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Daar S, Al-Naamani K, De Sanctis V, Al Rahbi S, Al Zadjali S, Khan H, Panjwani V, Al-Khabori M. Mortality and complications in Omani patients with beta-thalassemia major: a long-term follow-up study. Acta Biomed 2023; 94:e2023191. [PMID: 37539594 PMCID: PMC10440768 DOI: 10.23750/abm.v94i5.14856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 06/07/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND AIM Beta thalassemia major (β-TM) is a genetic blood disorder requiring lifelong blood transfusions. The resulting iron overload damages multiple organs, particularly the heart and endocrine organs. This study aimed to describe and assess the predictors of survival and complications in Omani patients with β-TM. Methods: All β-TM patients registered in the day care of Sultan Qaboos University Hospital were included in this retrospective study. Results: There were 187 patients with β-TM with a median follow-up of 24.9 years. The median ages at diagnosis and the start of chelation were 0.7 and 4.8 years, respectively. The following complications developed at different time points [Median (age in years), Complication Free Probability at 20 years]: Death (20.0 years;85%), hypogonadism (15.9 years;50%), insulin-dependent or non-insulin dependent diabetes (20.0 years;88%), cardiac complications (20.3 years;91%), osteoporosis (20.7 years;96%), hypothyroidism (25.7 years;97%), liver complications (7.3 years;54%). The number of complications predicted death (P = 0.0038). Those born after 1980 had a lower risk of death (P = 0.005), hypogonadism (P = < 0.0001), and cardiac complications (P = 0.004). Higher serum ferritin at the start of chelation was associated with the development of diabetes (P = < 0. 001). Conclusions: This long-term study shows complications development at different ages, and the number of complications is associated with survival. Later birth cohorts had a lower risk of death, hypogonadism, and cardiac complications. There was a persistent negative impact of delay in the start of iron chelation that is present even after a long follow-up. (www.actabiomedica.it).
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Alshekaili J, Nasr I, Al-Rawahi M, Ansari Z, Al Rahbi N, Al Balushi H, Al Zadjali S, Al Kindi M, Al-Maawali A, Cook MC. A homozygous loss-of-function C1S mutation is associated with Kikuchi-Fujimoto disease. Clin Immunol 2023; 252:109646. [PMID: 37209807 DOI: 10.1016/j.clim.2023.109646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Kikuchi-Fujimoto disease (KFD) is a self-limited inflammatory disease of unknown pathogenesis. Familial cases have been described and defects in classical complement components C1q and C4 have been identified in some patients. MATERIAL AND METHODS We describe genetic and immune investigations of a 16 years old Omani male, a product of consanguineous marriage, who presented with typical clinical and histological features of KFD. RESULTS We identified a novel homozygous single base deletion in C1S (c.330del; p. Phe110LeufsTer23) resulting in a defect in the classical complement pathway. The patient was negative for all serological markers of SLE. In contrast, two female siblings (also homozygous for the C1S mutation), one has autoimmune thyroid disease (Hashimoto thyroiditis) and a positive ANA and the other sibling has serology consistent with SLE. CONCLUSION We report the first association between C1s deficiency and KFD.
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Affiliation(s)
- Jalila Alshekaili
- Department of Microbiology and Immunology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman.
| | - Iman Nasr
- Department of Adult Allergy and Clinical Immunology, The Royal Hospital, Muscat, Oman
| | - Mohammed Al-Rawahi
- Department of Hematology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Zainab Ansari
- Department of Adult Allergy and Clinical Immunology, The Royal Hospital, Muscat, Oman
| | | | - Hamed Al Balushi
- Department of Microbiology and Immunology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Shoaib Al Zadjali
- Department of Hematology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Mahmood Al Kindi
- Department of Microbiology and Immunology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Almundher Al-Maawali
- Genetics Department, Sultan QaboosUniversity Hospital, Sultan Qaboos University, Muscat, Oman
| | - Matthew C Cook
- Department of Immunology and Infectious Disease, John Curtin School of Medical Research, Australian National University, Canberra, NSW, Australia; Department of Medicine, University of Cambridge, United Kingdom; Centre for Personalised Immunology, John Curtin School of Medical Research, Australian National University, Canberra, NSW, Australia.
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Nazir HF, Rawas AA, Tamemi SA, Zadjali SA, Hosni SA, Tauro M, Qassabi JA, Elnour I, Handgretinger R, Dennison D. Hematopoietic Stem Cell Transplantation for Patients with Autosomal Recessive Complete INF-λ Receptor 2 Deficiency: Experience in Oman. Transplant Cell Ther 2021; 27:881.e1-881.e5. [PMID: 34293519 DOI: 10.1016/j.jtct.2021.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/11/2021] [Accepted: 07/11/2021] [Indexed: 11/26/2022]
Abstract
Autosomal recessive complete INF-γ receptor-2 (IFN-γR2) deficiency is a rare, potentially fatal primary immune deficiency that predisposes to disseminated mycobacterial disease. Hematopoietic stem cell transplantation (HSCT) is currently the only curative treatment. Few patients have been reported so far. Here we report the outcomes of HSCT in 7 patients with IFNγ-R2 deficiency from 3 Omani families who underwent HSCT at Sultan Qaboos University Hospital in Oman. All patients were homozygous for the same mutation (c.-175_+102del) of INFGR2. Four patients underwent HLA-matched related donor (MRD) HSCT (3 siblings and 1 parent), and the other 3 underwent T cell-depleted (TCD) haploidentical HSCT from a family donor. The stem cell source was peripheral blood stem cells in 5 patients and bone marrow in 2 patients. Five patients received myeloablative conditioning, and 2 had reduced-intensity conditioning. The overall survival rate was 85.7%, and the event-free survival was 71.4%. One of the 7 patients died on day +31 with gram-negative sepsis, and the other 6 patients were cured from their original disease (median follow-up of 78.5 months). One patient had primary graft failure following a TCD-haploidentical transplantation and underwent successful retransplantation from another haploidentical relative. Three patients received a donor lymphocyte infusion for mixed chimerism. Our findings indicate that HSCT is curative for complete IFN-γR2 deficiency. In this cohort from Oman, 85.7% of the patients were cured with either an MRD or a TCD haploidentical transplantation. Genetic analysis at birth in children of high-risk couples permits early diagnosis, prevents the morbidity of BCG vaccination, and can enable safer and more successful transplantation outcomes.
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Affiliation(s)
- Hanan F Nazir
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman; Department of Pediatrics, Alexandria Faculty of Medicine, Alexandria, Egypt
| | | | - Salem Al Tamemi
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Shoaib Al Zadjali
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Saif Al Hosni
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Melanie Tauro
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Jamal Al Qassabi
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ibtisam Elnour
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Rupert Handgretinger
- Department of Hematology/Oncology, University Children's Hospital, Tuebingen, Germany
| | - David Dennison
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman; Hematology Section, Apollo Hospital Muscat, Oman.
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Al-Riyami AZ, Daar S, Kindi SA, Madhani AA, Wali Y, Rawahi MA, Zadjali SA. α-Globin Genotypes Associated with Hb H Disease: A Report from Oman and a Review of the Literature from the Eastern Mediterranean Region. Hemoglobin 2020; 44:20-26. [PMID: 32019385 DOI: 10.1080/03630269.2020.1720709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
α-Thalassemia (α-thal) is the most common autosomal recessive hemoglobinopathy. There is a vast diversity and geographical variability in underlying genotypes in Hb H (β4) patients. Herein, we describe the genotypes found in the largest report of Omani Hb H patients. Moreover, we reviewed and summarized the literature published from the Eastern Mediterranean region. A retrospective review of all genetically confirmed Hb H disease patients diagnosed between 2007 and 2017 at Sultan Qaboos University Hospital, Muscat, Oman, was performed. Hematological parameters and clinical presentations were assessed. Both α-globin genes were screened for deletional and nondeletional mutations using a stepwise diagnostic strategy as described before. A total of 52 patients (27 females and 25 males) with a mean age of 20.6 years (range 0.23-80.0) were molecularly confirmed to carry Hb H disease. The patients had a hemoglobin (Hb) level of 9.3 g/dL (range 5.7-13.0) and mean corpuscular volume (MCV) of 58.4 fL (range 48.2-82.1). A total of eight genotype combinations were identified, with α2 polyadenylation signal mutation (polyA1) (AATAAA>AATAAG (αPA1α/αPA1α), often cited as αT-Saudiα/αT-Saudiα, being the most common (53.8%) followed by -α3.7/- -MED I (28.8%). Our cohort also included patients with combinations of αPA1 with other Hb variants: αPA1α/αPA1α with Hb S (HBB: c.20A>T) trait (n = 2), -α3.7/αPA1α (n = 2) and αcodon 19α (HBA2: c.56delG)/αPA1α (n = 1). Nondeletional Hb H disease due to the αPA1 mutation is the most common in Omanis. Molecular diagnosis is necessary for accurate confirmation of the diagnosis of α-thal, determination of underlying genotypes, follow-up and counseling.
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Affiliation(s)
- Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Shahina Daar
- Department of Hematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Salam Al Kindi
- Department of Hematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ali Al Madhani
- Department of Medicine, Sohar Hospital, Ministry of Health, Muscat, Oman
| | - Yasser Wali
- Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mohammed Al Rawahi
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Shoaib Al Zadjali
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
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Daar S, Al Zadjali S, Alkindi S, Wali Y, Al-Rawas A, Al-Haddabi H, Al-Riyami AZ. Haemoglobin Fontainebleau (HBA2: c. 64G>C) in Oman: molecular and haematological characteristics and interaction with various haemoglobinopathies. Clin Mol Pathol 2018; 71:303-308. [DOI: 10.1136/jclinpath-2017-204617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/13/2017] [Accepted: 07/19/2017] [Indexed: 11/04/2022]
Abstract
ObjectivesTo describe the laboratory features of haemoglobin Fontainebleau (Hb FB) and its interactions with various α and β globin gene mutations in the Omani population.MethodsOver a period of 10 years, a total of 94 blood samples were suspected to have an α variant on HPLC at the Sultan Qaboos University Hospital, Muscat, Oman. Molecular testing was performed using PCR based techniques to define the variant and to analyse other interacting mutations in either α or β globin genes.ResultsOf 94 subjects, molecular analysis confirmed the Hb FB variant in 55 samples (38 non-cord and 17 cord blood). A total of 36/38 non-cord samples were heterozygous for the variant, while all 17 cord blood samples were heterozygotes. A total of 43/55 individuals had a concomitant α and/or β globin gene mutation.ConclusionsHb FB is the the most common α variant in the Omani population. We report the different HPLC profiles of this variant that we observed, with and without other haemoglobinopathies in non-cord and cord blood samples. This is the first report describing the HPLC profiles of this α globin chain variant on 1 year follow-up testing of cord blood samples. With careful analysis by HPLC, it is possible not only to identify Hb FB but also to predict any concomitant α and/or β globin gene mutations.
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DENNISON JD, Al Rawas A, Al Ghaithi H, Al Khabori M, Tauro M, Al Mamari S, Al Zadjali S, Al Said B, Nazir H, Tony S, Saad A, Al Abri Q, Al Farsi K, Al Tamemi S, Wali Y, Al Kindi S, El Shinawy M, Zachariah M, Mathew L, Al Huneini M. T-cell depleted haploidentical hematopoietic stem cell transplantation is the optimal graft source for patients with familial hemophagocytic lymphohistiocytosis who do not have matched family donors. The Journal of Immunology 2016. [DOI: 10.4049/jimmunol.196.supp.140.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Familial hemophagocytic lymphohistiocytosis (HLH) is a fatal disorder of immune regulation. When managed appropriately with systemic chemotherapy, cure can be achieved by subsequent allogeneic hematopoietic stem cell transplantation (HSCT). Although the best results are obtained with matched-family donors (MFD), alternative donor transplants may be necessary when such donors are not available. As there is urgency to proceed with curative therapy, T-cell depleted haploidentical HSCT could be a viable option as a parent or other haploidentical family member would be available instantly. Between August 2010 and September 2015 we performed haploidentical HSCT for six patients with HLH in this institution. These patients did not have MFDs, and in our center it was logistically easier to perform an haploidentical HSCT rather than to pursue with an unrelated donor or cord blood search from the international registries. The median age at transplant was 6 months (5–31 months) and all had perforin gene mutations. The first two patients had CD3/CD19 depleted procedures while the rest underwent TCR alpha/beta and CD19 depletion for faster immune reconstitution. All six patients engrafted following the transplant with minimal graft versus hot disease. Four patients are cured from the disease with a median follow-up of 3 years (7mths to 5 years). Two patients (siblings) who were transplanted in partial remission expired 2 months following transplant from multi-organ failure after successful engraftment. In the presence of an appropriate transplant laboratory facility, T-cell depleted haploidentical HSCT should be considered as the graft of choice for patients with HLH who do not have HLA-matched family donors.
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Riyami AA, Bakri NA, Salmi HA, Zadjali SA, Huneini MA, Khabori MA, Farsi KA, Rawas AA, Lamki ZA, Wali Y, Alkindi S. Cytogenetic Profile of Adult and Pediatric Acute Myeloid Leukemia in Oman: 10-Year Data From a Tertiary Care University Referral Hospital. Am J Clin Pathol 2015. [DOI: 10.1093/ajcp/144.suppl2.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Beshlawi I, Al Zadjali S, Bashir W, Elshinawy M, Alrawas A, Wali Y. Thiamine responsive megaloblastic anemia: the puzzling phenotype. Pediatr Blood Cancer 2014; 61:528-31. [PMID: 24249281 DOI: 10.1002/pbc.24849] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/15/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Thiamine responsive megaloblastic anemia (TRMA) is characterized by a triad of megaloblastic anemia, non-type 1 diabetes mellitus and sensorineural deafness. Other clinical findings have been described in few cases. The SLC19A2 gene on chromosome 1q 23.3 is implicated in all cases with TRMA. Our aim is to discuss the clinical manifestations of all Omani children diagnosed with TRMA and determine genotype-phenotype relationship. PROCEDURE Clinical and laboratory data of all patients diagnosed in Oman were retrospectively collected. Mutation analysis of affected families was conducted using two Microsatellite markers. Genotyping was performed with fluorescent-labeled PCR primers. To define the deletion breakpoint region, PCR reactions were carried out using different primer pairs located at the introns 3 and 3'-untranslated region with Expand Long Template PCR kit. RESULTS A total of six children have been diagnosed with this syndrome. They were five females and one male. They all presented with sensorineural deafness at birth while the age of anemia presentation ranged between 6 weeks to 19 months. They all belong to same family with complex interfamilial marriages and presented with the typical triad. Of interest is the very rare presentation of one patient with Uhl cardiac anomaly (total absence of right ventricular myocardium with apposition of endocardium and pericardium) that has never been described before in patients with TRMA. All patients have a novel large deletion of 5,224 bp involving exons 4, 5, and 6 of SLC19A2. CONCLUSIONS TRMA is a disease of expanding phenotypic spectrum with poor genotype-phenotype correlation.
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Affiliation(s)
- Ismail Beshlawi
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
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Al Zadjali S, Bashir W, Gravell D, Al Riyami AZ, Wali Y, Daar S. First reported case of compound heterozygosity for HbA2-Yialousa (HBD: c.82 G>C) and HbA2-Wrens (HBD: c.295 G>A) in Oman. Int J Hematol 2013; 98:240-2. [DOI: 10.1007/s12185-013-1388-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 06/11/2013] [Accepted: 06/16/2013] [Indexed: 11/24/2022]
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Knox-Macaulay HHM, Rehman JU, Al Zadjali S, Fawaz NA, Al Kindi S. Idiopathic thrombocytopenic purpura and hypokalaemic dRTA with compensated haemolysis and striking acanthocytosis in a band 3 (SLC4A1/AE1) A858D homozygote. Ann Hematol 2012; 92:553-4. [PMID: 23053187 DOI: 10.1007/s00277-012-1590-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
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Pathare AV, Zadjali SA, Misquith R, Alkindi SS, Panjwani V, Lapoumeroulie C, Pravin S, Paldi A, Krishnamoorthy R. Warfarin Pharmacogenetics: Polymorphisms of theCYP2C9, CYP4F2, and VKORC1Loci in a Genetically Admixed Omani Population. Hum Biol 2012; 84:67-77. [DOI: 10.3378/027.084.0103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fawaz NA, Beshlawi IO, Al Zadjali S, Al Ghaithi HK, Elnaggari MA, Elnour I, Wali YA, Al-Said BB, Rehman JU, Pathare AV, Knox-Macaulay H, Alkindi SS. dRTA and hemolytic anemia: first detailed description of SLC4A1 A858D mutation in homozygous state. Eur J Haematol 2012; 88:350-5. [PMID: 22126643 DOI: 10.1111/j.1600-0609.2011.01739.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mutations in the anion exchanger 1 (AE1) gene encoding the erythroid and kidney anion (chloride-bicarbonate) exchanger 1 may result in familial distal renal tubular acidosis (dRTA) in association with membrane defect hemolytic anemia. Seven children presenting with hyperchloremic normal anion gap metabolic acidosis, failure to thrive, and compensated hemolytic anemia were studied. Analysis of red cell AE1/Band 3 surface expression by Eosin 5'-maleimide (E5M) was performed in patients and their family members using flow cytometry. Genetic studies showed that all patients carried a common SLC4A1 mutation, c.2573C>A; p.Ala858Asp in exon 19, found as homozygous (A858D/A858D) mutation in the patients and heterozygous (A858D/N) in the parents. Analysis by flowcytometry revealed a single uniform fluorescence peak, with the mean channel fluorescence (MCF) markedly reduced in cases with homozygous mutation, along with a left shift of fluorescence signal but was only mildly reduced in the heterozygous state. Red cell morphology showed striking acanthocytosis in the homozygous state [patients] and only a mild acanthocytosis in heterozygous state [parents]. In conclusion, this is the first description of a series of homozygous cases with the A858D mutation. The E5M flowcytometry test is specific for reduction in the Band 3 membrane protein and was useful in conjunction with a careful morphological examination of peripheral blood smears in our patient cohort.
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Affiliation(s)
- Naglaa A Fawaz
- Departments of Hematology Child Health, Sultan Qaboos University Hospital, Muscat College of Medicine and Health Sciences, SQU, Muscat, Sultanate of Oman
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Al Zadjali S, Wali Y, Al Lawatiya F, Gravell D, Alkindi S, Al Falahi K, Krishnamoorthy R, Daar S. The β-globin promoter -71 C>T mutation is a β+ thalassemic allele. Eur J Haematol 2011; 87:457-60. [PMID: 21801233 DOI: 10.1111/j.1600-0609.2011.01687.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A novel β-globin gene promoter (-71 C>T) nucleotide change was recently posted to the HbVar database (ID 2701) without precision on phenotype and ethnicity. We found the same change in compound heterozygosity with Hb S [β6(A3)Glu>Val] in an Omani family with almost equal expression of Hb A and Hb S. This suggested that the -71 C to T mutation may be a mild β-thalassemic allele. Subsequent search found three other independent cases with the same atypical Hb A:Hb S ratio, further confirming the mild thalassemic feature of this mutation. In addition, molecular screening of a set of subjects (with only Hb A) with borderline Hb A(2) or MCV values revealed the presence of -71 C>T change in heterozygous state, altogether assigning the mutation as a mild β(+) thalassemic allele. In a region such as Oman, where several genetic conditions of the red blood cell coexist (α- and β-thalassemia, Hb S, Hb D, Hb E) in significant frequencies, it is crucial to decipher the molecular basis of these atypical forms of β(+) thalassemias, especially in a genetic counseling setting.
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Wali Y, Zadjali SA, Elshinawy M, Beshlawi I, Fawaz N, AlKindi S, Rawas A, Alsinani S, Daar S, Krishnamoorthy R. Severity ranking of non-deletional alpha thalassemic alleles: insights from an Omani family study. Eur J Haematol 2011; 86:507-11. [DOI: 10.1111/j.1600-0609.2011.01606.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Al Zadjali S, Daar S, AlKindi S, Gravell D, Al Haddabi H, Berbar T, Krishnamoorthy R. Hb Sheffield [β58(E2)Pro→His] in Oman: potential pitfall in genetic counseling. Hemoglobin 2011; 35:111-6. [PMID: 21417567 DOI: 10.3109/03630269.2011.558226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A novel β-globin structural variant, namely Hb Sheffield [β58(E2)Pro→His], was recently found as a sporadic event in a British Subject and posted to the HbVar database (ID 2672). Here we describe the same variant in 11 Omani subjects in the heterozygous state and in one Omani woman in compound heterozygosity with Hb S [β6(A3)Glu→Val]. Hb Sheffield coelutes in the Hb A(2) window in the high performance liquid chromatography (HPLC) system as does Hb E [β26(B8)Glu→Lys], and might be erroneously diagnosed as Hb E unless additional tests including DNA analyses are done. Indeed, correct diagnosis of Hb E is important because of its association with other β-thalassemic and variant alleles can result in relevant clinical conditions, while Hb Sheffield will not. In a genetic (premarital) counseling setting, and in regions where both Hb E ad Hb Sheffield are present, failure to distinguish these variants will represent a serious pitfall.
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Daar S, Al Zadjali S, Gravell D, Al Haddabi H, Al Riyami M, Al Belushi A, Berbar T, Krishnamoorthy R. Hb A2' (Hb B2) in the Omani population and diagnostic significance. Hemoglobin 2011; 35:117-24. [PMID: 21417568 DOI: 10.3109/03630269.2011.553557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hb A(2)' [δ16(A13)Gly→Arg], also called Hb B2, is a δ-globin chain variant that has been identified in several populations of African origin or ancestry and is easily identifiable in alkaline acetate cellulose electrophoresis as doubling of the Hb A(2) band. However, in high performance liquid chromatography (HPLC), commonly employed nowadays, it elutes in the S window. Over a period of 2 years at the Sultan Qaboos University Hospital, Muscat, Oman, we identified 25 Omanis with this variant. The quantity of Hb A(2) ranged from 0.9 to 1.8% in heterozygotes and was undetectable in the single homozygous case. As both α- and β-thalassemia (α- and β-thal) as well as Hb S [β6(A3)Glu→Val] are common in the Omani population, it is important to be aware of the presence of Hb A(2)' in this population to avoid misinterpretation of the HPLC data in terms of underdiagnosis of β-thal carriers and overestimation of α-thal based on Hb A(2) levels in sickle cell carriers. The haplotype associated with Hb A(2)' in Oman is identical to that described in African populations, suggesting a common origin for this mutation and its introduction into Oman by gene flow.
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Affiliation(s)
- Shahina Daar
- Department of Hematology, Sultan Qaboos University, Muscat, Oman
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Alkindi S, Al Zadjali S, Al Madhani A, Daar S, Al Haddabi H, Al Abri Q, Gravell D, Berbar T, Pravin S, Pathare A, Krishnamoorthy R. Forecasting Hemoglobinopathy Burden Through Neonatal Screening in Omani Neonates. Hemoglobin 2010; 34:135-44. [DOI: 10.3109/03630261003677213] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Al-Obaidli A, Gerard N, Al Zadjali S, Fawzi Z, Pravin S, Pathare A, Krishnamoorthy R. A novel deletional beta-thalassemic variant in an ethnic Qatari patient. Hemoglobin 2010; 33:214-9. [PMID: 19657835 DOI: 10.1080/03630260903081398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Point mutations are responsible for the majority of the disease-causing alleles in beta-thalassemia (beta-thal) worldwide. We report here a novel deletional variant beta-thal allele in an ethnic Qatari patient, hitherto unreported in the literature. The deletion spans exon 1, the entire intron 1 and the first two bases of exon 2 causing a frameshift and the premature appearance of a stop codon.
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Affiliation(s)
- Aisha Al-Obaidli
- Biological and Environmental Sciences Department, Qatar University, Doha, Qatar
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Pathare A, Al Zadjali S, Shah W. Novel human pathological mutations. Gene symbol: PROC. Disease: Protein C deficiency. Hum Genet 2009; 126:336-337. [PMID: 19694010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Anil Pathare
- Haematology, Sultan Qaboos University Hospital, Muscat, Oman.
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Daar S, Pathare AV, Jain R, Zadjali SA, Pennell DJ. T2* cardiovascular magnetic resonance in the management of thalassemia patients in Oman. Haematologica 2008; 94:140-1. [PMID: 19001285 DOI: 10.3324/haematol.13845] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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