobin less than 10 g/dL. In 25 patients with HbQ India trait, HbQ ranged from 13.6 to 24.4% and in 6 patients with HbQ India-BTT, HbQ India ranged from 7.4 to 9.0%. HbQ India is an uncommon structural hemoglobin variant. Although asymptomatic, it may cause diagnostic difficulty in the compound heterozygous state with beta thalassemia. HPLC provides a rapid, accurate and reproducible method for screening of this condition to identify and counsel individuals.
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Affiliation(s)
- Aradhana Harrison
- 1Department of Pathology, Christian Medical College & Hospital, Brown Road, Ludhiana, Punjab 141008 India
| | - Ranjeet Singh Mashon
- 1Department of Pathology, Christian Medical College & Hospital, Brown Road, Ludhiana, Punjab 141008 India
| | - Naveen Kakkar
- 1Department of Pathology, Christian Medical College & Hospital, Brown Road, Ludhiana, Punjab 141008 India
| | - Sheila Das
- 2HOD Hematopathology Section, Believers Church Medical College Hospital, St. Thomas Nagar, Kuttapuzha, Pathanamthitta, Thiruvalla, Kerala India
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Dass J, Gupta A, Mittal S, Saraf A, Langer S, Bhargava M. Comparison of the characteristics of two hemoglobin variants, Hb D-Iran and Hb E, eluting in the Hb A2 window. Blood Res 2017; 52:130-134. [PMID: 28698850 PMCID: PMC5503891 DOI: 10.5045/br.2017.52.2.130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 04/17/2017] [Accepted: 05/24/2017] [Indexed: 12/03/2022] Open
Abstract
Background Cation exchange-high performance liquid chromatography (CE-HPLC) is most commonly used to evaluate hemoglobin (Hb) variants, which elute in the Hb A2 window. This study aimed to assess prevalence of an uncommon Hb variant, Hb D-Iran, and compare its red cell parameters and peak characteristics with those of Hb E that commonly elutes in the Hb A2 window. Methods Generally, we assess abnormal Hb using CE-HPLC as the primary technique along with alkaline and acid electrophoresis. All cases with Hb A2 window >9%, as assessed by CE-HPLCs during 2009–2013, were selected. Results Twenty-nine cases with Hb D-Iran variant were identified—25 heterozygous, 2 homozygous, 1 compound heterozygous Hb D-Iran/β-thalassemia, and 1 Hb D-Iran/Hb D-Punjab. Overall prevalence of Hb D-Iran was 0.23%. Compared to patients with Hb E, those with Hb D-Iran had significantly higher Hb (12.1 vs. 11.3 g/dL, P=0.03), MCV (82.4 vs. 76.4 fL, P=0.0044), MCH (27.9 vs. 25.45 pg, P =0.0006), and MCHC (33.9 vs. 33.3 g/dL, P=0.0005). Amount of abnormal Hb (40.7 vs. 26.4%, P=0.0001) was significantly higher while retention time (3.56 vs. 3.70 min, P=0.0001) was significantly lower in Hb D-Iran than in Hb E. Conclusion Hb D-Iran peak can be easily missed if area and retention time of the Hb A2 window are not carefully analyzed. To distinguish between variants, careful analysis of peak area and retention time is sufficient in most cases and may be further confirmed by the second technique—alkaline electrophoresis.
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Affiliation(s)
- Jasmita Dass
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Aastha Gupta
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Suchi Mittal
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Amrita Saraf
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Sabina Langer
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
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Dass J, Mittal S, Saraf A, Kotwal J. C-Window Peaks on CE-HPLC are Extremely Rare in Northern India, and Only Infrequently Represent HbC. Indian J Hematol Blood Transfus 2017; 34:91-96. [PMID: 29398805 DOI: 10.1007/s12288-017-0815-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 04/04/2017] [Indexed: 11/26/2022] Open
Abstract
Hemoglobin C (HbC, HBB:c.19G > A) is a structural variant that has been reported rarely from India. This was a retrospective review of all high performance liquid chromatography (HPLCs) submitted over a 14 year period to a tertiary care center in North India with an aim of finding hemoglobins that elute in the C-window. Of the 32,364 HPLCs screened, 6 cases showed peaks in the C-window. Of these 6 cases, only two cases contained hemoglobin C. These was one case each of HbC/β thalassemia and compound heterozygosity for HbC and HbD. There were 4 cases which showed very similar red cell indices and chromatograms with multiple peaks eluting in D-window, C-window and an additional peak with a retention time of 4.74 min. These four cases were compound heterozygous for an α chain variant HbQ-India and a β-chain variant HbD.
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Affiliation(s)
- Jasmita Dass
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Suchi Mittal
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Amrita Saraf
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - Jyoti Kotwal
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
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Chandra D, Tyagi S, Deka R, Chauhan R, Seth T, Saxena R, Pati HP. A Novel Double Heterozygous Hb D-Punjab/Hb J-Meerut Hemoglobinopathy. Indian J Hematol Blood Transfus 2016; 33:611-613. [PMID: 29075078 DOI: 10.1007/s12288-016-0763-y] [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: 06/22/2016] [Accepted: 12/07/2016] [Indexed: 11/30/2022] Open
Abstract
A comprehensive laboratory diagnosis of hemoglobinopathies forms an integral part in workup of disorders of globin chain synthesis. Clinical findings, complete blood counts, peripheral smear examination along with hemoglobin (Hb) electrophoresis and/or cation exchange high performance liquid chromatography findings and parental study helps to clinch a final diagnosis. Compound heterozygous hemoglobinopathy presents with variable clinical findings and some of them are picked up on screening tests done as part of routine antenatal workup. Here we report a rare double heterozygous hemoglobinopathy of Hb D-Punjab and Hb J-Meerut in a 35 year antenatal female.
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Affiliation(s)
- Dinesh Chandra
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Tyagi
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Roopam Deka
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Chauhan
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Tulika Seth
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Renu Saxena
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - H P Pati
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
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Mondal SK, Mandal S. Prevalence of thalassemia and hemoglobinopathy in eastern India: A 10-year high-performance liquid chromatography study of 119,336 cases. Asian J Transfus Sci 2016; 10:105-10. [PMID: 27011683 PMCID: PMC4782486 DOI: 10.4103/0973-6247.175424] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Hereditary hemoglobin (Hb) disorders are the most commonly encountered single gene disorders in India. Proper timely identification of these disorders is of paramount importance to prevent thalassemia major and clinically severe hemoglobinopathy as well as for epidemiologic purposes. Aims: Our aim was to determine the prevalence of thalassemia and hemoglobinopathy in patients of a tertiary care hospital of West Bengal, India. Materials and Methods: This prospective study was conducted on 119,336 cases over a period of 10 years. After taking clinical history and familial history, complete hemogram report was obtained by an automated cell counter. High-performance liquid chromatography (HPLC) was performed on the samples with Bio-Rad Variant using beta thalassemia short program. Confirmatory tests were performed whenever required. Results: A normal Hb pattern was observed in 104,804 (87.83%) cases and abnormalities were detected in 14,532 (12.17%) patients. β (beta) thalassemia trait was the commonest abnormality found in 5,488 (4.60%) patients. HbE trait was found in 3,604 (3.02%) patients, β thalassemia major/intermedia in 1,981 (1.66%) cases, and Eβ thalassemia in 1,384 (1.16 %) cases. Other variants detected included HbE disease, sickle-cell disease, sickle β thalassemia, HbD-Punjab trait, HbQ-India trait, α-thal trait, double heterozygous state of HbS and HbE, double heterozygous state of HbS and HbD, HbJ-Meerut, hereditary persistence of fetal hemoglobin (HPFH), HbH, delta β-thal trait, and Hb Lepore. Conclusion: In view of the high prevalence of hemoglobinopathy in this region, a routine premarital screening program is needed for the identification and prevention of high-risk marriages and thus, prevention of the psychosocial trauma of bearing a transfusion-dependent child for life.
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Affiliation(s)
| | - Saikat Mandal
- Department of Pathology, Medical College, Kolkata, West Bengal, India
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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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Mukhopadhyay D, Saha K, Sengupta M, Mitra S, Datta C, Mitra PK. Spectrum of Hemoglobinopathies in West Bengal, India: A CE-HPLC Study on 10407 Subjects. Indian J Hematol Blood Transfus 2014; 31:98-103. [PMID: 25548453 DOI: 10.1007/s12288-014-0373-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 03/11/2014] [Indexed: 11/29/2022] Open
Abstract
Hemoglobinopathies are common genetic disorders of haemoglobin. Identification of these disorders is immensely important epidemiologically and they can be prevented by population screening. The present study was carried out to evaluate the spectrum of hemoglobinopathies in the state of West Bengal by the cation-exchange high-performance liquid chromatography (CE-HPLC). A retrospective, single-center, cross-sectional study was conducted on consecutive 10,407 participants. Out of 10,407 subjects, 8,898 (85.5 %) were diagnosed as normal, 579 (5.6 %) were as β-thalassemia trait (BTT) and 522 (5.0 %) were detected as HbE carrier on HPLC study. Apart from BTT and HbE carrier ten additional variants were encountered. The present study showed that CE-HPLC is a convenient, high-throughput, labour-saving and objective screening tool for early detection and management of hemoglobinopathies.
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Affiliation(s)
- Debasis Mukhopadhyay
- Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, India ; Thalassemia Control Unit (TCU), Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Kaushik Saha
- Department of Pathology, Murshidabad Medical College and Hospital, Berhampore, Murshidabad, India ; 42/9/2, Sashi Bhusan Neogi Garden Lane, Baranagar, Kolkata, 700 036 India
| | - Moumita Sengupta
- Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Sumit Mitra
- Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Chhanda Datta
- Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Pradip Kumar Mitra
- Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, India
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Kumar M, Sharma P, Kumar V, Bhargava M. Continuing Diagnostic Relevance of the Sickling Test in the Era of CE-HPLC. Indian J Hematol Blood Transfus 2014; 29:58-60. [PMID: 24426337 DOI: 10.1007/s12288-012-0144-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 01/14/2012] [Indexed: 10/14/2022] Open
Affiliation(s)
- Meet Kumar
- Department of Haematology, Sir Ganga Ram Hospital, 1st Floor-SSRB, Rajinder Nagar, 110060 New Delhi India
| | - Prashant Sharma
- Department of Haematology, Sir Ganga Ram Hospital, 1st Floor-SSRB, Rajinder Nagar, 110060 New Delhi India
| | - Vijay Kumar
- Department of Haematology, Sir Ganga Ram Hospital, 1st Floor-SSRB, Rajinder Nagar, 110060 New Delhi India
| | - Manorama Bhargava
- Department of Haematology, Sir Ganga Ram Hospital, 1st Floor-SSRB, Rajinder Nagar, 110060 New Delhi India
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A Comparison of Hemoglobin A2 Levels in Untreated and Treated Groups of HIV Patients on ART Including Zidovudine. PATHOLOGY RESEARCH INTERNATIONAL 2013; 2013:828214. [PMID: 24459601 PMCID: PMC3888724 DOI: 10.1155/2013/828214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 12/15/2013] [Accepted: 12/16/2013] [Indexed: 11/21/2022]
Abstract
Objective. To assess the level of haemoglobin A2 in HIV patients on antiretroviral therapy (ART) including zidovudine with untreated HIV patients. Material and Methods. The study was a case control study. A total of 185 patients were included in the study; the case group included 125 HIV patients who were on antiretroviral therapy (ART) including zidovudine and 60 were in the control group who were not receiving ART. The high-performance liquid chromatography (HPLC) was done and hemoglobin A2 level was observed; value more than 3.5% was considered significant. The Hb A2 percentages of HIV patients were compared with those of control using an unpaired t-test. Results. The mean of Hb A2 in case group was 3.462% (SD 0.675) and in control group it was 2.815% (SD0.246). The higher Hb A2 value was seen in significant number of treated patients than control group (P < 0.0001). Conclusion. The clinicians, pathologists, haematologists, and genetic counsellors should be aware of effects of nutritional anaemia and ART on Hb A2 to reduce the chances of misdiagnosis of β-thalassaemia especially in developing countries and for centres for antenatal screening.
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Chandrashekar V, Soni M. Hemoglobin disorders in South India. ISRN HEMATOLOGY 2011; 2011:748939. [PMID: 22084704 PMCID: PMC3199938 DOI: 10.5402/2011/748939] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 05/02/2011] [Indexed: 11/23/2022]
Abstract
Cation exchange-high performance liquid chromatography (CE-HPLC) is increasingly being used as a first line of investigation for hemoglobinopathies and thalassemias. Together with a complete blood count, the CE-HPLC is effective in categorizing hemoglobinopathies as traits, homozygous disorders and compound heterozygous disorders. We carried out a one year study in Apollo Hospitals, Chennai (Tamil Nadu, South India) during which 543 abnormal chromatogram patterns were seen. The commonest disorder we encountered was β-thalassemia trait (37.9%), followed by HbE trait (23.2%), homozygous HbE disease (18.9%), HbS trait (5.3%), HbE β-thalassemia (4.6%), HbS β-thalassemia (2.5%), β-thalassemia major (2.3%), HbH (1.6%), homozygous HbS (1.4%), HbD trait (0.7%). The average value of HbA2 in β-thalassemia minor was 5.4%. β-thalassemia major had an average HbF of 88% and in HbH the mean A2 was 1.4%. Among the HbE disorders the HbA2 + HbE was 30.1% in the heterozygous state, 90.8% in the homozygous state and 54.8% in HbE β-thalassemia. In the sickle cell disorders, HbS varied from 30.9% in the trait to 79.9% in the homozygous state to 65.6% in HbS β-thalassemia.
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Affiliation(s)
- Vani Chandrashekar
- Department of Hematology, Apollo Hospitals, 21, Greams Lane, Off Greams Road, Chennai 600006, India
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