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Rossetti E, Pepe C, Eandi Eberle S, Bindi V, Fernandez D, Nieto L, Gonzalez MM, Avalos V. Megaloblastic anemia with homocystinuria type cblE: Atypical presentation in a pediatric patient with high transfusion requirement and autoimmune phenomena. Pediatr Blood Cancer 2024; 71:e30867. [PMID: 38217084 DOI: 10.1002/pbc.30867] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024]
Affiliation(s)
- Estefania Rossetti
- Pediatric Hematology and Oncology Department, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
| | - Carolina Pepe
- Molecular Biology Department, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
| | - Silvia Eandi Eberle
- Inborn Errors of Metabolism Department, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
| | - Veronica Bindi
- Hospital de Pediatría Juan P. Garrahan, Biochemistry Laboratory, Buenos Aires, Argentina
| | - Diego Fernandez
- Inborn Errors of Metabolism Department, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
| | - Leandro Nieto
- Inborn Errors of Metabolism Department, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
| | - Maria Magdalena Gonzalez
- Inborn Errors of Metabolism Department, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
| | - Vanesa Avalos
- Pediatric Hematology and Oncology Department, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
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Rossetti E, Eandi Eberle S, Aguirre F, Pepe C, Díaz L, Harris V, Ávalos V. Hemoglobin Denver, a cause of desaturated pulse oximetry. A pediatric case report. ARCH ARGENT PEDIATR 2023; 121:e202202801. [PMID: 36857142 DOI: 10.5546/aap.2022-02801.eng] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Hemoglobinopathies are genetic disorders that affect the hemoglobin (Hb) molecule. Mutations in the alpha or beta chains altering the Hb tetramer may modify the molecule's oxygen-binding capacity. Hemoglobinopathies with low oxygen affinity may occur with cyanosis and an altered pulse oximetry reading, leading to unnecessary and sometimes invasive tests to rule out cardiovascular and respiratory conditions. In the case report described here, we present an asymptomatic pediatric patient who consulted for desaturated pulse oximetry. Her initial laboratory tests showed normocytic, normochromic anemia. Venous blood gas samples showed an elevated p50. After using extensive diagnostic tools, a variant of Hb with low oxygen affinity was diagnosed: Hb Denver.
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Affiliation(s)
- Estefanía Rossetti
- Department of Hematology and Oncology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Silvia Eandi Eberle
- Laboratory of Hematology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Fernando Aguirre
- Laboratory of Hematology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Carolina Pepe
- Laboratory of Molecular Biology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Lilian Díaz
- Department of Hematology and Oncology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Verónica Harris
- Clinic of Intermediate and Medium Care; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Vanesa Ávalos
- Department of Hematology and Oncology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
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Milanesio B, Pepe C, Defelipe LA, Eandi Eberle S, Avalos Gomez V, Chaves A, Albero A, Aguirre F, Fernandez D, Aizpurua L, Paula Dieuzeide M, Turjanski A, Bianchi P, Fermo E, Feliu-Torres A. Six novel variants in the PKLR gene associated with pyruvate kinase deficiency in Argentinian patients. Clin Biochem 2021; 91:26-30. [PMID: 33631127 DOI: 10.1016/j.clinbiochem.2021.02.003] [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: 12/08/2020] [Revised: 01/29/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pyruvate kinase deficiency (PKD) is a rare recessive congenital hemolytic anemia caused by mutations in the PKLR gene. The disease shows a marked variability in clinical expression. We studied the molecular features of nine unrelated Argentinian patients with congenital hemolytic anemia associated with erythrocyte pyruvate kinase deficiency. DESIGN AND METHODS Routine hematologic investigations were performed to rule out other causes of chronic hemolytic anemia. Sanger sequencing and in-sílico analysis were carried out to identify and characterize the genetics variants. RESULTS Six different novel missense variants were detected among the 18 studied alleles: c.661 G > C (Asp221His), c.956 G > T (Gly319Val), c.1595 G > C (Arg532Pro), c.347 G > A (Arg116Gln), c.1232 G > T (Gly411Val), c.1021G > A (Gly341Ser). Structural implications of amino-acid substitutions were correlated with the clinical phenotypes seen in the probands. CONCLUSIONS This is the first comprehensive report on molecular characterization of pyruvate kinase deficiency in Argentina and the second from South America that would contribute to our knowledge on the distribution and frequency of PKLR variants in our population but also offer new insights into the interpretation of the effect of PKLR variants and phenotype.
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Affiliation(s)
- Berenice Milanesio
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Carolina Pepe
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Lucas A Defelipe
- Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina; IQUIBICEN/UBA-CONICET, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Silvia Eandi Eberle
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Vanesa Avalos Gomez
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Alejandro Chaves
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Agustina Albero
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Fernando Aguirre
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Diego Fernandez
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Luciana Aizpurua
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - María Paula Dieuzeide
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Adrián Turjanski
- Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina; IQUIBICEN/UBA-CONICET, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Paola Bianchi
- U.O.C. Ematologia, U.O.S. FisiopatologiadelleAnemie, Fondazione IRCCS Ca Granada, OspedaleMaggiore Policlínico, Milan, Italy
| | - Elisa Fermo
- U.O.C. Ematologia, U.O.S. FisiopatologiadelleAnemie, Fondazione IRCCS Ca Granada, OspedaleMaggiore Policlínico, Milan, Italy
| | - Aurora Feliu-Torres
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina.
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Eandi Eberle S, Pepe C, Chaves A, Aguirre F, Milanesio B, Fernández D, Ávalos Gómez V, Sciuccati G, Díaz LA, Candas A, Cervio C, Bonduel M, Feliu Torres A. Phenotypic and genotypic characterization of glucose-6-phosphate dehydrogenase deficiency in Argentina. Retrospective and descriptive study. ARCH ARGENT PEDIATR 2020; 117:263-270. [PMID: 31339274 DOI: 10.5546/aap.2019.eng.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/05/2018] [Accepted: 02/18/2019] [Indexed: 11/12/2022]
Abstract
Glucose-6-phosphate dehydrogenase deficiency is an erythrocyte enzyme disorder caused by mutations in the G6PD gene, which has an X-linked inheritance. Here we analyze the clinical and laboratory characteristics of 24 subjects with G6PD deficiency over 25 years. Their median age at diagnosis was 10.2 years (range: 0.6-56.4). No symptoms were observed in 54.2 % of patients, whereas 25 % had chronic non-spherocytic hemolytic anemia; 12.5 %, neonatal jaundice and postinfectious hemolytic anemia; and 8.3 %, acute hemolytic anemia after ingestion of fava beans. The 24 studied patients had variants that had been previously described in the bibliography. The clinical characteristics observed here were consistent with the variants found. A total of 21 women from the maternal line of affected subjects were identified as deficiency carriers using molecular biology techniques, so they received the corresponding genetic counseling.
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Chaves A, Eandi Eberle S, Avalos Gomez V, Milanesio B, Fernandez D, Albero A, Aguirre F, Aizpurua L, Dieuzeide MP, Pepe C, Feliu-Torres A. Glucose 6 phosphate dehydrogenase deficiency: Description of a novel and de novo variant associated with chronic nonspherocytic hemolytic anemia. Clin Biochem 2020; 81:63-64. [PMID: 32387441 DOI: 10.1016/j.clinbiochem.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/17/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Alejandro Chaves
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan,", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Silvia Eandi Eberle
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan,", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Vanesa Avalos Gomez
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan,", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Berenice Milanesio
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan,", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Diego Fernandez
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan,", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Agustina Albero
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan,", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Fernando Aguirre
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan,", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Luciana Aizpurua
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan,", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Maria Paula Dieuzeide
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan,", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Carolina Pepe
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan,", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Aurora Feliu-Torres
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan,", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina.
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Eandi Eberle S, Pepe C, Aguirre F, Milanesio B, Fernández D, Ávalos Gómez V, Kinen A, Feliu Torres A. [Hereditary xerocytosis. Presentation of two pediatric cases]. ARCH ARGENT PEDIATR 2019; 117:e684-e687. [PMID: 31758911 DOI: 10.5546/aap.2019.e684] [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: 03/15/2019] [Accepted: 07/11/2019] [Indexed: 11/12/2022]
Abstract
Hereditary xerocytosis is a rare disorder caused by defects of red blood cell permeability that are characterized by hemolytic anemia of variable degree and iron overload. Diagnosis is usually late and confused with other hemolytic anemias, which can lead to procedural indications, such as splenectomy, contraindicated in these patients. We report the clinical, haematological, and molecular characteristics of two patients from two unrelated families affected by hereditary xerocytosis. Both patients had dehydrated erythrocytes with a high concentration of mean corpuscular hemoglobin, non-pathognomonic smears, markers of hemolysis and a resistant osmotic fragility curve. The diagnosis was confirmed by the sequencing of the PIEZO gene. We emphasize the importance of recognizing the cause of hemolytic anemia to give an accurate therapeutic approach and give adequate genetic counseling.
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Affiliation(s)
- Silvia Eandi Eberle
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires
| | - Carolina Pepe
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires
| | - Fernando Aguirre
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires
| | - Berenice Milanesio
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires
| | - Diego Fernández
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires
| | - Vanesa Ávalos Gómez
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires
| | - Analía Kinen
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires
| | - Aurora Feliu Torres
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires.
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Chaves A, Eandi Eberle S, Defelipe L, Pepe C, Milanesio B, Aguirre F, Fernandez D, Turjanski A, Feliú-Torres A. Corrigendum to ‘Two novel DNA variants associated with glucose-6-phosphate dehydrogenase deficiency found in Argentine pediatric patients’ [Clin. Biochem. 49 (2016) 808–810]. Clin Biochem 2018; 58:131. [DOI: 10.1016/j.clinbiochem.2018.06.005] [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: 10/28/2022]
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Chaves A, Eberle SE, Defelipe L, Pepe C, Milanesio B, Aguirre F, Fernandez D, Turjanski A, Feliú-Torres A. Two novel DNA variants associated with glucose-6-phosphate dehydrogenase deficiency found in Argentine pediatric patients. Clin Biochem 2016; 49:808-10. [PMID: 26827633 DOI: 10.1016/j.clinbiochem.2016.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 09/14/2015] [Revised: 01/22/2016] [Accepted: 01/25/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The enzyme glucose-6-phosphate dehydrogenase (G6PD) catalyses the first step in the pentose phosphate pathway, producing nicotinamide adenine dinucleotide phosphate (NADPH). NADPH plays a crucial role in preventing oxidative damage to proteins and other molecules in cells, mostly red blood cells. G6PD deficiency has an x-linked pattern of inheritance in which hemizygous males are deficient, while females may or may not be deficient depending on the number of affected alleles. We report two novel DNA variants in the G6PD gene detected in two male probands with chronic nonspherocytic hemolytic anemia (CNSHA), who were referred for hematological evaluation. METHOD Probands and their relatives underwent clinical, biochemical, and molecular assessment. RESULTS Two novel DNA variants, c.995C>T and c.1226C>A, were found in this study. At the protein level, they produce the substitution of Ser332Phe and Pro409Gln, respectively. These DNA variants were analyzed in the female relatives of probands for genetic counseling. CONCLUSIONS The novel DNA variants were classified as class I based on the clinical, biochemical, and molecular evaluations performed.
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Affiliation(s)
- Alejandro Chaves
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan,", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Silvia Eandi Eberle
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan,", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Lucas Defelipe
- Departamento de Química Biológica, INQUIMAE/UBA-CONICET, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Carolina Pepe
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan,", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Berenice Milanesio
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan,", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Fernando Aguirre
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan,", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Diego Fernandez
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan,", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina
| | - Adrian Turjanski
- Departamento de Química Biológica, INQUIMAE/UBA-CONICET, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Aurora Feliú-Torres
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan,", Combate de los Pozos 1881, (C1245AAM) Buenos Aires, Argentina.
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Felice MS, Rossi JG, Alonso CN, Gallego MS, Eberle SE, Alfaro EM, Guitter MR, Bernasconi AR, Rubio PL, Coccé MC, Zubizarreta PA. Experience with four consecutive BFM-based protocols for treatment of childhood with non-promyelocytic acute myeloblastic leukemia in Argentina. Leuk Lymphoma 2016; 57:2090-9. [DOI: 10.3109/10428194.2015.1131277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Coccé MC, Alonso CN, Rossi JG, Bernasconi AR, Rampazzi MA, Felice MS, Rubio PL, Eandi Eberle S, Medina A, Gallego MS. Cytogenetic and Molecular Findings in Children with Acute Lymphoblastic Leukemia: Experience of a Single Institution in Argentina. Mol Syndromol 2015; 6:193-203. [PMID: 26648836 DOI: 10.1159/000441046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2015] [Indexed: 11/19/2022] Open
Abstract
The purpose of the current study was to evaluate the cytogenetic findings in 1,057 children with acute lymphoblastic leukemia (ALL) referred to the cytogenetics laboratory at the Hospital de Pediatría Dr. Juan P. Garrahan, between 1991 and 2014. Chromosomal abnormalities were evaluated by G-banding and FISH. Since December 2002, RT-PCR determinations were systematically carried out for BCR-ABL1, KMT2A-AFF1, ETV6-RUNX1, and TCF3-PBX1 rearrangements in children, adding KMT2A-MLLT3 and KMT2A-MLLT1 in infants. The percentage of abnormalities detected by cytogenetics was 70.1%. Four novel abnormalities, t(2;8)(p11.2;p22), inv(4)(p16q25), t(1;7)(q25;q32), and t(5;6)(q21;q21), were found in this cohort. We compared cytogenetic and RT-PCR results for BCR-ABL1, KMT2A-AFF1 and TCF3-PBX1 rearrangements in 497 children evaluated by both methods. The results were highly concordant (p < 0.7), and interestingly, FISH was relevant to confirm G-banding findings that were discordant with RT-PCR studies. This study showed the importance of performing G-banding, FISH and RT-PCR simultaneously to improve the detection of chromosomal abnormalities considering their important value in the diagnosis and prognosis of childhood ALL patients. Finally, to the best of our knowledge, this is the first series of cytogenetic findings in children with ALL reported in Argentina.
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Affiliation(s)
- Mariela C Coccé
- Cytogenetics Laboratory, Genetics Department, Hospital de Pediatría 'Prof Dr. Juan P. Garrahan', Buenos Aires, Argentina
| | - Cristina N Alonso
- Department of Hematology and Oncology, Hospital de Pediatría 'Prof Dr. Juan P. Garrahan', Buenos Aires, Argentina
| | - Jorge G Rossi
- Department of Immunology and Rheumatology, Hospital de Pediatría 'Prof Dr. Juan P. Garrahan', Buenos Aires, Argentina
| | - Andrea R Bernasconi
- Department of Immunology and Rheumatology, Hospital de Pediatría 'Prof Dr. Juan P. Garrahan', Buenos Aires, Argentina
| | - Maria A Rampazzi
- Cytogenetics Laboratory, Genetics Department, Hospital de Pediatría 'Prof Dr. Juan P. Garrahan', Buenos Aires, Argentina
| | - Maria S Felice
- Department of Hematology and Oncology, Hospital de Pediatría 'Prof Dr. Juan P. Garrahan', Buenos Aires, Argentina
| | - Patricia L Rubio
- Department of Hematology and Oncology, Hospital de Pediatría 'Prof Dr. Juan P. Garrahan', Buenos Aires, Argentina
| | - Silvia Eandi Eberle
- Department of Hematology and Oncology, Hospital de Pediatría 'Prof Dr. Juan P. Garrahan', Buenos Aires, Argentina
| | - Adriana Medina
- Department of Hematology and Oncology, Hospital de Pediatría 'Prof Dr. Juan P. Garrahan', Buenos Aires, Argentina
| | - Marta S Gallego
- Cytogenetics Laboratory, Genetics Department, Hospital de Pediatría 'Prof Dr. Juan P. Garrahan', Buenos Aires, Argentina
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Eandi Eberle S, Pepe C, Aguirre F, Milanesio B, Fernández D, Mansini A, Chávez A, Sciuccati G, Díaz L, Candás A, Avalos Gómez V, Bonduel M, Feliú Torres A. [Beta thalassemia intermedia: clinical characteristics and molecular analysis. Case series]. ARCH ARGENT PEDIATR 2015; 113:e294-8. [PMID: 26294166 DOI: 10.5546/aap.2015.e294] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 04/22/2015] [Indexed: 11/12/2022]
Abstract
Beta thalassemia intermedia is a quantitative haemoglobinopathy covering a broad clinical spectrum, that results from the presence of one or two HBB gene mutations associated with secondary and/or tertiary genetic modifiers. We analyze the clinical and laboratory features of 29 patients with beta thalassemia intermedia, assessed over a period of 23 years. Median age was 10.8 years (range: 0.34-60.4). Hypochromic microcytic anemia was seen in 100% of the patients, while only 17.2% had splenomegaly and occasional transfusion requirement. The molecular analysis of patients detected: 3 with two HBB affected genes; 2 with one HBB affected gene and alpha quadruplicate/triplicate genes; 23 with one HBB affected gene and alpha triplicate genes and 1 with two HBB affected genes and polymorphisms of gamma genes. The adequate identification of these patients enables us to give appropriate genetic counseling and implementation of regular clinical follow up.
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Affiliation(s)
- Silvia Eandi Eberle
- Servicio de Hematología y Oncología, Hospital de Pediatría Prof. Dr. J. P. Garrahan
| | - Carolina Pepe
- Servicio de Hematología y Oncología, Hospital de Pediatría Prof. Dr. J. P. Garrahan
| | - Fernando Aguirre
- Servicio de Hematología y Oncología, Hospital de Pediatría Prof. Dr. J. P. Garrahan
| | - Berenice Milanesio
- Servicio de Hematología y Oncología, Hospital de Pediatría Prof. Dr. J. P. Garrahan
| | - Diego Fernández
- Servicio de Hematología y Oncología, Hospital de Pediatría Prof. Dr. J. P. Garrahan
| | - Adrián Mansini
- Servicio de Hematología y Oncología, Hospital de Pediatría Prof. Dr. J. P. Garrahan
| | - Alejandro Chávez
- Servicio de Hematología y Oncología, Hospital de Pediatría Prof. Dr. J. P. Garrahan
| | - Gabriela Sciuccati
- Servicio de Hematología y Oncología, Hospital de Pediatría Prof. Dr. J. P. Garrahan
| | - Lilian Díaz
- Servicio de Hematología y Oncología, Hospital de Pediatría Prof. Dr. J. P. Garrahan
| | - Andrea Candás
- Servicio de Hematología y Oncología, Hospital de Pediatría Prof. Dr. J. P. Garrahan
| | - Vanesa Avalos Gómez
- Servicio de Hematología y Oncología, Hospital de Pediatría Prof. Dr. J. P. Garrahan
| | - Mariana Bonduel
- Servicio de Hematología y Oncología, Hospital de Pediatría Prof. Dr. J. P. Garrahan
| | - Aurora Feliú Torres
- Servicio de Hematología y Oncología, Hospital de Pediatría Prof. Dr. J. P. Garrahan
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12
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Mansini AP, Fernández DA, Aguirre FM, Pepe C, Milanesio B, Chaves A, Eandi Eberle S, Feliú Torres A. [Hemoglobin Woodville associated with double point mutation in the gene of glucose-6-phosphate dehydrogenase]. Medicina (B Aires) 2015; 75:404-406. [PMID: 26707665] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
The co-inheritance of erythrocyte defects, hemoglobinopathies, enzymopathies, and membranopathies is not an unusual event. For the diagnosis, a laboratory strategy, including screening and confirmatory tests, additional to molecular characterization, was designed. As the result of this approach, a 24-year-old man carrying a hemoglobinopathy (Hemoglobin Woodville) and an enzymopathy (glucose-6-phosphate dehydrogenase deficiency) was identified. In the heterozygous state hemoglobin Woodville, is asymptomatic, and homozygous or double heterozygous individuals have not been reported thus far. On the other hand, previously described double point mutation in the gene for glucose-6-phosphate dehydrogenase c. [202G>A; 376A>G], p. [Val 68Met; Asn126Asp], causes hemolysis of varying severity after food or drug intake or infections. This case highlights the importance of the methodology carried out for the diagnosis, treatment, and proper genetic counseling.
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Affiliation(s)
- Adrián P Mansini
- Servicio de Hematología-Oncología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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13
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Pepe C, Eberle SE, Chaves A, Milanesio B, Aguirre FM, Gómez VA, Diaz L, Mansini AP, Fernandez DA, Sciuccati G, Candas A, Cervio C, Bonduel M, Feliú-Torres A. A new β(0) frameshift mutation, HBB: c.44delT (p.Leu14ArgfsX5), identified in an Argentinean family associated with secondary genetic modifiers of β-thalassemia. Hemoglobin 2014; 38:444-6. [PMID: 25268796 DOI: 10.3109/03630269.2014.964361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/13/2022]
Abstract
β-Thalassemia intermedia (β-TI) patients present with a wide spectrum of phenotypes depending on the presence of primary, secondary, and tertiary genetic modifiers which modulate, by different mechanisms, the degree of imbalance between α and β chains. Here we describe a new β(0) frameshift mutation, HBB: c.44delT (p.Leu14ArgfsX5), identified in four members of a family, associated with secondary genetic modifiers in three of them. The different genotype present in this family was suspected after hematological analysis and thorough observation of blood smears highlighting their importance in the identification of β-TI patients among members of the same family.
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Affiliation(s)
- Carolina Pepe
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" , Buenos Aires , Argentina
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14
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Rossi JG, Bernasconi AR, Alonso CN, Rubio PL, Gallego MS, Carrara CA, Guitter MR, Eberle SE, Cocce M, Zubizarreta PA, Felice MS. Lineage switch in childhood acute leukemia: an unusual event with poor outcome. Am J Hematol 2012; 87:890-7. [PMID: 22685031 DOI: 10.1002/ajh.23266] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 05/03/2012] [Accepted: 05/07/2012] [Indexed: 11/06/2022]
Abstract
Although rarely, switches between lymphoid and myeloid lineages may occur during treatment of acute leukemias (AL). Correct diagnosis relies upon confirmation by immunophenotyping of the lineage conversion and certification that the same cytogenetic/molecular alterations remain despite the phenotypic changes. From a total of 1,482 AL pediatric patients, we report nine cases of lineage conversion (0.6%), seven from lymphoid (four Pro-B, two Pre-B, one Common) to myelo-monocytic, and two from myeloid (bilineal, with myeloid predominance) to Pro-B. Eight patients were infants. Switches were suggested by morphology and confirmed with a median of 15 days (range: 8 days-6 months) from initiation of therapy. Of note, in five cases switches occurred before day 15. Stability of the clonal abnormalities was assessed by cytogenetic, RT-PCR/Ig-TCR rearrangement studies in all patients. Abnormalities in 11q23/MLL gene were detected in seven cases. Treatment schedules were ALL (two pts), Interfant-99 (five pts) and AML (two pts) protocols. Despite changing chemotherapy according to the new lineage, all patients died. Our findings support the association of lineage switches with MLL gene alterations and the involvement of a common lymphoid B-myeloid precursor. New therapies should be designed to address these rare cases. Possible mechanisms implicated are discussed.
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MESH Headings
- Adolescent
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cell Lineage/genetics
- Child
- Child, Preschool
- Chromosomes, Human, Pair 11/genetics
- Cytogenetic Analysis
- Gene Rearrangement, T-Lymphocyte/genetics
- Histocytochemistry
- Histone-Lysine N-Methyltransferase
- Humans
- Immunophenotyping
- Infant
- Infant, Newborn
- Leukemia, Monocytic, Acute/drug therapy
- Leukemia, Monocytic, Acute/genetics
- Leukemia, Monocytic, Acute/mortality
- Leukemia, Monocytic, Acute/pathology
- Myeloid-Lymphoid Leukemia Protein/genetics
- Oncogene Proteins, Fusion/genetics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Reverse Transcriptase Polymerase Chain Reaction
- Translocation, Genetic
- Treatment Outcome
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Affiliation(s)
- Jorge G Rossi
- Immunology and Rheumatology Department, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Argentina.
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15
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Eandi Eberle S, García Rosolen N, Urtasun C, Sciuccati G, Díaz L, Savietto V, Candás A, Avalos Gómez V, Cervio C, Bonduel M, Feliú Torres A. [Glucose 6 phosphate dehydrogenase deficiency: a case series]. ARCH ARGENT PEDIATR 2012. [PMID: 21829878 DOI: 10.1590/s0325-00752011000400012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We describe the laboratory and clinical characteristics of 50 patients with glucose 6 phosphate dehydrogenase deficiency (G6PD). G6PD deficiency represented 1.1% of all the diagnosis made. Coexistence of G6PD with other erythropathy was detected as follow: G6PG/HbS 2 patients and G6PG/hereditary spherocytosis 1 patient. A positive Brewer's test was found in 100% of males but in only 56% of women. Males had a mean enzymatic activity (MEA) of 0.85 ± 0.52 U/g Hb. Women, with positive Brewer's test, showed a MEA of 3.82 ± 1.26 U/g Hb, while the MEA of women with negative Brewer's test was 5.65 ± 2.84 U/g Hb. Genetic counseling and the list of food and drugs potentially harmful was given to all patients. The inclusion of simple screening tests, such as Brewer's test, in the study of anemia, enables us to detect asymptomatic males and carriers in whom this enzymopathy was co-inherited with another erythropathy.
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Affiliation(s)
- Silvia Eandi Eberle
- Servicio de Hematología-Oncología, Hospital Nacional de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
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16
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Feliu-Torres A, Eberle SE, Bragós IM, Sciuccati G, Ojeda MJ, Calvo KL, Voss ME, Pratti AF, Milani AC, Bonduel M, Díaz L, Noguera NI. Hb S-San Martin: a new sickling hemoglobin with two amino acid substitutions [β6(A3)Glu→Val;β105(G7)Leu→Pro] in an Argentinean family. Hemoglobin 2011; 34:500-4. [PMID: 20854125 DOI: 10.3109/03630269.2010.513646] [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
A new sickling hemoglobin (Hb) detected in an Argentinean family from San Martín, Buenos Aires, Argentina, is hereby described. Two mutations were identified on the same β-globin gene resulting in a new variant named Hb San Martin. One mutation was found on exon 1, corresponding to Hb S [β6Glu→Val, GAG>GTG] and the second one on exon 3 at β105(G7)Leu→Pro, CTC>CCC. The replacement of leucine by proline will likely impair the structure breaking helix G and causing instability of the molecule and the clinical manifestations typical of unstable Hbs. The mutation at β105 seemed to be a de novo one in our patients, arising on a previously mutated gene, due to the fact that Hb S is the most frequent structural variant.
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Affiliation(s)
- Aurora Feliu-Torres
- Servicio de Hematología-Oncología, Hospital Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
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17
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Feliu-Torres A, Eberle SE, Roldán A, González S, Sciuccati G. Hb Johnstown [β109(G11)Val→Leu]: a High Oxygen Affinity Variant Associated with β0‐Thalassemia. Hemoglobin 2009; 28:335-8. [PMID: 15658189 DOI: 10.1081/hem-200037799] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Hb Johnstown [beta109(G11)Val-->Leu], a high oxygen affinity hemoglobin (Hb) variant associated with beta0-thalassemia (thal) [IVS-I-1 (G-->A)], was identified in an 8-year-old girl referred to our laboratory because of erythrocytosis and a left-shifted oxygen dissociation curve (ODC). The phylogenetic tree showed that the mother was heterozygous for the Hb variant and the father was a beta0-thal carrier. This Hb variant, with normal electrophoresis, was characterized at the DNA level by beta gene sequencing. The amino acid substitution potentially disrupts alpha1beta1 contacts i n the deoxyHb conformation, thus shifting the equilibrium towards the high affinity oxyHb conformation. The erythrocytosis and low values for actual P50 due to Hb Johnstown were more marked due to the co-inheritance of the beta0-thal.
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Affiliation(s)
- Aurora Feliu-Torres
- Servicio de Hematología-Oncología, Hospital de Pediatría Professor Dr Juan P Garrahan, Buenos Aires, Argentina.
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18
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Eandi Eberle S, Noguera NI, Sciuccati G, Bonduel M, Díaz L, Staciuk R, Feliu-Torres A. Hb Southampton [β106(G8)Leu→Pro, CTG→CCG] in an Argentinean Boy. Hemoglobin 2009; 30:401-3. [PMID: 16840233 DOI: 10.1080/03630260600755930] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Hb Southampton (also known as Hb Casper) is characterized by the substitution of a leucine residue for a proline at codon beta106 (CTG-->CCG). This mutation breaks the G helix and severely distorts the tertiary structure of the molecule, producing an unstable hemoglobin (Hb) and severe hemolysis. We identified this hemoglobinopathy in a young patient with severe hemolytic anemia and hepatosplenomegaly.
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Affiliation(s)
- Silvia Eandi Eberle
- Servicio de Hematología-Oncología, Hospital de Pediatría, Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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19
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Eberle SE, Noguera NI, Sciuccati G, Bonduel M, Díaz L, Staciuk R, Targovnik HM, Feliu-Torres A. Hb Alesha [beta67(E11)Val-->Met, GTG-->ATG] in an Argentinean girl. Hemoglobin 2007; 31:379-82. [PMID: 17654076 DOI: 10.1080/03630260701459408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Hb Alesha is caused by a GTG-->ATG mutation at codon 67 of the beta-globin gene, resulting in abnormal beta-globin chains in which the normal beta67(E11) valine is changed to methionine. This hemoglobin (Hb) is also known as Hb Bristol, the first unstable Hb described, since in a fraction of the variant the methionine is modified into an aspartic acid by a posttranslational modification. This replacement disrupts the apolar bonds between the valine and the heme group, producing an unstable Hb and severe hemolysis. We have identified this rare hemoglobinopathy in an Argentinean girl with severe hemolytic anemia, splenomegaly and frequent requirement for red blood cell transfusions.
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Affiliation(s)
- Silvia Eandi Eberle
- Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan. P. Garrahan", Buenos Aires, Argentina
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20
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Eberle SE, Sciuccati G, Bonduel M, Díaz L, Staciuk R, Torres AF. [Erythrocyte indexes in hereditary spherocytosis]. Medicina (B Aires) 2007; 67:698-700. [PMID: 18422060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Hereditary spherocytosis is a group of heterogenous disorders characterized by variability in its clinical manifestations, membrane protein defects and inheritance. We analysed the sensitivity and specificity of mean corpuscular hemoglobin concentration (MCHC) and red cell distribution width (RDW) in the diagnostic screening of hereditary spherocytosis. Ninety-four patients were compared to equal number of healthy, age-matched children. All indexes were derived from measurements obtained by aperture impedance (Coulter Counter Model JT). In patients with hereditary spherocytosis, MCHC (35.67+/-1.33 g/dl) and RDW (20.60+/-4.5%) were significantly higher than in normal control subjects (MCHC 33.48+/-0.68 g/dl, p: 0.000; RDW 13.22+/-0.9%, p: 0.000). By using a cutoff for the MCHC of 34.5 g/dl and for the RDW of 14.5%, both indexes showed a sensitivity of 81% and a specificity of 98.9%. The combination of the two test is an excellent predictor for the diagnosis of hereditary spherocytosis.
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Affiliation(s)
- Silvia Eandi Eberle
- Servicio de Hematología-Oncología, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
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21
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Torres AF, Eberle SE, Sciuccati G, Bonduel M. [Effect of hydroxyurea on hemoglobin S]. Medicina (B Aires) 2003; 63:140-2. [PMID: 12793083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Previous studies have determined the laboratory alterations, clinical efficacy and toxicity profile associated with hydroxyurea (HU) therapy in patients with severe sickle cell anemia. We report the efficacy of HU treatment in the prevention of vaso-occlusive crises in an 11-years-old boy with severe sickle cell disease. The number of vaso-occlusive crises, hospital days and blood transfusions in the year before HU treatment were compared with the same parameters at 6, 12, 24, 36 and 72 months of treatment. A decrease in the frequency of vaso-occlusive crises, blood transfusions and days spent in hospital were demonstrated during the HU treatment period compared to the same period before hand. The clinical and laboratory response to HU was dramatic in this severely affected patient, allowing him a normal schooling and social life. The adverse effects observed were not serious and reversed after transient discontinuation of HU. We conclude that long-term chronic treatment with HU for seriously ill sickle cell patients appears feasible, and devoid of any major toxicity.
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Affiliation(s)
- Aurora Felíu Torres
- Servicio de Hematología-Oncología, Hospital de Pediatría Juan P. Garrahan, Combate de los Pozos 1881, 1245 Buenos Aires, Argentina.
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