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Zhang Y, Xie H, Liang G, Qin Y, Wei X, Ning S, Liang Y, Liang X, Xie Y, Lin Z, Zhu D, Lin J, Xiong F, Xu X, Shang X. A novel gain-of-function PIP4K2A mutation elevates the expression of β-globin and aggravates the severity of α-thalassemia. Br J Haematol 2023; 202:1018-1023. [PMID: 37423903 DOI: 10.1111/bjh.18967] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 03/22/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
Haemoglobin H (Hb H) disease (intermediate status of α-thalassemia) shows marked phenotypic variability from asymptomatic to severe anaemia. Apart from the combined β-thalassemia allele ameliorating clinical severity, reports of genetic modifier genes affecting the phenotype of Hb H disease are scarce which bring inconvenience to precise diagnosis and genetic counselling of the patients. Here, we present a novel mutation (c.948C>A, p.S316R) in the PIP4K2A gene in a female Hb H disease patient who displayed moderate anaemia and a relatively high Hb H level. Haematological analysis in her family members revealed that individuals carrying this mutation have upregulated β-globin expression, leading to a more imbalanced β/α-globin ratio and more Hb H inclusion bodies in peripheral red blood cells. According to functional experiments, the mutant PIP4K2A protein exhibits enhanced protein stability, increased kinase activity and a stronger regulatory effect on downstream proteins, suggesting a gain-of-function mutation. Moreover, introduction of the S316R mutation into HUDEP-2 cells increased expression of β-globin, further inhibiting erythroid differentiation and terminal enucleation. Thus, the S316R mutation is a novel genetic factor associated with β-globin expression, and the PIP4K2A gene is a new potential modifier gene affecting the α-thalassemia phenotype.
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Affiliation(s)
- Yanxia Zhang
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Hongting Xie
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Guanxia Liang
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yunrong Qin
- Department of Clinical Laboratory, Yulin Women and Children Health Care Hospital, Yulin, China
| | - Xiaofeng Wei
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Sisi Ning
- Department of Clinical Laboratory, Yulin Women and Children Health Care Hospital, Yulin, China
| | - Yi Liang
- Department of Clinical Laboratory, Yulin Women and Children Health Care Hospital, Yulin, China
| | - Xiongda Liang
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yuling Xie
- Department of Clinical Laboratory, Yulin Women and Children Health Care Hospital, Yulin, China
| | - Zezhang Lin
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Dina Zhu
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Jiaqiong Lin
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Fu Xiong
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Xiangming Xu
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Innovation Center for Diagnostics and Treatment of Thalassemia, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xuan Shang
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Innovation Center for Diagnostics and Treatment of Thalassemia, Nanfang Hospital, Southern Medical University, Guangzhou, China
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2
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Qiu Y, Wei S, Hou W, Lai K, Zhu H, Li W, Li Q, Yang Z, Shu Q, Chen P, Mo W. Molecular Basis and Hematologic Phenotype of Hemoglobin H Disease Combined with Two Rare β-Globin Mutations. Hemoglobin 2023:1-4. [PMID: 37309066 DOI: 10.1080/03630269.2023.2219008] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In area where α-thalassemia and β-thalassemia are prevalent, the coinheritance of hemoglobin H disease (Hb H disease) and β-thalassemia are not uncommon and could result in complex thalassemia intermedia syndromes. In this study, we investigate the hematological and molecular characteristics of two previously undescribed cases that co-inherited Hb H disease and rare β-globin gene (HBB) mutations found in Chinese populations. Proband I was a boy with Hb H disease in association with IVS-II-5(G > C) (HBB:c0.315 + 5G > C) mutation. Proband II was a boy with a combination of Hb H and Hb Zengcheng [β114(G16) Leu > Met; HBB:c.343C > A]. Both of them had mild hypochromic microcytic anemia, and neither had ever received a blood transfusion. In both cases, the level of Hb A2 was within normal range, and no Hb H was detected, but a small amount of Hb Bart's was observed in proband I. Routine DNA analysis detected the deletional Hb H disease in both cases. IVS-II-5(G > C) (HBB:c0.315 + 5G > C) and Hb Zengcheng (HBB:c.343C > A) mutations were found by DNA sequencing of β-globin gene. The co-inheritance of Hb H disease with rare β-thalassemia may result in an atypical pattern of Hb H disease, and further investigation of rare genotypes should be conducted to avoid missed diagnosis.
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Affiliation(s)
- Yuling Qiu
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Thalassemia Research, Guangxi Medical University, Nanning, China
- NHC Key Laboratory of Thalassemia Medicine, Guangxi Medical University, Nanning, China
| | - Shilu Wei
- Guangxi Key Laboratory of Thalassemia Research, Guangxi Medical University, Nanning, China
- NHC Key Laboratory of Thalassemia Medicine, Guangxi Medical University, Nanning, China
| | - Wei Hou
- Guangxi Key Laboratory of Thalassemia Research, Guangxi Medical University, Nanning, China
- NHC Key Laboratory of Thalassemia Medicine, Guangxi Medical University, Nanning, China
| | - Ketong Lai
- Guangxi Key Laboratory of Thalassemia Research, Guangxi Medical University, Nanning, China
- NHC Key Laboratory of Thalassemia Medicine, Guangxi Medical University, Nanning, China
| | - Hengying Zhu
- Guangxi Key Laboratory of Thalassemia Research, Guangxi Medical University, Nanning, China
- NHC Key Laboratory of Thalassemia Medicine, Guangxi Medical University, Nanning, China
| | - Wenwei Li
- Guangxi Key Laboratory of Thalassemia Research, Guangxi Medical University, Nanning, China
- NHC Key Laboratory of Thalassemia Medicine, Guangxi Medical University, Nanning, China
| | - Qi Li
- Guangxi Key Laboratory of Thalassemia Research, Guangxi Medical University, Nanning, China
- NHC Key Laboratory of Thalassemia Medicine, Guangxi Medical University, Nanning, China
| | - Zheng Yang
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qisheng Shu
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ping Chen
- Guangxi Key Laboratory of Thalassemia Research, Guangxi Medical University, Nanning, China
- NHC Key Laboratory of Thalassemia Medicine, Guangxi Medical University, Nanning, China
| | - Wuning Mo
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Wu SM, Huang SR, Li C, Chen GL, Li DZ. Severe Hb H Disease Caused by Hb Zürich-Albisrieden ( HBA1: c.178G>C): Another Case Report. Hemoglobin 2022; 46:341-343. [PMID: 36815319 DOI: 10.1080/03630269.2023.2165444] [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] [Indexed: 02/24/2023]
Abstract
Hb Zürich-Albisrieden, [α59(E8)Gly→Arg, HBA1: c.178G>C] is a rare and highly unstable α-globin chain variant. The involved mutation has been reported in both HBA1 and HBA2 genes. A few compound heterozygotes of Hb Zürich-Albisrieden and α0-thalassemia have shown that this variant is associated with severe Hb H disease. We describe here another case of Hb Zürich-Albisrieden who presented with transfusion-dependent anemia beginning shortly after birth.
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Affiliation(s)
- Shao-Min Wu
- Prenatal Diagnosis Center, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong Province, People's Republic of China
| | - Su-Ran Huang
- Prenatal Diagnosis Center, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong Province, People's Republic of China
| | - Chan Li
- Prenatal Diagnosis Center, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong Province, People's Republic of China
| | - Gui-Lan Chen
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Dong-Zhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
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Guan ZY, Zhong ZY, Xu ZB, Chen JH, Liu YH. A Case of Misdiagnosis Caused by the Coinheritance of Hb G-Siriraj [β7(A4)Glu→Lys; HBB: c.22G>A] and Hb H Disease. Hemoglobin 2022; 46:338-340. [PMID: 36691989 DOI: 10.1080/03630269.2022.2158098] [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] [Indexed: 01/25/2023]
Abstract
Despite the fact that most hemoglobin (Hb) variants are clinically and hematologically silent, they can interact with thalassemias, which could sometimes give rise to complicated routine thalassemia diagnostics. Hb G-Siriraj [β7(A4)Glu→Lys; HBB: c.22G>A] alone is a benign condition, but its coinheritance with α-thalassemia (α-thal) may lead to misdiagnosis. We describe the case of a Chinese woman with an elevated Hb A2 level who was assumed to carry heterozygous β-thalassemia (β-thal), but was later shown to be a double heterozygote for Hb G-Siriraj and Hb H disease. This study for the first time described hematological characteristics of a patient with a double heterozygosity for Hb G-Siriraj and Hb H disease. It is of great significance for technicians and clinicians to expand their knowledge as well as to help guide clinical diagnosis, population screening and genetic counseling.
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Affiliation(s)
- Zhi-Yang Guan
- The First Clinical Medical College, Guangdong Medical University, Zhanjiang, Guangdong, People's Republic of China.,Department of Medical Genetics and Prenatal Diagnosis, Huizhou First Maternal and Child Health Care Hospital, Huizhou, People's Republic of China
| | - Ze-Yan Zhong
- Department of Medical Genetics and Prenatal Diagnosis, Huizhou First Maternal and Child Health Care Hospital, Huizhou, People's Republic of China
| | - Zhi-Bang Xu
- Department of Medical Genetics and Prenatal Diagnosis, Huizhou First Maternal and Child Health Care Hospital, Huizhou, People's Republic of China
| | - Jian-Hong Chen
- Department of Medical Genetics and Prenatal Diagnosis, Huizhou First Maternal and Child Health Care Hospital, Huizhou, People's Republic of China
| | - Yan-Hui Liu
- The First Clinical Medical College, Guangdong Medical University, Zhanjiang, Guangdong, People's Republic of China.,Department of Prenatal Diagnosis Center, Affiliated Dongguan Maternal and Child Health Care Hospital, Southern Medical University, Guangdong, People's Republic of China
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5
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Li Y, Liang L, Qin T, Tian M. Detection of hemoglobin H disease by long molecule sequencing. J Clin Lab Anal 2022; 36:e24687. [PMID: 36059093 PMCID: PMC9550979 DOI: 10.1002/jcla.24687] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/20/2022] [Accepted: 08/24/2022] [Indexed: 11/11/2022] Open
Abstract
Background Hemoglobin H (Hb H) disease is a moderate‐to‐severe form of α‐thalassemia (α‐thal), and parts of patients may require intermittent transfusion therapy, especially during intercurrent illness. However, rare Hb H diseases remain undetected using routine methods being outside of the testing scope. In this study, we present an approach to detecting Hb H disease by long molecule sequencing (LMS). Methods A total of 206 known genotype samples were collected and carried to blind detected by LMS on the PacBio Sequel platform. Circular consensus sequencing reads were aligned to the hg19 reference genome using Free‐Bayes finished LMS. LMS accuracy would be compared with routine methods, including Gap‐PCR and PCR‐Reverse dot blot hybridization (PCR–RDB). Results The assay could detect carriers of both deletion and point mutations. It had an overall accuracy of 100% when compared with routine methods. In addition, LMS detected six mutations based on routine methods and corrected three case results. Hb H diseases were identified using LMS, whether a common or rare genotype, a deletion or non‐deletion genotype. However, two cases of Hb H disease were misdiagnosed using routine methods. Conclusions Long molecule sequencing can be suggested as a rapid and reliable assay to detect probable carriers of hemoglobinopathies. LMS accurately identified the common and rare genotypes of Hb H disease.
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Affiliation(s)
- Youqiong Li
- Center for Medical Genetics and Prenatal Diagnosis, People Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Liang Liang
- Center for Medical Genetics and Prenatal Diagnosis, People Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Ting Qin
- Center for Medical Genetics and Prenatal Diagnosis, People Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Mao Tian
- Center for Medical Genetics and Prenatal Diagnosis, People Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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Ren ZM, Xing ZH, Chen SL, Fu XY, Chen YS, Li DF. Identification of a Novel Hb H Disease with Glucose-6-Phosphate Dehydrogenase Deficiency Using Whole Genome Sequencing. Hemoglobin 2022; 46:160-163. [PMID: 35582759 DOI: 10.1080/03630269.2022.2070072] [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] [Indexed: 11/04/2022]
Abstract
With the development of sequencing technology, more and more rare thalassemia types have been found. In this article, we found a novel Hb H disease combined with glucose-6-phosphate dehydrogenase (G6PD) deficiency through whole genome sequencing (WGS), which was verified by Sanger sequencing and polymerase chain reaction (PCR)-reverse dot-blot hybridization, respectively.
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Affiliation(s)
- Zhen-Min Ren
- Department of Laboratory Medicine, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, People's Republic of China
| | - Zhi-Hao Xing
- Department of Laboratory Medicine, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, People's Republic of China
| | - Shi-Lin Chen
- Aegicare Technology Co. Ltd., Shenzhen, Guangdong Province, People's Republic of China
| | - Xiao-Ying Fu
- Department of Laboratory Medicine, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, People's Republic of China
| | - Yun-Sheng Chen
- Department of Laboratory Medicine, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, People's Republic of China
| | - De-Fa Li
- Department of Laboratory Medicine, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, People's Republic of China
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Gao W, Jin Y, Huang Y, Tang H. Discordantly high HbA1c may assist in diagnosing α-thalassemia but not diabetes: A case report. J Diabetes Investig 2022; 13:1633-1635. [PMID: 35474445 PMCID: PMC9434564 DOI: 10.1111/jdi.13820] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 02/05/2023] Open
Abstract
Glycated hemoglobin (HbA1c) is an important method for monitoring blood glucose and diagnosing diabetes. High‐performance liquid chromatography is more commonly used in the laboratory for the detection of HbA1c. Although HbA1c detected by high‐performance liquid chromatography is susceptible to abnormal hemoglobin, there are few reports that it is affected by α‐thalassemia. Previous reports have generally concluded that α‐thalassemia does not affect or lower HbA1c. Here, we report a case of discordantly high HbA1c inconsistent with fasting blood glucose. Finally, the patient was diagnosed with α‐thalassemia and insulin resistance. α‐Thalassemia might lead to a discordantly high HbA1c result, which could be attributed to elevated hemoglobin H. In this case, glycated albumin might accurately reflect the real average level of blood glucose. When finding discordant HbA1c, patients should be advised to undergo thalassemia and hemoglobinopathy screening by diabetologists/endocrinologists or primary care physicians to avoid a missed diagnosis of hematopathy.
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Affiliation(s)
- Wei Gao
- Health Management Center, West China Hospital, Sichuan University, Chengdu, 610041, P.R. China
| | - Yanwen Jin
- Biliary surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R. China
| | - Yan Huang
- Health Management Center, West China Hospital, Sichuan University, Chengdu, 610041, P.R. China
| | - Huairong Tang
- Health Management Center, West China Hospital, Sichuan University, Chengdu, 610041, P.R. China
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Singha K, Sanchaisuriya K, Fucharoen G, Fucharoen S. Genetic and non-genetic factors affecting hemoglobin A 2 expression in a large cohort of Thai individuals: implication for population screening for thalassemia. Am J Transl Res 2021; 13:11632-11642. [PMID: 34786089 PMCID: PMC8581855] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Increased hemoglobin (Hb) A2 level is an important diagnostic marker for β-thalassemia carrier screening. The level of Hb A2 is also useful for differentiating several thalassemia syndromes. We have examined data bases for reduced Hb A2 expression in a large cohort of Thai subjects. METHODS A study was done on 1,498 subjects with non-thalassemia and various types of thalassemia and Hb variants to determine the effect of thalassemia genotypes and on 103 women of reproductive age to determine the effect of iron deficiency. Hb analysis was done using capillary electrophoresis, and thalassemia genotypes were defined by DNA analysis. Serum ferritin was measured using chemiluminescent microparticle immunoassay. RESULTS Subjects were divided into 35 groups based on iron status, Hb, and DNA analysis. Decreased Hb A2 level was observed in those with Hb Q-Thailand, δ-hemoglobinopathies, δβ0-thalassemia, Hb Lepore, iron deficiency, α-thalassemia, and especially Hb Constant Spring (Hb CS). While β-thalassemia carriers with Hb H disease still had elevated Hb A2 levels, most of the β-thalassemia carriers with Hb H-CS disease had Hb A2 less than 3.5% as a diagnostic cut-off. The lowest Hb A2 level was observed in those with Hb H-CS disease. CONCLUSION Iron deficiency, Hb CS trait, homozygous Hb CS, and Hb H disease may reduce Hb A2 level, leading possibly to misdiagnosis of β-thalassemia, especially in carriers with borderline Hb A2. Hb CS showed the strongest effect on Hb A2 expression. Understanding the basis for reduced Hb A2 expression may help reduce the diagnostic pitfalls of β-thalassemia in the region.
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Affiliation(s)
- Kritsada Singha
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen UniversityThailand
- Faculty of Medicine, Mahasarakham UniversityThailand
| | - Kanokwan Sanchaisuriya
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen UniversityThailand
| | - Goonnapa Fucharoen
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen UniversityThailand
| | - Supan Fucharoen
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen UniversityThailand
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9
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Guan ZY, Zhong ZY, He HL, Chen D, Zhong GX, Yang KX, Chen JH. Genetic counseling and prenatal decision for hemoglobin H disease caused by the rare α2 codon 30 (-GAG) (HBA2: c.91_93delGAG) mutation and the SEA deletion: Case series study. Taiwan J Obstet Gynecol 2021; 60:763-765. [PMID: 34247821 DOI: 10.1016/j.tjog.2021.05.031] [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] [Accepted: 02/08/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We report a rare mutation on the α2-globin gene, HBA2: c.91_93delGAG and its potential functions. CASE REPORT We mainly described four patients with hemoglobin (Hb) H disease caused by the rare mutation and the SEA deletion but diversity in clinical presentation. Two had survived to adulthood with normal physical and mental development, except for mild anemia. However, two were children, who had more severe clinical manifestations. One child had developmental disorders of speech and language and mild growth retardation, and the other child suffered from severe hemolytic crises precipitated by infection and received blood transfusion. CONCLUSION This study is of great significance for clinicians to provide genetic counseling to couples at-risk of having offspring with Hb H disease and let them make the pregnancy decision, particularly reduce the occurrence of severe Hb H disease.
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Affiliation(s)
- Zhi-Yang Guan
- Prenatal Diagnosis Center, The First Women and Children's Hospital of Huizhou, Huizhou, Guangdong Province, China
| | - Ze-Yan Zhong
- Prenatal Diagnosis Center, The First Women and Children's Hospital of Huizhou, Huizhou, Guangdong Province, China
| | - Hai-Lin He
- Prenatal Diagnosis Center, The First Women and Children's Hospital of Huizhou, Huizhou, Guangdong Province, China
| | - Dan Chen
- Prenatal Diagnosis Center, The First Women and Children's Hospital of Huizhou, Huizhou, Guangdong Province, China
| | - Guo-Xing Zhong
- Prenatal Diagnosis Center, The First Women and Children's Hospital of Huizhou, Huizhou, Guangdong Province, China
| | - Kun-Xiang Yang
- Prenatal Diagnosis Center, The First Women and Children's Hospital of Huizhou, Huizhou, Guangdong Province, China
| | - Jian-Hong Chen
- Prenatal Diagnosis Center, The First Women and Children's Hospital of Huizhou, Huizhou, Guangdong Province, China.
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Ruengdit C, Khamphikham P, Jinorose N, Pornprasert S. Hb Bart's Hydrops Fetalis Syndrome and Hb H Disease Caused by Deletional Chiang Rai (- - CR) α 0-Thalassemia in Two Unrelated Thai Families. Hemoglobin 2021; 45:75-79. [PMID: 33821735 DOI: 10.1080/03630269.2021.1906269] [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] [Indexed: 10/21/2022]
Abstract
α0-Thalassemia (α0-thal) Chiang Rai (- -CR; NC_000016.10: g.144215_188843del) was identified as a novel 44.6 kb deletional type of α-thalassemia (α-thal), removing all α-like globin genes. However, little is known about the deleterious effects of this genetic disorder, particularly when it is combined with other types of thalassemia. We performed molecular analysis of the - -CR deletion using gap-polymerase chain reaction (gap-PCR) in two independent families residing in Phayao and Chiang Mai, Thailand, with an unknown causative mutation for Hb Bart's hydrops fetalis syndrome and Hb H disease. Five out of seven individuals were diagnosed to be heterozygous for the - -CR deletion. Of these, two also carried Hb H disease with compound heterozygosities for - -CR and -α3.7 (rightward) deletions. However, hematological parameters of the - -CR carriers displayed microcytic hypochromic anemia that is comparable to other α0-thal traits. Although the prevalence of - -CR has never been elucidated in a specific population, our study demonstrated that genotyping for - -CR might be considered as an additional investigation for unexplained Hb Bart's hydrops fetal syndrome and Hb H disease.
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Affiliation(s)
- Chedtapak Ruengdit
- Division of Clinical Microscopy, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Pinyaphat Khamphikham
- Division of Clinical Microscopy, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | - Sakorn Pornprasert
- Division of Clinical Microscopy, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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Abstract
Anemia is common in patients with systemic lupus erythematosus (SLE). The association between thalassemia and SLE is rare. In this study, we report the first patient who was found to have a severe hemolytic anemia caused by combination of SLE and Hb H disease. The patient had a more severe presentation in the hematological system. Our case indicates that for a patient who was diagnosed with SLE and developed deterioration in her hematological cell lines, investigation of other possible coexisting causes would be warranted.
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Affiliation(s)
- Qi-Yin Lin
- Thalassemia Diagnostic Laboratory, Department of Fetal Medicine and Prenatal Diagnosis, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Di-Yu Chen
- Thalassemia Diagnostic Laboratory, Department of Fetal Medicine and Prenatal Diagnosis, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Shu Kong
- Thalassemia Diagnostic Laboratory, Department of Fetal Medicine and Prenatal Diagnosis, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Wei-Qiang Liu
- Thalassemia Diagnostic Laboratory, Department of Fetal Medicine and Prenatal Diagnosis, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Xiao-Fang Sun
- Thalassemia Diagnostic Laboratory, Department of Fetal Medicine and Prenatal Diagnosis, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Dong-Zhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University, Guangzhou, People's Republic of China
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12
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Tantiworawit A, Khemakapasiddhi S, Rattanathammethee T, Hantrakool S, Chai-Adisaksopha C, Rattarittamrong E, Norasetthada L, Charoenkwan P, Srichairatanakool S, Fanhchaksai K. Correlation of hepcidin and serum ferritin levels in thalassemia patients at Chiang Mai University Hospital. Biosci Rep 2021; 41:BSR20203352. [PMID: 33565577 DOI: 10.1042/BSR20203352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 11/24/2022] Open
Abstract
Hepcidin is a key iron-regulatory hormone, the production of which is controlled by iron stores, inflammation, hypoxia and erythropoiesis. The regulation of iron by hepcidin is of clinical importance in thalassemia patients in which anemia occurs along with iron overload. The present study aimed to evaluate the correlation between serum hepcidin and ferritin levels in thalassemia patients. This cross-sectional study investigated 64 patients with thalassemia; 16 β-thalassemia major (BTM), 31 β-thalassemia/hemoglobin (Hb) E (BE), and 17 Hb H + AE Bart’s disease (Hb H + AE Bart’s). The levels of serum hepcidin and ferritin, and Hb of the three groups were measured. The median values of serum ferritin and Hb were significantly different among the three groups, whereas serum hepcidin values were not observed to be significantly different. The correlation of the serum hepcidin and ferritin levels was not statistically significant in any of the three groups of thalassemia patients with BTM, BE, or Hb H + AE Bart’s (r = −0.141, 0.065 and −0.016, respectively). In conclusion, no statistically significant correlations were observed between serum hepcidin with any variables including serum ferritin, Hb, age, labile plasma iron (LPI), and number of blood transfusion units among the three groups of thalassemia patients. Likely, the regulation of hepcidin in thalassemia patients is affected more by erythropoietic activity than iron storage.
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Panyasai S, Kunyanone N, Satthakarn S. Hb Athens-Georgia (beta 40(C6) Arg > Lys, HBB:c.122G > A) with a single α-globin gene ( Hb H disease) in a Thai family: molecular, hematological, and diagnostic aspects. Scand J Clin Lab Invest 2020; 81:52-58. [PMID: 33287582 DOI: 10.1080/00365513.2020.1852598] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Interaction of structural hemoglobin (Hb) variants with α- or β-globin defects are occasional in Southeast Asia. Herein we provide the first description of Hb Athens-Georgia (Hb A-Ga) in association with deletional Hb H disease, a novel combination previously undescribed in the population. Hematological, Hb and DNA analysis, and β-globin haplotype analyses were performed in seven participants from one ethnic Thai family. Hemoglobin analysis by capillary electrophoresis revealed an abnormal Hb fraction in the proband, his father and grandmother (I-2). DNA sequencing revealed that the G > A substitution at codon 40 of the β-globin gene was identical to the Hb A-Ga (HBB:c.122G > A). Interestingly, α-thal-1 (SEA deletion) and α-thal-2 (-α3.7 deletion) were identified in the proband resulting in Hb H disease, while α-thal-1 was identified in the father, and no α-thal was observed in I-2. Hematological analysis indicated that the proband (βA-Ga/βA, -SEA/-α3.7) had moderate anemia and was markedly hypochromic with microcytic red blood cells (RBCs). The father (βA-Ga/βA, -SEA/αα) presented mild microcytic anemia, while normal hematology was observed in the I-2 who was heterozygous for Hb Athens-Georgia (βA-Ga/βA, αα/αα). The relative level of Hb A-Ga was distinctly reduced according to the degree of α-globin defects. The developed allele-specific PCR method can successfully be used for confirmation of Hb A-Ga. The Thai Hb A-Ga allele associated with a β-haplotype [+ - - - - - +]. These findings were in accordance with the previous conclusion that this variant is a non-pathological β-Hb variant.
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Affiliation(s)
- Sitthichai Panyasai
- Department of Medical Technology, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
| | - Naowarat Kunyanone
- Department of Medical Technology, Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand
| | - Surada Satthakarn
- Department of Medical Technology, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
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14
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Qian H, Huang J, Xu J, Zhao W, Ye X, Liu W. Prenatal diagnosis of a rare β-thalassemia gene -90 (C>T) (HBB: c.-140 C>T) mutation associated with deletional Hb H disease (-- SEA /-α 4.2 ). Mol Genet Genomic Med 2020; 8:e1472. [PMID: 32885601 PMCID: PMC7667371 DOI: 10.1002/mgg3.1472] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022] Open
Abstract
Background Hemoglobin H (Hb H) disease can be caused by compound heterozygosity for two different mutations or from homozygotes for mutations, and conventional genetic methods may lead to misdiagnosis when Hb H disease is combined with a rare β‐thalassemia. Methods Hematology parameters and hemoglobin electrophoresis analysis, gap‐polymerase chain reaction (gap‐PCR) and reverse dot‐blot hybridization (RDB‐PCR) were employed to identify common α‐thalassemia and Hb H disease. Rare β‐thalassemia mutations were detected by DNA sequencing. Results Hematological analysis and hemoglobin electrophoresis revealed a mild anemia α0‐thalassemia trait (Hb 90 g/L, MCV 71 fL, and MCH 22.7 pg) compound with β+‐thalassemia trait (MCV 71 fL, MCH 22.7 pg, and HbA2 5.51%) for the pregnant woman. DNA sequencing for the β‐globin gene revealed rare a -90 (C>T) (HBB: c.‐140 C>T) mutation for the woman. DNA analysis identified that the fetus inherited the α0‐thalassemia mutation [‐‐SEA (Southeast Asian)] and a rare β+‐thalassemia mutation -90 (C>T) (HBB: c.‐140 C>T) from the mother, and the α+‐thalassemia mutation [‐α4.2 (leftward)] from the father. Conclusion We reported a rare -90 (C>T) (HBB: c.‐140 C>T) mutation combined with the ‐‐SEA/‐α4.2 in a family. This finding enriched the mutation spectrum of thalassemia molecular characteristics in China and emphasized the significance in DNA sequencing in mutation screening for the families with thalassemia.
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Affiliation(s)
- Hou Qian
- The Medical Genetics & Molecular Diagnosis Laboratory, Shenzhen, China.,Prenatal Diagnosis Center, Shenzhen, China.,Department of Obstetrics, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Jianlin Huang
- The Medical Genetics & Molecular Diagnosis Laboratory, Shenzhen, China.,Prenatal Diagnosis Center, Shenzhen, China.,Department of Obstetrics, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Ji Xu
- The Medical Genetics & Molecular Diagnosis Laboratory, Shenzhen, China.,Prenatal Diagnosis Center, Shenzhen, China.,Department of Obstetrics, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Weihua Zhao
- Prenatal Diagnosis Center, Shenzhen, China.,Department of Obstetrics, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Xiufeng Ye
- The Medical Genetics & Molecular Diagnosis Laboratory, Shenzhen, China.,Prenatal Diagnosis Center, Shenzhen, China.,Department of Obstetrics, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Wenlan Liu
- The Medical Genetics & Molecular Diagnosis Laboratory, Shenzhen, China.,Prenatal Diagnosis Center, Shenzhen, China.,Department of Obstetrics, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
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15
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Aksu T, Coşkun Ç, Kuşkonmaz B, Ünal Ş, Aytaç S, Gümrük F. Hb H Disease Diagnosed During Adolescent Pregnancy. Hemoglobin 2020; 44:137-138. [PMID: 32400222 DOI: 10.1080/03630269.2020.1762642] [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] [Indexed: 10/24/2022]
Abstract
Hb H disease is a moderate to severe form of α-thalassemia (α-thal). Patients with Hb H disease may become symptomatic, especially during infections and pregnancy, and may require transfusions. Herein, we present a 16-year-old female with Hb H disease who was initially diagnosed during adolescent pregnancy and was found to carry the -α3.7/-(α)20.5 deletions. The relatively mild presentation of this case highlights the milder phenotypic consequences of deletional α mutations. The case describes the screening and management of pregnancy with Hb H disease. Additionally, this case demonstrates that screening of some undiagnosed inherited blood disorders is important during pregnancy.
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Affiliation(s)
- Tekin Aksu
- Department of Pediatrics, Division of Hematology, Hacettepe University Faculty of Medicine, Sıhhiye, Turkey
| | - Çağrı Coşkun
- Department of Pediatrics, Division of Hematology, Hacettepe University Faculty of Medicine, Sıhhiye, Turkey
| | - Barış Kuşkonmaz
- Department of Pediatrics, Division of Hematology, Hacettepe University Faculty of Medicine, Sıhhiye, Turkey
| | - Şule Ünal
- Department of Pediatrics, Division of Hematology, Hacettepe University Faculty of Medicine, Sıhhiye, Turkey
| | - Selin Aytaç
- Department of Pediatrics, Division of Hematology, Hacettepe University Faculty of Medicine, Sıhhiye, Turkey
| | - Fatma Gümrük
- Department of Pediatrics, Division of Hematology, Hacettepe University Faculty of Medicine, Sıhhiye, Turkey
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16
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Nakavachara P, Kajchamaporn W, Pooliam J, Viprakasit V. Early development of decreased β-cell insulin secretion in children and adolescents with hemoglobin H disease and its relationship with levels of anemia. Pediatr Blood Cancer 2020; 67:e28109. [PMID: 31876111 DOI: 10.1002/pbc.28109] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 10/23/2019] [Accepted: 11/03/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) associated with iron overload has been reported among adults with transfusion-dependent thalassemia and those with non-transfusion-dependent thalassemia (NTDT), especially in β-thalassemia disease. However, little is known about glucose metabolism and how early its dysregulation can develop in α-thalassemia hemoglobin H (Hb H) disease, which is one of the most common types of NTDT worldwide. PROCEDURE We prospectively calculated glucose metabolism index in 40 patients (aged 10-25 years) with Hb H disease. Glucose metabolism data were compared between patients with deletional versus nondeletional Hb H, and between patients with normal versus abnormal insulin secretion/sensitivity. RESULTS Despite normal glucose tolerance in all patients, 52.5% had abnormal insulinogenic index indicating decreased β-cell insulin secretion. Patients with functional hemoglobin < 8 g/dL had significantly higher percentages of abnormal insulinogenic index. There was no significant difference in abnormal insulinogenic index between deletional and nondeletional Hb H. CONCLUSION Decreased β-cell insulin secretion is highly prevalent among children and adolescents with Hb H disease, and it is associated with levels of functional anemia at baseline, but not with the type of Hb H disease. This result warrants heightened awareness among hematologists due to potentially increased risk of DM later in life.
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Affiliation(s)
- Pairunyar Nakavachara
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Worarat Kajchamaporn
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Julaporn Pooliam
- Clinical Epidemiology Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vip Viprakasit
- Division of Pediatric Haematology and Oncology and Thalassemia Center, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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17
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Li Y, Liang L, Tian M, Qin T, Wu X. Detection of Hb H disease caused by a novel mutation and -- SEA deletion using capillary electrophoresis. J Clin Lab Anal 2019; 33:e22949. [PMID: 31199523 PMCID: PMC6757179 DOI: 10.1002/jcla.22949] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/20/2019] [Indexed: 11/11/2022] Open
Abstract
Background Hb H disease is a serious type of α‐thalassemia which cause moderate anemia while misdiagnosis by routine genetic analysis in a rare or novel Hb H disease. Methods The study was done on three patients and one fetus in a suspected Hb H disease family. Hb analysis was carried out using capillary electrophoresis (CE), and hematological analysis was conducted with an automated cell counter. Common α‐ and β‐thalassemia mutations were detected by routine genetic analysis (gap‐PCR and RDB‐PCR). Novel mutation diagnostic methods were based on DNA sequencing. Results Capillary electrophoresis revealed clinical feature of classic Hb H disease in the proband, and hematology analysis showed moderate anemia (Hb 87 g/L). But routine genetic analysis was found that it was only a heterozygote for the ‐‐SEA deletion. DNA sequencing of α‐globin genes (α1 and α2) identified the breakpoints between nts 34162 and 34171 at α2 gene, named CD 90‐93 (‐AGCTTCGG) mutation. The genotype of proband and fetus was the same ‐‐SEA/‐αCD90‐93. His father was homozygous for the novel mutation (‐αCD90‐93/‐αCD90‐93), and his mother was heterozygote for the ‐‐SEA deletion. Conclusions Our study for the first time described the novel mutation CD 90‐93 (‐AGCTTCGG). CE is a way to avoid misdiagnosis of rare or novel Hb H disease.
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Affiliation(s)
- Youqiong Li
- The Center of Reproduction and Genetic, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.,The Center of Prenatal Diagnosis, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Liang Liang
- The Center of Prenatal Diagnosis, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Mao Tian
- The Center of Prenatal Diagnosis, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Ting Qin
- The Center of Prenatal Diagnosis, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Xin Wu
- The Center of Prenatal Diagnosis, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
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18
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Abstract
The α+-thal deletion of 3.557 kb (NG_000006.1: g.32745_36301del, -αMAL3.5), involving the entire α2-globin gene, was identified in a Chinese family by multiplex ligation-dependent probe amplification (MLPA) followed by gap-polymerase chain reaction (gap-PCR) and sequencing. The proband, a compound heterozygote for this mutant gene and the Southeast Asian (- -SEA; NG_000006.1: g.26264_45564del19301) deletion, had a phenotype of Hb H disease [hemoglobin (Hb) 7.6 g/dL, mean corpuscular volume (MCV) 60.0 fL, Hb H (β4) 0.7%, Hb Bart's (γ4) 2.4% and Hb A2 1.1%]; one of her sisters with same genotype showed a similar phenotype. Another two family members, who were carriers of this mutant gene, had a hematological phenotype of a silent α-thal. The 5' and 3' breakpoints of this deletion are located at the Y2 and Y1 boxes, respectively, therefore, it probably originated from an unequal crossover between these two homologous boxes. This mutation constitutes an additional heterogeneous defect causing α-thal in the Chinese population and would be valuable for elucidating the arrangement in the human α-globin gene cluster.
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Affiliation(s)
- Ying Zhao
- a Dongguan Maternal and Child Health Hospital , Prenatal Diagnosis Center , Dongguan , Guangdong , People's Republic of China
| | - Jiwu Lou
- a Dongguan Maternal and Child Health Hospital , Prenatal Diagnosis Center , Dongguan , Guangdong , People's Republic of China
| | - Manna Sun
- a Dongguan Maternal and Child Health Hospital , Prenatal Diagnosis Center , Dongguan , Guangdong , People's Republic of China
| | - Youqing Fu
- a Dongguan Maternal and Child Health Hospital , Prenatal Diagnosis Center , Dongguan , Guangdong , People's Republic of China
| | - Wanling Ye
- a Dongguan Maternal and Child Health Hospital , Prenatal Diagnosis Center , Dongguan , Guangdong , People's Republic of China
| | - Yanjin Li
- a Dongguan Maternal and Child Health Hospital , Prenatal Diagnosis Center , Dongguan , Guangdong , People's Republic of China
| | - Yunshi Dai
- a Dongguan Maternal and Child Health Hospital , Prenatal Diagnosis Center , Dongguan , Guangdong , People's Republic of China
| | - Yanhui Liu
- a Dongguan Maternal and Child Health Hospital , Prenatal Diagnosis Center , Dongguan , Guangdong , People's Republic of China
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Abstract
The aim of this study was to determine the hematological characteristics in a large group of Hb H (β4) patients with or without a coexisting β-thalassemia (β-thal), identified by a thalassemia screening program in mainland China. A total of 361 patients with Hb H disease were found, including 343 with deletional types and 18 with nondeletional types. β-Thalassemia was found in 28 (7.8%) out of the 361 Hb H cases, and all of the 28 cases had the deletional type of Hb H disease. Lower hemoglobin (Hb) levels were detected in cases with the nondeletional type compared to those in cases with the deletional type. β-Thalassemia significantly increases the Hb levels in Hb H cases. The Hb H and Hb Bart's (γ4) fractions were visible in 270 (85.7%) and 122 (38.7%) out of 315 deletional type cases, respectively, while no Hb H or Hb Bart's fractions were detectable in 28 deletional type cases with β-thal. Therefore, the diagnosis of Hb H disease in a β-thal carrier is challenging. Molecular analysis of α- and β-globin genes is imperative in all cases with a β-thal trait.
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Affiliation(s)
- Gui-Lan Chen
- a Prenatal Diagnostic Center , Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University , Guangzhou, Guangdong Province , People's Republic of China
| | - Fan Jiang
- a Prenatal Diagnostic Center , Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University , Guangzhou, Guangdong Province , People's Republic of China
| | - Jian Li
- a Prenatal Diagnostic Center , Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University , Guangzhou, Guangdong Province , People's Republic of China
| | - Jian-Ying Zhou
- a Prenatal Diagnostic Center , Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University , Guangzhou, Guangdong Province , People's Republic of China
| | - Dong-Zhi Li
- a Prenatal Diagnostic Center , Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University , Guangzhou, Guangdong Province , People's Republic of China
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20
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Van de Water N, Tan T, Crowley M, Kerr R, Browett P. Novel α-Globin Splice Site Mutation (HBA2: c.96-5C>A) in Combination with Three-Gene Deletion Hb H Disease. Hemoglobin 2018; 42:122-125. [PMID: 30200833 DOI: 10.1080/03630269.2018.1487307] [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] [Indexed: 10/28/2022]
Abstract
The choice of acceptor splice site during exon-exon splicing by the spliceosome is determined by a variety of factors. We report here a family with a novel acceptor splice site variant within intron 1 of the α-globin gene that provides some in vivo insight into the rules governing RNA splicing in homo sapiens. A 2-year-old female with Hb H disease, was found to have not only three α-globin genes deleted (- -FIL/-α3.7) but also a HBA2: c.96-5C>A variant on her remaining α-globin gene. The HBA2: c.96-5C>A variant was in cis with -α3.7 and mRNA studies indicate that this variant creates a new acceptor splice site which is used in approximately 35.0% of α-globin mRNA transcripts. The reduced levels of normal mRNA transcript predicts a more severe Hb H disease than expected for the three-gene deletion Hb H disease with a phenotype similar to nondeletional Hb H disease. We propose that this variant be called Hb Beach Haven (HBA2: c.96-5C>A).
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Affiliation(s)
- Neil Van de Water
- a Diagnostic Genetics Department , LabPlus, Auckland City Hospital , Auckland , New Zealand
| | - Tina Tan
- a Diagnostic Genetics Department , LabPlus, Auckland City Hospital , Auckland , New Zealand
| | - Megan Crowley
- a Diagnostic Genetics Department , LabPlus, Auckland City Hospital , Auckland , New Zealand
| | - Romy Kerr
- b Genetic Health Service , Auckland City Hospital , New Zealand
| | - Peter Browett
- a Diagnostic Genetics Department , LabPlus, Auckland City Hospital , Auckland , New Zealand.,c Department of Molecular Medicine & Pathology , University of Auckland , Auckland , New Zealand
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21
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Zhang Q, Fan X, Xu M, Zhang Y, Xu H, Wen X, Zhou W. Hb H Disease Caused by Multiple Mutations in the Polyadenylation Signal Site and - - SEA/αα. Hemoglobin 2018; 41:189-192. [PMID: 28950779 DOI: 10.1080/03630269.2017.1366917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Thalassemia is the most common monogenic disease, with the highest incidence in Guangxi Zhuang Autonomous Region, People's Republic of China (PRC). The blood test result was not consistent with α-globin gene testing in one of the patients during daily screening. It was confirmed that there were multiple mutations at the α2-globin gene polyadenylation (polyA) signal site: HBA2: c.*64(T>C), HBA2: c.*68(A>C), HBA2: c.*71(G>A), HBA2: c.*74(C>A), HBA2: c.*82(G>A), HBA2: c.*92(A>G) and HBA2: c.*98(T>C) and compound - -SEA/αα by sequencing of the HBA1 and HBA2 genes of the proband and core family members. After that, we found a further two cases of unrelated patients with this type of mutation. The mutation is not an accidental phenomenon, and likely to occur with a considerable incidence in Guangxi Zhuang Autonomous Region, PRC. We analyzed the hematological manifestations of this type of thalassemia and showed that it was a Hb H (β4) disease caused by rare mutations. We suggest that it is essential to pay attention to this mutation during future clinical diagnoses and genetic counseling of patients.
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Affiliation(s)
- Qiang Zhang
- a Department of Medical Genetics , School of Basic Medical Sciences, Southern Medical University , Guangzhou , Guangdong Province , People's Republic of China.,b Department of Genetic Metabolism , Prenatal Diagnostic Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region , Nanning , Guangxi Zhuang Autonomous Region , People's Republic of China
| | - Xin Fan
- b Department of Genetic Metabolism , Prenatal Diagnostic Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region , Nanning , Guangxi Zhuang Autonomous Region , People's Republic of China
| | - Mingli Xu
- a Department of Medical Genetics , School of Basic Medical Sciences, Southern Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Yijia Zhang
- a Department of Medical Genetics , School of Basic Medical Sciences, Southern Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Huiling Xu
- a Department of Medical Genetics , School of Basic Medical Sciences, Southern Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Xiaojun Wen
- a Department of Medical Genetics , School of Basic Medical Sciences, Southern Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Wanjun Zhou
- a Department of Medical Genetics , School of Basic Medical Sciences, Southern Medical University , Guangzhou , Guangdong Province , People's Republic of China
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Traivaree C, Boonyawat B, Monsereenusorn C, Rujkijyanont P, Photia A. Clinical and molecular genetic features of Hb H and AE Bart's diseases in central Thai children. Appl Clin Genet 2018; 11:23-30. [PMID: 29662324 PMCID: PMC5892615 DOI: 10.2147/tacg.s161152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background α-Thalassemia, one of the major thalassemia types in Thailand, is caused by either deletion or non-deletional mutation of one or both α-globin genes. Inactivation of three α-globin genes causes hemoglobin H (Hb H) disease, and the combination of Hb H disease with heterozygous hemoglobin E (Hb E) results in AE Bart’s disease. Objective This study aimed to characterize the clinical and hematological manifestations of 76 pediatric patients with Hb H and AE Bart’s diseases treated at Phramongkutklao Hospital, a tertiary care center for thalassemia patients in central Thailand. Patients and methods Seventy-six unrelated pediatric patients, 58 patients with Hb H disease and 18 patients with AE Bart’s disease, were enrolled in this study. Their clinical presentations, transfusion requirement, laboratory findings, and mutation analysis were retrospectively reviewed and analyzed. Results A total of 76 pediatric patients with Hb H and AE Bart’s diseases who mainly lived in central Thailand were included in this study. The clinical severities of patients with non-deletional mutations were more severe than those with deletional mutations. Eighty-six percent of patients with non-deletional AE Bart’s disease required more blood transfusion compared to 12.5% of patients with deletional AE Bart’s disease. Non-deletional AE Bart’s disease also had a history of urgent blood transfusion with the average of 6±0.9 times compared to 1±0.3 times in patients with deletional Hb H disease. The difference was statistically significant. Conclusion This study revealed the differences in clinical spectrum between patients with Hb H disease and those with AE Bart’s disease in central Thailand. The differentiation of α-thalassemia is essential for appropriate management of patients. The molecular diagnosis is useful for diagnostic confirmation and genotype–phenotype correlation.
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Affiliation(s)
- Chanchai Traivaree
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Boonchai Boonyawat
- Division of Genetics, Department of Pediatrics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Chalinee Monsereenusorn
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Piya Rujkijyanont
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Apichat Photia
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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23
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Lee SY, Goh JH, Tan KML, Liu TC. Coinheritance of High Oxygen Affinity Hb Helsinki [HBB: c.248A>T; β82(EF6)Lys→Met] with Hb H Disease. Hemoglobin 2017; 41:209-212. [PMID: 28791912 DOI: 10.1080/03630269.2017.1351986] [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] [Indexed: 10/19/2022]
Abstract
Hb Helsinki [HBB: c.248A>T; β82(EF6)Lys→Met] is a high oxygen affinity hemoglobin (Hb) causing polycythemia, whereas Hb H (β4) disease causes mild to severe chronic hemolytic anemia. The clinical characteristics, gel electrophoresis, capillary electrophoresis (CE) and molecular genotyping of a case of Hb Helsinki coinherited with Hb H disease in an ethnic Malay is described, illustrating the interaction between the β-globin variant and coinheritance of three α gene deletions. The proband was asymptomatic, exhibited microcytosis and a normal with Hb value.
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Affiliation(s)
- Shir-Ying Lee
- a Department of Laboratory Medicine, Haematology Division , National University Hospital , Singapore
| | - Jia-Hui Goh
- a Department of Laboratory Medicine, Haematology Division , National University Hospital , Singapore
| | - Karen M L Tan
- b Molecular Diagnosis Centre , Department of Laboratory Medicine , National University Hospital , Singapore
| | - Te-Chih Liu
- a Department of Laboratory Medicine, Haematology Division , National University Hospital , Singapore
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24
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Yang X, Yan JM, Li J, Xie XM, Zhou JY, Li Y, Li DZ. Hydrops Fetalis Associated with Compound Heterozygosity for Hb Zurich-Albisrieden (HBA2: C.178G > C) and the Southeast Asian (- - SEA/) Deletion. Hemoglobin 2016; 40:353-355. [PMID: 27686733 DOI: 10.1080/03630269.2016.1230067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 10/20/2022]
Abstract
Hb Zurich-Albisrieden [HBA2: c.178G > C; α59(E8)Gly→Arg (α2)] is a rare nondeletional α-thalassemia (α-thal) that results from a nucleotide substitution at codon 59 of the α2-globin gene. In this report, we present a fetus with cardiomegaly, enlarged placenta and increased middle cerebral artery-peak systolic velocity (MCA-PSV) at 25 weeks' gestation. Fetal blood sampling revealed the severe anemia [hemoglobin (Hb) level being 5.5 g/dL] and Hb H (β4) disease-like hematological findings with Hb Bart's (γ4) level of 30.7%. Molecular analysis of the family found that the father was an Hb Zurich-Albisrieden carrier, the mother heterozygous for the - -SEA α0-thal deletion, and the fetus was a compound heterozygote for Hb Zurich-Albisrieden and the - -SEA α0-thal deletion. Therefore, this was a rare case of Hb Bart's hydrops fetalis associated with Hb Zurich Albisrieden.
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Affiliation(s)
- Xin Yang
- a Prenatal Diagnostic Center, Guangzhou Women and Children Medical Center affiliated to Guangzhou Medical University , Guangzhou , Guangdong , People's Republic of China
| | - Jin-Mei Yan
- a Prenatal Diagnostic Center, Guangzhou Women and Children Medical Center affiliated to Guangzhou Medical University , Guangzhou , Guangdong , People's Republic of China
| | - Jian Li
- a Prenatal Diagnostic Center, Guangzhou Women and Children Medical Center affiliated to Guangzhou Medical University , Guangzhou , Guangdong , People's Republic of China
| | - Xing-Mei Xie
- a Prenatal Diagnostic Center, Guangzhou Women and Children Medical Center affiliated to Guangzhou Medical University , Guangzhou , Guangdong , People's Republic of China
| | - Jian-Ying Zhou
- a Prenatal Diagnostic Center, Guangzhou Women and Children Medical Center affiliated to Guangzhou Medical University , Guangzhou , Guangdong , People's Republic of China
| | - Yan Li
- b Guangzhou Cord Blood Bank, Guangzhou Women and Children Medical Center affiliated to Guangzhou Medical University , Guangzhou , Guangdong , People's Republic of China
| | - Dong-Zhi Li
- a Prenatal Diagnostic Center, Guangzhou Women and Children Medical Center affiliated to Guangzhou Medical University , Guangzhou , Guangdong , People's Republic of China
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25
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Farashi S, Garous NF, Ashki M, Vakili S, Zeinali F, Imanian H, Azarkeivan A, Giordano PC, Najmabadi H. Homozygosity for the AATAAA > AATA- - Polyadenylation Site Mutation on the α2-Globin Gene Causing Transfusion-Dependent Hb H Disease in an Iranian Patient: A Case Report. Hemoglobin 2015; 39:355-8. [PMID: 26193977 DOI: 10.3109/03630269.2015.1059850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We describe a case of Hb H disease associated with homozygosity for a two nucleotide deletion in the polyadenylation signal of the α2-globin gene (HBA2: c.*93_*94delAA). The patient, a 27-year-old son of a consanguineous couple, needs regular blood transfusions every 6 months.
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Affiliation(s)
- Samaneh Farashi
- a Kariminejad-Najmabadi Pathology & Genetics Center , Tehran , Iran
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26
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Abstract
The aim of this study was to demonstrate the performance of nondeletional α-thalassemia (α-thal) prevention using a reverse dot-blot method at a Mainland Chinese hospital. A prenatal control program for nondeletional Hb H disease was performed between January 2009 and December 2013. All couples were screened for α-thal trait, and for couples in which one partner tested positive for α(0)-thal, the other was subjected to screening for Hb Constant Spring (Hb CS, HBA2: c.427T > C) and Hb Quong Sze (Hb QS, HBA2: c.377T > C) mutations by reverse dot-blot assay. Prenatal diagnoses were offered in at-risk pregnancies. During the study period, 51,105 couples were found to be carrying α-thal; among these, 35 (0.07%) couples were found to be at-risk of conceiving an offspring with nondeletional Hb H disease, including 25 couples for Hb H-CS and 10 cases for Hb H-QS. Nine fetuses were diagnosed with nondeletional Hb H disease, and eight of the affected pregnancies were terminated. Detection of nondeletional α-thal is necessary for any prenatal diagnosis (PND) programs in Southeast Asian countries. Reverse dot-blot is a relatively simple method for simultaneous typing of common nondeletional α-thal mutations.
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Affiliation(s)
- Jian Li
- Prenatal Diagnostic Center, Guangzhou Women & Children's Medical Center, Guangzhou Medical University , Guangzhou, Guangdong , People's Republic of China
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27
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Chiou SS, Tsao CJ, Tsai SM, Wu YR, Liao YM, Lin PC, Tsai LY. Metabolic pathways related to oxidative stress in patients with hemoglobin h disease and iron overload. J Clin Lab Anal 2014; 28:261-8. [PMID: 24577940 DOI: 10.1002/jcla.21676] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 05/30/2013] [Accepted: 08/14/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Iron overload is a major complication in patients with hemoglobin H (Hb H) disease and causes damage of tissues. METHODS We investigated 26 Hb H patients and 75 controls to evaluate their oxidative stress and antioxidant statuses. RESULTS There were significantly increased levels of superoxide anion in leucocytes, nitrite (NO2-), and malondialdehyde (MDA) in plasma, and activities of superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GRx) and oxidized glutathione (GSSG) in erythrocytes, decreased levels of nitrate (NO3-) and vitamin C in plasma, and reduced glutathione (GSH) in erythrocytes, in addition to the abnormal iron status in the patients when compared with those in the controls. Meanwhile, levels of serum ferritin were positively correlated with serum iron, plasma MDA, and erythrocyte SOD in the patients. In addition, the activities of SOD were positively correlated with those of GPx and GRx, and the levels of GSSG and MDA, but negatively correlated with those of GSH. Furthermore, the levels of MDA were negatively correlated those of vitamin C. CONCLUSIONS These results demonstrate the presence of oxidative stress and decreased levels of antioxidants; moreover, the related metabolic antioxidant pathway is active in Hb H patients with iron overload.
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Affiliation(s)
- Shyh-Shin Chiou
- Department of Pediatrics, Faculty of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Hematology-Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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28
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Kimura EM, Oliveira DM, Fertrin K, Pinheiro VR, Jorge SEDC, Costa FF, de Fátima Sonati M. Hb H disease resulting from the association of an α-thalassemia allele [-(α)] with an unstable α-globin variant [Hb Icaria]: First report on the occurrence in Brazil. Genet Mol Biol 2009; 32:712-5. [PMID: 21637442 PMCID: PMC3036908 DOI: 10.1590/s1415-47572009005000071] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 05/21/2009] [Indexed: 11/23/2022] Open
Abstract
Hb H Disease is caused by the loss or inactivation of three of the four functional α-globin genes. Patients present chronic hemolytic anemia and splenomegaly. In some cases, occasional blood transfusions are required. Deletions are the main cause of this type of thalassemia ( α-thalassemia). We describe here an unusual case of Hb H disease caused by the combination of a common α0 deletion [-( α) 20.5 ] with a rare point mutation (c.427T > A), thus resulting in an elongated and unstable α-globin variant, Hb Icaria, (X142K), with 31 additional amino-acid residues. Very high levels of Hb H and Hb Bart's were detected in the patient's red blood cells (14.7 and 19.0%, respectively). This is the first description of this infrequent association in the Brazilian population.
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Affiliation(s)
- Elza M Kimura
- Departamento de Patologia Clínica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP Brazil
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