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Oliveira ÉL, Belisário AR, Silva NP, Rezende PV, Muniz MB, Oliveira LMM, Velloso-Rodrigues C, Viana MB. Clinical, laboratory, and molecular characteristics of a cohort of children with hemoglobinopathy S/beta-thalassemia. Hematol Transfus Cell Ther 2024; 46:167-175. [PMID: 38182466 DOI: 10.1016/j.htct.2023.11.002] [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: 09/25/2023] [Revised: 11/18/2023] [Accepted: 11/25/2023] [Indexed: 01/07/2024] Open
Abstract
INTRODUCTION Hemoglobinopathy Sβ-thalassemia (HbSβ-thal) has a wide range of clinical and laboratory severity. There is limited information on the natural history of HbSβ-thal and its modulating factors. We described the molecular, hematological, and clinical characteristics of a cohort of children with HbSβ-thal and estimated its incidence in Minas Gerais, Brazil. METHODS Laboratory and clinical data were retrieved from medical records. Molecular analysis was performed by HBB gene sequencing, PCR-RFLP, gap-PCR, and MLPA. RESULTS Eighty-nine children were included in the study. Fourteen alleles of β-thal mutations were identified. The incidence of HbSβ-thal in the state was 1 per 22,250 newborns. The most common βS-haplotypes were CAR and Benin. The most frequent βthal-haplotypes were V, II, and I. Coexistence of 3.7 kb HBA1/HBA2 deletion was present in 21.3 % of children. β-thalassemia mutations were associated with several clinical and laboratory features. In general, the incidence of clinical events per 100 patient-years was similar for children with HbSβ0-thal, IVS-I-5 G>A, and IVS-I-110 G>A. Children with HbSβ+-intermediate phenotypes had a more severe laboratory and clinical profile when compared with those with HbSβ+-mild ones. βS-haplotypes and α-thalassemia did not meaningfully influence the phenotype of children with HbSβ-thal. CONCLUSION The early identification of β-thalassemia alleles may help the clinical management of these children.
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Affiliation(s)
- Érica Louback Oliveira
- Faculdade de Medicina/Núcleo de Ações e Pesquisa em Apoio Diagnóstico (NUPAD), UFMG, Belo Horizonte, MG, Brazil
| | - André Rolim Belisário
- Centro de Tecidos Biológicos de Minas Gerais, Fundação Hemominas, Lagoa Santa, MG, Brazil
| | - Natiely Pereira Silva
- Faculdade de Medicina/Núcleo de Ações e Pesquisa em Apoio Diagnóstico (NUPAD), UFMG, Belo Horizonte, MG, Brazil
| | - Paulo Val Rezende
- Ambulatório do Hemocentro de Belo Horizonte, Fundação Hemominas, Belo Horizonte, MG, Brazil
| | - Maristela Braga Muniz
- Ambulatório do Hemocentro de Belo Horizonte, Fundação Hemominas, Belo Horizonte, MG, Brazil
| | | | - Cibele Velloso-Rodrigues
- Departamento de Ciências Básicas da Vida, Instituto de Ciências da Vida, Universidade Federal de Juiz de Fora, Governador Valadares, MG, Brazil
| | - Marcos Borato Viana
- Faculdade de Medicina/Núcleo de Ações e Pesquisa em Apoio Diagnóstico (NUPAD), UFMG, Belo Horizonte, MG, Brazil.
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Pistoia L, Meloni A, Positano V, Longo F, Borsellino Z, Spasiano A, Righi R, Renne S, Izzo D, Savino K, Mavrogeni S, Quaia E, Cademartiri F, Pepe A. Multiparametric Cardiac Magnetic Resonance Assessment in Sickle Beta Thalassemia. Diagnostics (Basel) 2024; 14:691. [PMID: 38611604 PMCID: PMC11012026 DOI: 10.3390/diagnostics14070691] [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: 02/08/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Cardiac involvement in sickle beta thalassemia (Sβ-thal) patients has been poorly investigated. We aimed to evaluate cardiac function and myocardial iron overload by cardiovascular magnetic resonance (CMR) in patients with Sβ-thal. One-hundred and eleven Sβ-thal patients consecutively enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) network were studied and compared with 46 sickle cell anemia (SCA) patients and with 111 gender- and age- matched healthy volunteers. Cine images were acquired to quantify biventricular function. Myocardial iron overload (MIO) was assessed by the T2* technique, while macroscopic myocardial fibrosis was evaluated by the late gadolinium enhancement (LGE) technique. In Sβ-thal and SCA patients, the morphological and functional CMR parameters were not significantly different, except for the left atrial area and left ventricular (LV) stroke volume, indexed by body surface area (p = 0.023 and p = 0.048, respectively), which were significantly higher in SCA patients. No significant differences between the two groups were found in terms of myocardial iron overload and macroscopic myocardial fibrosis. When compared to healthy subjects, Sβ-thal patients showed significantly higher bi-atrial and biventricular parameters, except for LV ejection fraction, which was significantly lower. The CMR analysis confirmed that Sβ-thal and SCA patients are phenotypically similar. Since Sβ-thal patients showed markedly different morphological and functional indices from healthy subjects, it would be useful to identify Sβ-thal/SCA-specific bi-atrial and biventricular reference values.
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Affiliation(s)
- Laura Pistoia
- Unità Operativa Complessa Ricerca Clinica, Fondazione G. Monasterio CNR—Regione Toscana, 56124 Pisa, Italy;
- Department of Radiology, Fondazione G. Monasterio CNR—Regione Toscana, 56124 Pisa, Italy; (A.M.); (V.P.); (F.C.)
| | - Antonella Meloni
- Department of Radiology, Fondazione G. Monasterio CNR—Regione Toscana, 56124 Pisa, Italy; (A.M.); (V.P.); (F.C.)
- Bioengineering Unit, Fondazione G. Monasterio CNR—Regione Toscana, 56124 Pisa, Italy
| | - Vincenzo Positano
- Department of Radiology, Fondazione G. Monasterio CNR—Regione Toscana, 56124 Pisa, Italy; (A.M.); (V.P.); (F.C.)
- Bioengineering Unit, Fondazione G. Monasterio CNR—Regione Toscana, 56124 Pisa, Italy
| | - Filomena Longo
- Unità Operativa Day Hospital della Talassemia e delle Emoglobinopatie, Azienda Ospedaliero-Universitaria “S. Anna”, 44124 Ferrara, Italy;
| | - Zelia Borsellino
- Unità Operativa Complessa Ematologia con Talassemia, ARNAS Civico “Benfratelli-Di Cristina”, 90134 Palermo, Italy;
| | - Anna Spasiano
- Unità Operativa Semplice Dipartimentale Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale “A. Cardarelli”, 80131 Napoli, Italy;
| | - Riccardo Righi
- Diagnostica per Immagini e Radiologia Interventistica, Ospedale del Delta, 44023 Ferrara, Italy;
| | - Stefania Renne
- Struttura Complessa di Cardioradiologia-UTIC, Presidio Ospedaliero “Giovanni Paolo II”, 88046 Cosenza, Italy;
| | - Daniela Izzo
- Unità Operativa Complessa di Cardiologia-UTIC, Presidio Ospedaliero “D.ssa Anastasia Guerriero”, 81025 Caserta, Italy;
| | - Ketty Savino
- Sezione di Cardiologia e Fisiopatologia Cardiovascolare, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, 06132 Perugia, Italy;
| | | | - Emilio Quaia
- Istituto di Radiologia, Dipartimento di Medicina, Università di Padova, 35128 Padova, Italy;
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR—Regione Toscana, 56124 Pisa, Italy; (A.M.); (V.P.); (F.C.)
| | - Alessia Pepe
- Istituto di Radiologia, Dipartimento di Medicina, Università di Padova, 35128 Padova, Italy;
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Khargekar N, Banerjee A, Athalye S, Mahajan N, Kargutkar N, Tapase P, Madkaikar M. Role of hydroxyurea therapy in the prevention of organ damage in sickle cell disease: a systematic review and meta-analysis. Syst Rev 2024; 13:60. [PMID: 38331925 PMCID: PMC10851507 DOI: 10.1186/s13643-024-02461-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Hydroxyurea is an affordable drug that reduces vaso-occlusive crises and transfusion requirements in sickle cell disease. However, its effectiveness in preventing chronic organ damage is still unclear. This systematic review and meta-analysis aimed to evaluate the role of hydroxyurea in preventing organ morbidity. METHOD We included original articles published in English from 1st January 1990 to 31st January 2023, reporting hydroxyurea therapy and organ damage from PubMed, Google Scholar, Scopus, and CrossRef databases. A total of 45 studies with 4681 sickle cell disease patients were evaluated for organ damage. RESULTS Our analysis showed that hydroxyurea intervention significantly lowered transcranial Doppler and tricuspid regurgitant velocity, with a standardized mean difference of - 1.03 (- 1.49; - 0.58); I 2 = 96% and - 1.37 (CI - 2.31, - 0.42); I 2 = 94%, respectively. Moreover, the pooled estimate for albuminuria showed a beneficial effect post-hydroxyurea therapy by reducing the risk of albuminuria by 58% (risk ratio of 0.42 (0.28; 0.63); I 2 = 28%). CONCLUSION Our study found that a hydroxyurea dose above 20 mg/kg/day with a mean rise in HbF by 18.46% post-hydroxyurea therapy had a beneficial role in reducing transcranial doppler velocity, tricuspid regurgitant velocity, albuminuria, and splenic abnormality. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023401187.
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Affiliation(s)
- Naveen Khargekar
- Department of Haematogenetics, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Mumbai, Parel, 400 012, India.
| | - Anindita Banerjee
- Department of Transfusion Transmitted Disease, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Mumbai, Parel, 400 012, India
| | - Shreyasi Athalye
- Department of Transfusion Transmitted Disease, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Mumbai, Parel, 400 012, India
| | - Namrata Mahajan
- Department of Haematogenetics, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Mumbai, Parel, 400 012, India
| | - Neha Kargutkar
- Department of Haematogenetics, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Mumbai, Parel, 400 012, India
| | - Prashant Tapase
- Department of Paediatric Immunology & Leukocyte Biology, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Parel, Mumbai, 400 012, India
| | - Manisha Madkaikar
- Department of Paediatric Immunology & Leukocyte Biology, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Parel, Mumbai, 400 012, India
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Kirkham JK, Estepp JH, Weiss MJ, Rashkin SR. Genetic Variation and Sickle Cell Disease Severity: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2337484. [PMID: 37851445 PMCID: PMC10585422 DOI: 10.1001/jamanetworkopen.2023.37484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/30/2023] [Indexed: 10/19/2023] Open
Abstract
Importance Sickle cell disease (SCD) is a monogenic disorder, yet clinical outcomes are influenced by additional genetic factors. Despite decades of research, the genetics of SCD remain poorly understood. Objective To assess all reported genetic modifiers of SCD, evaluate the design of associated studies, and provide guidelines for future analyses according to modern genetic study recommendations. Data Sources PubMed, Web of Science, and Scopus were searched through May 16, 2023, identifying 5290 publications. Study Selection At least 2 reviewers identified 571 original, peer-reviewed English-language publications reporting genetic modifiers of human SCD phenotypes, wherein the outcome was not treatment response, and the comparison was not between SCD subtypes or including healthy controls. Data Extraction and Synthesis Data relevant to all genetic modifiers of SCD were extracted, evaluated, and presented following STREGA and PRISMA guidelines. Weighted z score meta-analyses and pathway analyses were conducted. Main Outcomes and Measures Outcomes were aggregated into 25 categories, grouped as acute complications, chronic conditions, hematologic parameters or biomarkers, and general or mixed measures of SCD severity. Results The 571 included studies reported on 29 670 unique individuals (50% ≤ 18 years of age) from 43 countries. Of the 17 757 extracted results (4890 significant) in 1552 genes, 3675 results met the study criteria for meta-analysis: reported phenotype and genotype, association size and direction, variability measure, sample size, and statistical test. Only 173 results for 62 associations could be cross-study combined. The remaining associations could not be aggregated because they were only reported once or methods (eg, study design, reporting practice) and genotype or phenotype definitions were insufficiently harmonized. Gene variants regulating fetal hemoglobin and α-thalassemia (important markers for SCD severity) were frequently identified: 19 single-nucleotide variants in BCL11A, HBS1L-MYB, and HBG2 were significantly associated with fetal hemoglobin (absolute value of Z = 4.00 to 20.66; P = 8.63 × 10-95 to 6.19 × 10-5), and α-thalassemia deletions were significantly associated with increased hemoglobin level and reduced risk of albuminuria, abnormal transcranial Doppler velocity, and stroke (absolute value of Z = 3.43 to 5.16; P = 2.42 × 10-7 to 6.00 × 10-4). However, other associations remain unconfirmed. Pathway analyses of significant genes highlighted the importance of cellular adhesion, inflammation, oxidative and toxic stress, and blood vessel regulation in SCD (23 of the top 25 Gene Ontology pathways involve these processes) and suggested future research areas. Conclusions and Relevance The findings of this comprehensive systematic review and meta-analysis of all published genetic modifiers of SCD indicated that implementation of standardized phenotypes, statistical methods, and reporting practices should accelerate discovery and validation of genetic modifiers and development of clinically actionable genetic profiles.
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Affiliation(s)
- Justin K. Kirkham
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jeremie H. Estepp
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
- Now with Agios Pharmaceuticals, Cambridge, Massachusetts
| | - Mitch J. Weiss
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Sara R. Rashkin
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, Tennessee
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5
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Al-Jabory M, Ameen N. Serum visfatin level in sickle/β thalassemia in correlation with frequency of vaso occlusion crises: A comparative study. MEDICAL JOURNAL OF BABYLON 2022. [DOI: 10.4103/mjbl.mjbl_83_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Extreme Genotype/Phenotype Heterogeneity of Double Heterozygous Sickle β-Thalassemia in a Family: Implications in Antenatal Diagnosis. Indian J Hematol Blood Transfus 2021; 37:689-691. [PMID: 34744353 DOI: 10.1007/s12288-021-01412-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022] Open
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7
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Azarkeivan A, Cohan N, Niazkar HR, Azizi A, Rad F. Hb S (HBB: c.20A>T) and α- and β-Thalassemia Coinheritance in Iranian Patients. Hemoglobin 2020; 44:109-112. [DOI: 10.1080/03630269.2020.1757462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Azita Azarkeivan
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Nader Cohan
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Reza Niazkar
- Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Arsalan Azizi
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Fariba Rad
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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Dehury S, Meher S, Patel S, Das K, Jana A, Bhattacharya S, Sahoo S, Sarkar B, Mohanty PK. Compound Heterozygote of Hb S (HBB: c.20A>T)/Hb Westdale (HBB: c.380_396delTGCAGGCTGCCTATCAG): Report of Four Cases from Odisha State, India. Hemoglobin 2019; 43:132-136. [PMID: 31190580 DOI: 10.1080/03630269.2019.1602052] [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: 10/26/2022]
Abstract
We report four cases of compound heterozygotes for Hb S (HBB: c.20A>T) and a rare β0-thalassemia (β0-thal) mutation, Hb Westdale (HBB: c.380_396delTGCAGGCTGCCTATCAG), characterized by a 17 bp deletion between codons 126 to 131 in exon 3 of the β-globin gene of human hemoglobin (Hb) confirmed by direct β-globin gene sequencing. All four cases were from four unrelated families belonging to the Agharia caste, an endogamous ethnic community of the Sundargarh and Jharsuguda districts of Odisha State, India. Detailed observations indicated that all four cases of Hb S/Hb Westdale were clinically severe. On family screening, six family members were found to be heterozygous for Hb Westdale and were asymptomatic. Deletional α-thalassemia (α-thal) and XmnI polymorphism were studied for all the Hb Westdale cases. The Hb S/Hb Westdale cases had an early median age at onset of symptoms and presentation, more requirement of blood transfusions, splenomegaly and hepatomegaly and were found to be clinically more severe when compared with the Hb S-β-thal with IVS-I-5 (G>C) (HBB: c.92 + 5G>C) cases. Overall, the findings indicate that this rare and hitherto unreported compound heterozygosity of Hb S/Hb Westdale is a clinically significant hemoglobinopathy and its finding in a large endogamous community of Odisha State, India will have important implication in the epidemiology and understanding of the clinical spectrum of sickle cell disease in Indian context and prenatal diagnosis.
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Affiliation(s)
- Snehadhini Dehury
- a Odisha Sickle Cell Project (NHM), Sickle Cell Institute, Veer Surendra Sai Institute of Medical Science and Research (VIMSAR), Burla , Sambalpur , Odisha State , India
| | - Satyabrata Meher
- a Odisha Sickle Cell Project (NHM), Sickle Cell Institute, Veer Surendra Sai Institute of Medical Science and Research (VIMSAR), Burla , Sambalpur , Odisha State , India
| | - Siris Patel
- a Odisha Sickle Cell Project (NHM), Sickle Cell Institute, Veer Surendra Sai Institute of Medical Science and Research (VIMSAR), Burla , Sambalpur , Odisha State , India
| | - Kishalaya Das
- a Odisha Sickle Cell Project (NHM), Sickle Cell Institute, Veer Surendra Sai Institute of Medical Science and Research (VIMSAR), Burla , Sambalpur , Odisha State , India
| | - Arpita Jana
- b Anthropological Survey of India , 4th Floor, Spirit Building , Kolkata , West Bengal State , India
| | - Subhra Bhattacharya
- b Anthropological Survey of India , 4th Floor, Spirit Building , Kolkata , West Bengal State , India
| | - Sarmila Sahoo
- a Odisha Sickle Cell Project (NHM), Sickle Cell Institute, Veer Surendra Sai Institute of Medical Science and Research (VIMSAR), Burla , Sambalpur , Odisha State , India
| | - Biswanath Sarkar
- b Anthropological Survey of India , 4th Floor, Spirit Building , Kolkata , West Bengal State , India
| | - Pradeep K Mohanty
- a Odisha Sickle Cell Project (NHM), Sickle Cell Institute, Veer Surendra Sai Institute of Medical Science and Research (VIMSAR), Burla , Sambalpur , Odisha State , India.,c Department of Medicine , VIMSAR, Burla , Sambalpur , Odisha State , India
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9
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Jha AN, Mishra H, Verma HK, Pandey I, Lakkakula BVKS. Compound Heterozygosity of β-Thalassemia and the Sickle Cell Hemoglobin in Various Populations of Chhattisgarh State, India. Hemoglobin 2018; 42:84-90. [PMID: 30200838 DOI: 10.1080/03630269.2018.1483946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Hemoglobinopathies evolved as a protective mechanism against malaria, which exhibit selective advantage in the heterozygous state. However, in a homozygous recessive condition, it poses a serious socioeconomic burden. Sickle cell anemia is an autosomal recessive hemoglobinopathy associated with erythrocytes sickling, vaso-occlusive crisis (VOC), as well as multi-organ failure and death. The coinheritance of other hemoglobinopathies is known to substantially modulate the clinical manifestation of sickle cell anemia. In the present study, we aimed to analyze the coinheritance of β-thalassemia (β-thal) in Hb S (HBB: c.20A>T) patients. The study includes 918 sickle cell anemia patients from 10 ethnic populations of Chhattisgarh State, India. Complete blood counts (CBCs) and hemoglobin (Hb) high performance liquid chromatography (HPLC) fractionation data were collected from patient record books. We observed Hb S-β-thal in all the analyzed populations. Interestingly, high frequencies of Hb S-β-thal have been observed in Satnami (53.8%), Rawat (47.1%), Gond (35.1%) and Panika (30.6%) populations. Inter-population comparison of hematological parameters [Hb F (p < 0.001), Hb A2 (p < 0.001), Hb (p = 0.03) and red blood cell distribution width (RDW) (p < 0.001)] revealed significant differences. We also observed that mean Hb F levels were significantly higher in Hb S compared to Hb S-β-thal patients in the respective populations. Our study highlights the higher prevalence of β-thal as well as the compound heterozygosity for Hb S and β-thal in various populations of Chhattisgarh State, India.
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Affiliation(s)
- Aditya N Jha
- a Sickle Cell Institute Chhattisgarh (SCIC), Pandit Jawaharlal Nehru Memorial Medical College Campus , Raipur , Chhattisgarh State , India
| | - Hrishikesh Mishra
- a Sickle Cell Institute Chhattisgarh (SCIC), Pandit Jawaharlal Nehru Memorial Medical College Campus , Raipur , Chhattisgarh State , India
| | - Henu K Verma
- a Sickle Cell Institute Chhattisgarh (SCIC), Pandit Jawaharlal Nehru Memorial Medical College Campus , Raipur , Chhattisgarh State , India
| | - Isha Pandey
- a Sickle Cell Institute Chhattisgarh (SCIC), Pandit Jawaharlal Nehru Memorial Medical College Campus , Raipur , Chhattisgarh State , India
| | - Bhaskar V K S Lakkakula
- a Sickle Cell Institute Chhattisgarh (SCIC), Pandit Jawaharlal Nehru Memorial Medical College Campus , Raipur , Chhattisgarh State , India
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10
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Dash PM, Sahu PK, Patel S, Mashon RS, Kharat KR, Mukherjee MB. Effect of Assorted Globin Haplotypes and α-Thalassemia on the Clinical Heterogeneity of Hb S-β-Thalassemia. Hemoglobin 2018; 42:236-242. [PMID: 30486691 DOI: 10.1080/03630269.2018.1536666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Hemoglobinopathies and thalassemias are the most commonly encountered monogenic disorders of blood in humans, posing a major genetic and public health problem round the globe. Hb S (HBB: c.20A>T)-β-thalassemia (β-thal) is a compound aberrant heterozygosity with inconsistent phenotypic expression, which are poorly described and clinically mapped. Comprehensive genetic characterization of such a population is highly warranted for complete understanding of the clinical heterogeneity, disease prognosis and therapeutic management. In this study, Hb S-β-thal (n = 60) patients, strictly defined by varying degrees of clinical presentations, were selected to evaluate their genotype-phenotype agreement. Furthermore, β-globin (n = 120) and α-globin gene clusters (n = 60) were genetically characterized and statistically correlated with clinical terminologies to explain the clinical heterogeneity. Our results revealed the association of the Arab-Indian haplotypes with nine different frameworks of β-thal together with the modulating role of α-thalassemia (α-thal). The study subjects, including carriers of β-thal haplotype III [- - - - - - -] (8.0%), presented with varying severe patterns of clinical symptoms such as painful crisis, multiple infections and splenomegaly, as an outcome of significantly less Hb F and higher Hb S levels (p < 0.5). The study findings indicated that together with α-thal, β-thal haplotypes and Hb F levels, may possibly provide a close justification to support the clinical heterogeneity in the study population.
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Affiliation(s)
- Preetinanda M Dash
- a Department of Biotechnology, Centre for Advanced Life Sciences , Deogiri College , Aurangabad , Maharashtra , India.,b Sickle Cell Clinic and Malaria Research Centre , Veer Surendra Sai (VSS) Institute of Medical Sciences and Research , Burla, Sambalpur , Odisha , India
| | - Praveen K Sahu
- c Molecular and Immunology Laboratory , Ispat General Hospital , Rourkela , Odisha , India
| | - Siris Patel
- b Sickle Cell Clinic and Malaria Research Centre , Veer Surendra Sai (VSS) Institute of Medical Sciences and Research , Burla, Sambalpur , Odisha , India
| | - Ranjeet S Mashon
- b Sickle Cell Clinic and Malaria Research Centre , Veer Surendra Sai (VSS) Institute of Medical Sciences and Research , Burla, Sambalpur , Odisha , India.,d Department of Haematopathology , Christian Medical College , Ludhiana , India
| | - Kiran R Kharat
- a Department of Biotechnology, Centre for Advanced Life Sciences , Deogiri College , Aurangabad , Maharashtra , India
| | - Malay B Mukherjee
- e Department of Haematogenetics , National Institute of Immuno-Haematology , Parel, Mumbai , India
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11
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Silva FAC, Ferreira ALCG, Hazin-Costa MF, Dias MLG, Araújo AS, Souza AI. Adverse clinical and obstetric outcomes among pregnant women with different sickle cell disease genotypes. Int J Gynaecol Obstet 2018; 143:89-93. [PMID: 30030929 DOI: 10.1002/ijgo.12626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/15/2018] [Accepted: 07/20/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare clinical and obstetric adverse events among pregnant women with sickle cell disease (SCD) according to genotype. METHODS The present cross-sectional study enrolled women aged 15-49 years with SCD and prior pregnancy attending a hematology center in Recife, Brazil, between September 1, 2015, and April 30, 2016. Associations between sickle cell genotype (HbSS, HbSC, Sβ-thalassemia) and adverse events were evaluated. RESULTS Overall, 89 women were included; 74 (83%) had HbSS genotype, 8 (9%) had HbSC genotype, and 7 (8%) had Sβ-thalassemia genotype. Fifty-three (60%) self-reported being of mixed race, and 27 (30%) self-reported they were black. Blood transfusion was observed more frequently among women with HbSS than among those with HbSC genotype (P=0.007). Postpartum adverse events were more frequent in the Sβ-thalassemia than in the HbSS group (P=0.030). Fetal intrauterine death occurred only among women with the HbSS genotype (11 [15%]). In the HbSS group, there was a higher frequency of blood transfusion (P=0.004) and lower rate of spontaneous abortion (P=0.001) among women with six or more consultations. CONCLUSION The HbSS genotype was associated with a higher frequency of blood transfusion. Sβ-thalassemia was associated with a higher frequency of postpartum adverse events. Prenatal care was associated with a lower rate of spontaneous abortion in the HbSS group.
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Affiliation(s)
- Flávia A C Silva
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil.,Faculdade Pernambucana de Saúde, Recife, Brazil
| | | | - Manuela F Hazin-Costa
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil.,Hematology Department at Universidade Federal de Pernambuco, Recife, Brazil.,Fundação de Hematologia e Hemoterapia de Pernambuco, Recife, Brazil
| | | | - Aderson S Araújo
- Fundação de Hematologia e Hemoterapia de Pernambuco, Recife, Brazil
| | - Ariani I Souza
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil.,Faculdade Pernambucana de Saúde, Recife, Brazil
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12
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Abstract
Sickle cell disease (SCD) is a group of inherited disorders caused by mutations in HBB, which encodes haemoglobin subunit β. The incidence is estimated to be between 300,000 and 400,000 neonates globally each year, the majority in sub-Saharan Africa. Haemoglobin molecules that include mutant sickle β-globin subunits can polymerize; erythrocytes that contain mostly haemoglobin polymers assume a sickled form and are prone to haemolysis. Other pathophysiological mechanisms that contribute to the SCD phenotype are vaso-occlusion and activation of the immune system. SCD is characterized by a remarkable phenotypic complexity. Common acute complications are acute pain events, acute chest syndrome and stroke; chronic complications (including chronic kidney disease) can damage all organs. Hydroxycarbamide, blood transfusions and haematopoietic stem cell transplantation can reduce the severity of the disease. Early diagnosis is crucial to improve survival, and universal newborn screening programmes have been implemented in some countries but are challenging in low-income, high-burden settings.
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13
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Shah PS, Ray HSP, Vaghasia KK, Shah SC, Rao MV. Prenatal Screening for Rare Co-Inheritance of HbE and β-Thalassaemia Traits in Western India. J Clin Diagn Res 2017; 11:GD01-GD03. [PMID: 29207734 DOI: 10.7860/jcdr/2017/26068.10674] [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: 12/16/2016] [Accepted: 05/01/2017] [Indexed: 11/24/2022]
Abstract
The mutations in Haemoglobin Beta (HBB) gene, bring about less or no production of Hb β-chain synthesis in affected cases, leading from minor to major types depending on haematological indices. In compound heterozygotic conditions, two traits are involved, in which one parent has HbE trait and the other has β-thalassaemia carrier (trait). Here, we report a family of Rajasthan, West India which had a proband (son) having HbE/ β-thalassaemia a co-inherited compound heterozygosity as revealed by DNA sequencing. It also contained upper levels of HbE with altered Hb and red cell indices showing asymptomatic to symptomatic state requiring blood transfusion periodically. The parents and Chorionic Villus Sampling (CVS) were HbE and β-thalassaemia traits only. Such case is rare in Western India and we recommend this family for genetic counseling and genetic testing before they want reproductive choices in future for better management in a society.
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Affiliation(s)
- Parth S Shah
- Chief Scientific Officer (CSO), Molecular Genomics, Supratech Micropath Laboratory and Research Institute, Ahmedabad, Gujarat, India
| | - Hari Shankar P Ray
- Research Scientist, Supratech Micropath Laboratory and Research Institute, Ahmedabad, Gujarat, India
| | - Ketan K Vaghasia
- Senior Scientist, Supratech Micropath Laboratory and Research Institute, Ahmedabad, Gujarat, India
| | - Sandip C Shah
- Laboratory Director, Supratech Micropath Laboratory and Research Institute, Ahmedabad, Gujarat, India
| | - Mandava V Rao
- Ex. Director, School of Sciences, Gujarat University, Ahmedabad, Gujarat, India
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14
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Abstract
Sβ-thalassemia (Sβ-thal) is common among Gulf Arab patients with sickle cell disease, but the phenotype of this group had not been well-documented. We have studied a group of Kuwaiti patients and compared the phenotype in the homozygotes (SS) and Sβ-thal patients. Complete blood count, hemoglobin quantitation, serum bilirubin, and lactate dehydrogenase were determined with standard techniques. The patients were screened for α-globin genotype. The Sβ-thal patients were also screened for the HBG2 Xmn-1 polymorphism. β-Thal mutations were determined by arrayed primer extension or direct sequencing. There were 70 SS and 32 Sβ-thal patients with mean ages of 14.8±5.9 and 14.2±5.9 years, respectively. The Sβ-thal patients had more frequent, severe pain episodes per year compared with the SS, while the patterns among Sβ-thal and Sβ-thal patients were not significantly different. There were no differences in the frequencies of acute chest syndrome, gallstones, and blood transfusion in the SS and Sβ-thal patients. However, none of the Sβ-thal patients had been transfused. Among the Sβ-thal patients, 25 had β-thal and 7 had β-thal mutations, the most common being cd39 (C→T) and IVS-I-110 (G→A), respectively. Sβ-thal shows a severe phenotype in Kuwait, even among those with Sβ-thal, in whom the IVS-I-110 (G→A) mutation is predominant.
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15
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Chandra S, Ali M, Mishra P, Kapoor AK, Jindal Y. Detection of Compound Heterozygous Sickle Cell-β + Thalassaemia in a Patient with Extreme Weakness, Mild Jaundice and Moderate Anaemia - A Case Report. J Clin Diagn Res 2017; 11:ED07-ED08. [PMID: 28658777 PMCID: PMC5483679 DOI: 10.7860/jcdr/2017/24471.9778] [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: 09/28/2016] [Accepted: 01/13/2017] [Indexed: 11/24/2022]
Abstract
A 16-year-old female complained of extreme weakness. She had moderate anaemia; her Haemoglobin (Hb) was 7.7 gm/dl. Peripheral blood smear showed few sickled red cells. Sickle cell test was positive. High-Performance Liquid Chromatography (HPLC) revealed elevated levels of HbS (38.4%) and HbF (15.7%). In addition, HbA2 concentration was 3.8% and HbA concentration was 42.1%. Results suggested a diagnosis of compound heterozygous sickle cell-β+ thalassaemia. Sickle cell test was also positive with blood of patient's brother; Hb HPLC examination showed relatively low concentration of HbS (25.2%) suggesting a diagnosis of sickle cell trait. Chromatogram of patient's step sister suggested a diagnosis of thalassaemia trait. Findings of this study suggested that abnormal genes were inherited in the patient from both the parents. It was interpreted that repeated haemolysis in the patient might have contributed to anaemia, weakness, rise in indirect bilirubin and jaundice. Furthermore, high level of HbF (>12%) may interfere with polymerization of sickle haemoglobin suggesting beneficial effects of HbF-inducing agents which may inhibit sickling.
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Affiliation(s)
- Subhash Chandra
- Professor, Department of Pathology, GCRG Medical College, Lucknow, Uttar Pradesh, India
| | - Mostafa Ali
- Professor, Department of Pathology, Vivekanand Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pooja Mishra
- Senior Technician, Department of Pathology, Vivekanand Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashok Kumar Kapoor
- Pathologist, Department of Pathology, RML Mehrotra Pathology Pvt Ltd, Lucknow, Uttar Pradesh, India
| | - Yamini Jindal
- Resident, Department of Pathology, RML Mehrotra Pathology Pvt Ltd, Lucknow, Uttar Pradesh, India
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16
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Vincent O, Oluwaseyi B, James B, Saidat L. Coinheritance of B-Thalassemia and Sickle Cell Anaemia in Southwestern Nigeria. Ethiop J Health Sci 2016; 26:517-522. [PMID: 28450766 PMCID: PMC5389070 DOI: 10.4314/ejhs.v26i6.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Genes for haemoglobin S are found in high frequencies in Nigeria. However, there is little information on beta thalassemia in sickle cell anaemia in this population. The clinical presentation of HbS- β thalassemia is enormously variable, ranging from an asymptomatic state to a severe disorder similar to homozygous sickle cell disease. MATERIALS AND METHODS Haemoglobin A2 and HbF were determined in sickle cell anaemia patients attending LAUTECH Teaching Hospital, Osogbo, by elution after electrophoresis and alkaline denaturation methods respectively. Haematological parameters were estimated using Sysmex KX-21N and percentage target cells using Leishman's staining technique. RESULTS Exactly 6% f the SCA patients were found to have elevated HbA2 (>3.3%) and HbF (>1.3%). These patients also had normal erythrocyte indices, increased platelet count, a significantly higher HCT and an increased % target cell. CONCLUSION These findings confirm that the frequency of beta thalassaemia in sickle cell patients in Nigeria is higher than previously thought. It is therefore important to consider the possibility of this variant in patients with sickle cell anaemia since their course may differ from that of patients with homozygous sickle cell anaemia.
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Affiliation(s)
- Osunkalu Vincent
- Haematology and Blood Transfusion Science Department, University of Lagos, Nigeria
| | - Bamisaye Oluwaseyi
- Haematology Division, Medical Laboratory Science Department, Afe Babalola University, Ado-Ekiti, Nigeria
| | | | - Lawal Saidat
- Haematology and Blood Transfusion Laboratory, LAUTECH Teaching Hospital, Osogbo, Nigeria
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17
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Jain D, Arjunan A, Sarathi V, Jain H, Bhandarwar A, Vuga M, Krishnamurti L. Clinical events in a large prospective cohort of children with sickle cell disease in Nagpur, India: evidence against a milder clinical phenotype in India. Pediatr Blood Cancer 2016; 63:1814-21. [PMID: 27279568 DOI: 10.1002/pbc.26085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/19/2016] [Accepted: 05/06/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The clinical phenotype of sickle cell disease (SCD) has been reported to be milder in India than in the United States. The objective of this large single-center study was to examine the rate of complications to define the phenotype of SCD in India. METHODS The rate of complications per 100 person-years in 833 pediatric SCD patients for 1954 person-years in Nagpur, India including those diagnosed on newborn screen (NBS) and those presenting later in childhood (non-NBS) was compared to those reported in the cooperative study of sickle cell disease (CSSCD). Event rates were also compared between patients belonging to scheduled castes (SCs), scheduled tribes (STs), and other backward classes (OBC). RESULTS Comparison of CSSCD versus Nagpur NBS versus Nagpur non-NBS for rates of pain (32.4 vs. 85.2 vs. 62.4), severe anemia (7.1 vs. 27 vs. 6.6), stroke (0.7 vs. 0.8 vs. 1.4), splenic sequestration (3.4 vs. 6.7 vs. 1.6), acute chest syndrome (24.5 vs. 23.6 vs. 1.0), and meningitis (0.8 vs. 0 vs. 0.1) revealed more frequent complications in Nagpur compared to CSSCD. Comparison of ST, SC, and OBC for rates of pain (84.6 vs. 71.9 vs. 63.5), acute chest syndrome (3.6 vs. 2.8 vs. 2.2), severe anemia (5.4 vs. 9.5 vs. 11.4), stroke (1.2 vs. 0.4 vs. 0.3), splenic sequestration (0.6 vs. 2.4 vs. 1.9), and meningitis (0.8 vs. 0 vs. 0.1) revealed significantly more frequent complications among ST. CONCLUSIONS SCD-related complications are more frequent in Indian children than that observed in CSSCD. Further study is indicated to define SCD phenotype in India.
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Affiliation(s)
- Dipty Jain
- Indira Gandhi, Government Medical College and Hospital, Nagpur, Maharashtra, India.,Department of Pediatrics, Government Medical College, Nagpur, Maharashtra, India
| | - Aishwarya Arjunan
- Division of Hematology/Oncology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Vijaya Sarathi
- Department of Pediatrics, Government Medical College, Nagpur, Maharashtra, India
| | - Harshwardhan Jain
- Department of Pediatrics, Government Medical College, Nagpur, Maharashtra, India
| | - Amol Bhandarwar
- Department of Pediatrics, Government Medical College, Nagpur, Maharashtra, India
| | - Marike Vuga
- Division of Hematology/Oncology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Lakshmanan Krishnamurti
- Division of Hematology/Oncology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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18
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Benites BD, Bastos SO, Baldanzi G, dos Santos ADO, Ramos CD, Costa FF, Gilli SCO, Saad STO. Sickle cell/β-thalassemia: Comparison of Sβ0and Sβ+Brazilian patients followed at a single institution. Hematology 2016; 21:623-629. [DOI: 10.1080/10245332.2016.1187843] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | - Gabriel Baldanzi
- Hematology and Hemotherapy Center, University of Campinas, Brazil
| | | | - Celso Dario Ramos
- Division of Nuclear Medicine, Department of Radiology, University of Campinas, Brazil
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19
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Colah RB, Mukherjee MB, Martin S, Ghosh K. Sickle cell disease in tribal populations in India. Indian J Med Res 2016; 141:509-15. [PMID: 26139766 PMCID: PMC4510747 DOI: 10.4103/0971-5916.159492] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The sickle gene is widespread among many tribal population groups in India with prevalence of heterozygotes varying from 1-40 per cent. Co-inheritance of the sickle gene with β-thalassaemia, HbD Punjab and glucose-6-phosphate dehydrogenase (G6PD) deficiency has also been reported. Most of the screening programmes in India now use high performance liquid chromatography (HPLC) analysis although the solubility test is also sensitive and cheap. Sickle cell disease (SCD) among tribal populations is generally milder than among non-tribal groups with fewer episodes of painful crises, infections, acute chest syndrome and need for hospitalization. This has partly been attributed to the very high prevalence of α-thalassaemia among these tribes as well as higher foetal haemoglobin levels. However, the clinical presentation is variable with many cases having a severe presentation. There is not much information available on maternal and perinatal outcome in tribal women with sickle cell disease. Newborn screening programmes for SCD have recently been initiated in Maharashtra, Gujarat, Odisha and Chattisgarh and monitoring these birth cohorts will help to understand the natural history of SCD in India. Prenatal diagnosis is acceptable by tribal families in India. The Indian Council of Medical Research and the National Rural Health Mission in different States are undertaking outreach programmes for better management and control of the disease.
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Affiliation(s)
- Roshan B Colah
- National Institue of Immunohaematology (ICMR), Mumbai, India
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20
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Dhiman P, Chaudhary R, Sudha K. Sickle cell-β thalassemia with concomitant hemophilia A: a rare presentation. Blood Res 2016; 50:264-7. [PMID: 26770958 PMCID: PMC4705056 DOI: 10.5045/br.2015.50.4.264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/23/2015] [Accepted: 11/13/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Pratibha Dhiman
- Department of Hematology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Krishna Sudha
- Department of Pathology, ESI Hospital, New Delhi, India
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21
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Mohanty D. A century after discovery of sickle cell disease: keeping hope alive! Indian J Med Res 2014; 139:793-5. [PMID: 25109713 PMCID: PMC4164988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Dipika Mohanty
- Senior Consultant Hematologist & Chief of Lab Services Apollo Hospitals, Bhubaneswar 751 005, India
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22
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23
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Bhukhanvala DS, Sorathiya S, Surve R, Nair S, Italia K, Colah R, Ghosh K, Gupte SC. Hemoglobin variants in Muslim community in South Gujarat, Western India. Int J Lab Hematol 2013; 36:e15-7. [PMID: 23795655 DOI: 10.1111/ijlh.12123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- D S Bhukhanvala
- Surat Raktadan Kendra & Research Centre (NABH Accredited Regional Blood Transfusion Centre), Surat, India.
| | - S Sorathiya
- Surat Raktadan Kendra & Research Centre (NABH Accredited Regional Blood Transfusion Centre), Surat, India
| | - R Surve
- National Institute of Immunohaematology (ICMR), Mumbai, India
| | - S Nair
- National Institute of Immunohaematology (ICMR), Mumbai, India
| | - K Italia
- National Institute of Immunohaematology (ICMR), Mumbai, India
| | - R Colah
- National Institute of Immunohaematology (ICMR), Mumbai, India
| | - K Ghosh
- National Institute of Immunohaematology (ICMR), Mumbai, India
| | - S C Gupte
- Surat Raktadan Kendra & Research Centre (NABH Accredited Regional Blood Transfusion Centre), Surat, India
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24
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Saleh-gohari N, Mohammadi-Anaie M. Co-inheritance of sickle cell trait and thalassemia mutations in South central iran. IRANIAN JOURNAL OF PUBLIC HEALTH 2012; 41:81-6. [PMID: 23304665 PMCID: PMC3494235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 08/27/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND We aimed to determine the incidence of co-inheritance as well as interaction of sickle cell trait (SCT) and α(thal)/β(thal) mutations in south and south central of Iran. METHOD We employed a PCR and restriction fragment length polymorphism techniques to confirm diagnosis of sickle cell trait. All subjects were screened for any α/β -thalassemia mutations using a gap-polymerase chain reaction and amplification refractory mutations system. RESULTS Our results showed combination of sickle cell trait and β-globin mutation results in a severe clinical course of similar to sickle cell disease, while coinheritance of α-globin gene defects usually modulates the clinical course. A coexistence of sickle cell trait and α-globin gene mutation was the frequent genotype in overall samples (57. 5%). CONCLUSION Sickle cell trait mainly co-inherits with α-globin gene mutation in the south and south central region of Iran. This combination modulates hematological indices and interferes with the SCT diagnosis.
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Affiliation(s)
- N Saleh-gohari
- Dept. of Genetic, Medical School, Kerman University of Medical Sciences, Kerman, Iran,Corresponding Author: Tel: +98-341-3222246
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25
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Kumar R, Sharma DC, Kishor P. Hb E/β-Thalassemia: The Second Most Common Cause of Transfusion-Dependent Thalassemia in the Gwalior-Chambal Region of Central India. Hemoglobin 2012; 36:485-90. [DOI: 10.3109/03630269.2012.699489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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26
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Pandey S, Mishra RM, Pandey S, Shah V, Saxena R. Molecular characterization of hemoglobin D Punjab traits and clinical-hematological profile of the patients. SAO PAULO MED J 2012; 130:248-51. [PMID: 22965366 PMCID: PMC10619953 DOI: 10.1590/s1516-31802012000400008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 07/11/2011] [Accepted: 01/18/2012] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Hemoglobin (Hb) D hemoglobinopathies are widespread diseases in northwestern India and usually present with mild hemolytic anemia and mild to moderate splenomegaly. The heterozygous form of Hb D is clinically silent, but coinheritance of Hb D with Hb S or beta-thalassemia produces clinically significant conditions like thalassemia intermedia of moderate severity. Under heterozygous conditions with coinheritance of alpha and beta-thalassemia, patients show a degree of clinical variability. Thus, our aim was to molecularly characterize the Hb D trait among individuals who were clinically symptomatic because of co-inheritance of alpha deletions or any beta-globin gene mutations. DESIGN AND SETTING This was a cross-sectional study conducted in an autonomous tertiary-care hospital. METHODS Complete blood count and red cell indices were measured using an automated cell analyzer. Quantitative assessment of hemoglobin Hb F, Hb A, Hb A2 and Hb D was performed by means of high performance liquid chromatography (HPLC). DNA extraction was done using the phenol-chloroform method. Molecular analyses on common alpha deletions and common beta mutations were done using the Gap polymerase chain reaction and Amplification Refractory Mutation System, respectively. RESULTS We evaluated 30 patients and found clinical variation in the behavior of Hb D traits. In six patients, the Hb D traits were clinically symptomatic and behaved like those of thalassemia intermedia. Molecular characterization showed that three out of these six were IVS-1-5 positive. CONCLUSIONS HPLC may not be the gold standard for diagnosing symptomatic Hb D Punjab traits. Hence, standard confirmation should include molecular studies.
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Affiliation(s)
- Sanjay Pandey
- MSc. Senior Research Fellow, Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.
| | - Rahasya Mani Mishra
- PhD. Professor, Department of Environmental Biology, Awadhesh Pratap Singh University, Rewa, Madhya Pradesh, India
| | - Sweta Pandey
- MSc. Student, Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.
| | - Vineet Shah
- MSc. Senior Research Fellow, Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India.
| | - Renu Saxena
- MD. Professor, Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.
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