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Anderson S, Perram J, Nelson A, Matthews S, Gou M, Ho PJ. Pregnancy and assisted reproductive technology use in Australian female transfusion-dependent haemoglobinopathy patients: a 20-year retrospective analysis. Intern Med J 2024; 54:290-294. [PMID: 37449655 DOI: 10.1111/imj.16169] [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] [Received: 12/19/2022] [Accepted: 06/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND In the last few decades, the life expectancy of patients with transfusion-dependent thalassaemia (TDT) and sickle cell disease (SCD) has improved significantly, in part because of improved iron chelation. Fertility challenges and pregnancy complications have historically limited reproductive options in this group; however, improved multi-disciplinary care has made infertility a chronic disease complication requiring attention. Despite this, there are very few reports and no Australian data describing fertility and pregnancy outcomes in this population. AIMS To identify the rate of assisted reproductive technologies (ART) utilisation in our female transfusion-dependent haemoglobinopathy patients and to establish the nature of maternal and neonatal complications in this cohort. METHODS A 20-year retrospective analysis (1997-2017) at an Australian centre captured data on conception rates, use of assisted reproductive techniques (ART), and pregnancy and neonatal outcomes in female transfusion-dependent haemoglobinopathy patients. RESULTS Conception was attempted in 14 women (11 TDT and three SCD) during the study period. A total of 28 pregnancies resulting in 25 live births were recorded. ART supported 13 conceptions. A positive association was not identified between elevated mean serum ferritin and ART use; however, all patients with an established diagnosis of hypogonadotropic hypogonadism (HH) required ART. Maternal complications included gestational diabetes mellitus and post-partum haemorrhage. There were no cardiac complications. Two-thirds of women underwent lower segment caesarean section, with prematurity complicating 20% of births. There were no neonatal or maternal deaths. CONCLUSION Pregnancy is an achievable goal for women with transfusion-dependent haemoglobinopathies, although the support of ART may be required in a subset of patients.
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Affiliation(s)
- Stephanie Anderson
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jacinta Perram
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Anna Nelson
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Stephen Matthews
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Mel Gou
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - P Joy Ho
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Chakravorty S, Drasar E, Kaya B, Kesse-Adu R, Velangi M, Wright J, Howard J. UK Haemoglobin Disorders Peer Review: A Quality Standards-based review programme for sickle cell disease and thalassaemia. Br J Haematol 2024; 204:668-676. [PMID: 37786398 DOI: 10.1111/bjh.19114] [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] [Received: 03/02/2023] [Revised: 08/17/2023] [Accepted: 09/08/2023] [Indexed: 10/04/2023]
Abstract
We evaluated the impact of peer reviews in driving improvement in healthcare quality for people with haemoglobinopathy in the United Kingdom. We analysed compliance to four Quality Standards (QS)-based peer reviews from 2010 to 2020 to evaluate its impact in driving healthcare quality. Seventeen paediatric and 29 adult haemoglobinopathy centres were reviewed in 2010/11 and 2012/13 respectively; 33 paediatric and 33 adult centres were reviewed in 2014/16, and 32 paediatric and 32 adult centres were reviewed in 2018/2020. Compliance with QS and participant feedback were analysed to assess the impact of peer review programmes to drive improvement in quality of care. We noted that haemoglobinopathy centres significantly improved their compliance to QS between the first two review programmes, but not in the final review programme. In comparison to other disease-group reviews, the haemoglobinopathy departments were less able to address critical peer review recommendations in their own institutions. The peer review programme was unable to drive sustained improvement in healthcare quality, underscoring the need for sustained development and support for haemoglobinopathy services in the National Health Service. Further work is needed to understand why disparities exist among peer review-driven improvement initiatives within different disease groups.
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Affiliation(s)
| | - E Drasar
- Whittington Hospital NHS Trust, London, UK
| | - B Kaya
- Barts Health NHS Trust, London, UK
| | - R Kesse-Adu
- Guy's and St Thomas's Hospital NHS Trust, London, UK
| | - M Velangi
- Birmingham Children's Hospital NHS Trust, Birmingham, UK
| | - J Wright
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - J Howard
- Guy's and St Thomas's Hospital NHS Trust, London, UK
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Daniel Y, Henthorn J. Lessons learnt in the screening and diagnosis of haemoglobinopathies. Br J Haematol 2024; 204:68-73. [PMID: 37932940 DOI: 10.1111/bjh.19181] [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] [Received: 07/24/2023] [Revised: 09/22/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
For this paper, cases reported formally and anecdotally to the authors in their screening and diagnostic roles have been selected to demonstrate areas where errors have occurred, and caution should be exercised. The cases demonstrate that it is vital that the performance and limitations of the techniques used, along with the phenotypic presentation of cases where haemoglobin variants and/or thalassaemias are coinherited are understood by those performing result interpretation. Those who deliver the service as well as those who receive reports and give results and counselling should be aware of the complexity of the topic.
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Affiliation(s)
- Yvonne Daniel
- Synnovis Analytics, Guy's Hospital, London, UK
- The NHS Sickle Cell and Thalassaemia Screening Programme, London, UK
| | - Joan Henthorn
- The NHS Sickle Cell and Thalassaemia Screening Programme, London, UK
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4
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David SM, Sasikumar M, Basheer K M M, Rose A, George K, Minz S. A proposed methodology of health education for inherited genetic disorders: Bag and Ball technique. Trop Doct 2024; 54:45-48. [PMID: 37774770 DOI: 10.1177/00494755231204633] [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: 10/01/2023]
Abstract
The life-threatening genetic blood disorder, thalassaemia, which causes decreased haemoglobin production, is preventable. Sociocultural determinants and the level of public health awareness must be used to adopt control measures of prevention. Identifying information gaps and educating the community about screening should be a priority, especially in areas with high disease burdens. A relevant health education technique, with which the audience can identify, can effectively bring understanding necessary effectively to sensitise the community. We propose the 'Bag and Ball' method, which includes role-play for health education specifically concerning inherited genetic disorders.
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Affiliation(s)
- Sam Marconi David
- Department of Community Health, Christian Medical College Vellore, Vellore, TN, India
| | - Midhun Sasikumar
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, TN, India
| | - Muhammed Basheer K M
- Centre for Stem Cell Research, Christian Medical College Vellore, Vellore, TN, India
| | - Anuradha Rose
- Department of Community Health, Christian Medical College Vellore, Vellore, TN, India
| | - Kuryan George
- Centre for Stem Cell Research, Christian Medical College Vellore, Vellore, TN, India
| | - Shantidani Minz
- Rural Unit for Health and Social Affairs, Christian Medical College Vellore, Vellore, TN, India
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Gravholt EAE, Petersen J, Mottelson M, Nardo-Marino A, Rathe M, Olsen M, Holm C, Jørgensen FS, Birgens H, Glenthøj A. The Danish national haemoglobinopathy screening programme: Report from 16 years of screening in a low-prevalence, non-endemic region. Br J Haematol 2024; 204:329-336. [PMID: 37694757 DOI: 10.1111/bjh.19103] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
The Danish national haemoglobinopathy screening programme seeks to determine parental haemoglobinopathy carrier state antenatally. In this retrospective register-based study, we evaluated the 16-year trajectory of this programme, utilising the Danish Red Blood Cell Centre's laboratory database, covering approximately 77% of the Danish population. During the study period, we observed a substantial increase in annual diagnostic examinations performed, from 389 in 2007 to 3030 in 2022. Women constituted 88% of these cases, aligning with the emphasis of the screening programme. Of these, 54% of women of reproductive age (15-40 years) and 10% of women >40 years were specified as pregnant. During our study period, 61 children were born with a severe haemoglobinopathy, out of which 23 children were born from mothers not residing in Denmark during their first trimester thus not included in the screening programme. Prenatal invasive testing was performed for 60 fetuses, identifying 12 with homozygous or compound heterozygous haemoglobinopathy. The Danish haemoglobinopathy screening programme has provided screening, information and reproductive choices for numerous families. During the study period, screening for haemoglobinopathies has been steadily increasing and is expected to continue to increase. Awareness of and adherence to the screening programme is subject of further investigation and optimisation.
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Affiliation(s)
| | - Jesper Petersen
- Danish Red Blood Cell Centre, Department of Haematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Mathis Mottelson
- Danish Red Blood Cell Centre, Department of Haematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Amina Nardo-Marino
- Danish Red Blood Cell Centre, Department of Haematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Mathias Rathe
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marianne Olsen
- Department of Paediatrics and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte Holm
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Finn Stener Jørgensen
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Fetal Medicine Unit, Department of Gynaecology and Obstetrics, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Henrik Birgens
- Danish Red Blood Cell Centre, Department of Haematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Andreas Glenthøj
- Danish Red Blood Cell Centre, Department of Haematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Twum S, Fosu K, Felder RA, Sarpong KAN. Bridging the gaps in newborn screening programmes: Challenges and opportunities to detect haemoglobinopathies in Africa. Afr J Lab Med 2023; 12:2225. [PMID: 38116518 PMCID: PMC10729498 DOI: 10.4102/ajlm.v12i1.2225] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/27/2023] [Indexed: 12/21/2023] Open
Abstract
Background Haemoglobinopathies, including sickle cell disease and β-thalassaemia, are monogenic disorders with a relatively higher prevalence among malaria-endemic areas in Africa. Despite this prevalence, most African countries lack the necessary resources for diagnosing and managing these debilitating conditions. Aim This study provides a critical review of newborn screening for detecting haemoglobinopathies in Africa, highlighting challenges and proposing strategies for improved diagnosis and management. Methods A literature search on haemoglobinopathies in Africa was conducted in PubMed, Google Scholar and ScienceDirect, using specific keywords and Boolean operators, including articles published from January 1981 to December 2022. Results The data show that sickle cell disease is prevalent among populations in Central and West Africa; however, β-thalassaemia is prevalent among people in the northern parts of Africa. Newborn screening pilot initiatives for haemoglobinopathies were being implemented in Angola, Nigeria, Ghana, the Democratic Republic of Congo and the Republic of Benin. The cost of testing, lack of sufficient and accessible medical records, and inadequacy in healthcare infrastructure pose significant challenges in bridging the gaps in newborn screening. Furthermore, the stigmatisation and lack of awareness of haemoglobinopathies and access to newborn screening programmes pose additional challenges. Conclusion This review highlights the challenges associated with haemoglobinopathy testing, effective strategies for mitigating these challenges, and future perspectives for expanding efforts toward detecting and managing these disorders across Africa. Providing affordable diagnostic tools, mobile clinics, government subsidies, education campaigns, and the implementation of electronic medical records systems could help bridge the gaps in newborn screening in Africa. What this study adds The study presents a comprehensive view of newborn screening of haemoglobinopathies in Africa, provides a detailed outline of the challenges faced by newborn screening for haemoglobinopathies in Africa, and offers strategies for better diagnosis and care.
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Affiliation(s)
- Seth Twum
- West African Centre for Cell Biology of Infectious Pathogens, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana
| | - Kwadwo Fosu
- West African Centre for Cell Biology of Infectious Pathogens, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana
| | - Robin A Felder
- Department of Pathology, The University of Virginia, Charlottesville, Virginia, United States
| | - Kwabena A N Sarpong
- West African Centre for Cell Biology of Infectious Pathogens, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana
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Fragodimitri C, Schiza V, Giakoumis A, Drakaki K, Salichou A, Karampatsos F, Yousef J, Karageorga M, Berdoukas V, Aessopos A. Successful chelation in beta-thalassemia major in the 21st century. Medicine (Baltimore) 2023; 102:e35455. [PMID: 37832083 PMCID: PMC10578721 DOI: 10.1097/md.0000000000035455] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2023] Open
Abstract
This century has seen a revolution the management of beta-thalassemia major. Over a 12-year period to 2016, we aimed to analyze the benefits of such advances. In 209 patients, independent of the chelation regimen, ferritin, cardiac T2* and liver iron concentration changes were evaluated. We defined chelation success (ChS) as no iron load in the heart and acceptable levels in the liver. Over 3 early magnetic resonance imagings, the same parameters were assessed in 2 subgroups, the only 2 that had sufficient patients continuing on 1 regimen and for a significant period of time, 1 on deferrioxamine (low iron load patients n = 41, Group A) and 1 on deferoxamine-deferiprone (iron overloaded n = 60, Group B). Finally, 28 deaths and causes were compared to those of an earlier period. The 209 patients significantly optimized those indices, while the number of patients with chelation success, increased from 6% to 51% (P < .0001). In group A, ChS after about 8 years increased from 21 to 46% (P = .006), while in Group B, from 0% to 60% (P < .001) after about 7 years. Deaths over the 2 periods showed significant reduction. Combined clearance of cardiac and liver iron (ChS) is feasible and should become the new target for all patients. This requires, serial magnetic resonance imagings and often prolonged intensified chelation for patients.
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Affiliation(s)
| | - Vasiliki Schiza
- Thalassemia Unit, “Aghia Sofia” Children’s Hospital, Athens, Greece
| | | | - Kalliopi Drakaki
- Thalassemia Unit, “Aghia Sofia” Children’s Hospital, Athens, Greece
| | | | | | | | | | | | - Athanasios Aessopos
- 1 Academic Department of Internal Medicine, “Laiko” General Hospital, Athens, Greece
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8
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Kontoghiorghes GJ. The Vital Role Played by Deferiprone in the Transition of Thalassaemia from a Fatal to a Chronic Disease and Challenges in Its Repurposing for Use in Non-Iron-Loaded Diseases. Pharmaceuticals (Basel) 2023; 16:1016. [PMID: 37513928 PMCID: PMC10384919 DOI: 10.3390/ph16071016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/26/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
The iron chelating orphan drug deferiprone (L1), discovered over 40 years ago, has been used daily by patients across the world at high doses (75-100 mg/kg) for more than 30 years with no serious toxicity. The level of safety and the simple, inexpensive synthesis are some of the many unique properties of L1, which played a major role in the contribution of the drug in the transition of thalassaemia from a fatal to a chronic disease. Other unique and valuable clinical properties of L1 in relation to pharmacology and metabolism include: oral effectiveness, which improved compliance compared to the prototype therapy with subcutaneous deferoxamine; highly effective iron removal from all iron-loaded organs, particularly the heart, which is the major target organ of iron toxicity and the cause of mortality in thalassaemic patients; an ability to achieve negative iron balance, completely remove all excess iron, and maintain normal iron stores in thalassaemic patients; rapid absorption from the stomach and rapid clearance from the body, allowing a greater frequency of repeated administration and overall increased efficacy of iron excretion, which is dependent on the dose used and also the concentration achieved at the site of drug action; and its ability to cross the blood-brain barrier and treat malignant, neurological, and microbial diseases affecting the brain. Some differential pharmacological activity by L1 among patients has been generally shown in relation to the absorption, distribution, metabolism, elimination, and toxicity (ADMET) of the drug. Unique properties exhibited by L1 in comparison to other drugs include specific protein interactions and antioxidant effects, such as iron removal from transferrin and lactoferrin; inhibition of iron and copper catalytic production of free radicals, ferroptosis, and cuproptosis; and inhibition of iron-containing proteins associated with different pathological conditions. The unique properties of L1 have attracted the interest of many investigators for drug repurposing and use in many pathological conditions, including cancer, neurodegenerative conditions, microbial conditions, renal conditions, free radical pathology, metal intoxication in relation to Fe, Cu, Al, Zn, Ga, In, U, and Pu, and other diseases. Similarly, the properties of L1 increase the prospects of its wider use in optimizing therapeutic efforts in many other fields of medicine, including synergies with other drugs.
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Affiliation(s)
- George J Kontoghiorghes
- Postgraduate Research Institute of Science, Technology, Environment and Medicine, Limassol 3021, Cyprus
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Kohlbry P, Al-Karmi B, Yamashita R. Quality-of-life of patients living with thalassaemia in the West Bank and Gaza. East Mediterr Health J 2023; 29:425-435. [PMID: 37551754 DOI: 10.26719/emhj.23.045] [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] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/21/2022] [Indexed: 08/09/2023]
Abstract
Background In countries with low resources, the health and quality-of-life of people living with thalassaemia can be severely affected. Aims This study examined the health-related quality-of-life of people living with thalassaemia in the West Bank and Gaza, Palestine. Methods This was a cross-sectional study of a convenience sample of 104 patients (71 adults and 33 children) who lived with thalassaemia and their families in 2015 in the West Bank and Gaza. Participants were surveyed using the 36-item Short Form Health Survey, version 2 (SF36v2), Pediatric Quality of Life InventoryTM (PedsQL) and PedsQL Family Impact Module to assess their quality-of-life. With the SF36v2, we used normed-based scoring and for the PedsQL and Family Impact Module, we used the 0-100 scoring. Scores are reported as means and standard deviations and P < 0.05 considered statistically significant. Results Quality-of-life scores were low across all domains, indicating poor quality-of-life. For bodily pain in the SF36v2, a significant difference was observed between the West Bank and Gaza. No significant differences were found between males and females. Data from the PedsQL showed no significant differences between the West Bank and Gaza. With the Family Impact Module, the summary score was higher among adults than among paediatric patients. Compared with other countries, thalassaemia patients in Palestine generally had lower quality-of-life scores in most domains. Conclusion The lack of access to healthcare and blood transfusions, and the geopolitical challenges may be responsible for the low quality-of-life scores of patients living with thalassaemia in Palestine.
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Affiliation(s)
- Pamela Kohlbry
- School of Nursing, California State University San Marcos, San Marcos, CA, United States of America
| | - Bashar Al-Karmi
- Thalassemia Patients Friends Society, Ramalla, West Bank, Palestine
| | - Robert Yamashita
- California State University San Marcos, San Marcos, CA, United States of America
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Bain BJ, Daniel Y, Henthorn J, de la Salle B, Hogan A, Roy NBA, Mooney C, Langabeer L, Rees DC. Significant haemoglobinopathies: A guideline for screening and diagnosis: A British Society for Haematology Guideline: A British Society for Haematology Guideline. Br J Haematol 2023; 201:1047-1065. [PMID: 37271570 DOI: 10.1111/bjh.18794] [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: 01/01/2023] [Revised: 03/12/2023] [Accepted: 03/24/2023] [Indexed: 06/06/2023]
Abstract
Antenatal screening/testing of pregnant women should be carried out according to the guidelines of the National Health Service (NHS) Sickle Cell and Thalassaemia Screening Programme. Newborn screening and, when necessary, follow-up testing and referral, should be carried out according to the guidelines of the NHS Sickle Cell and Thalassaemia Screening Programme. All babies under 1 year of age arriving in the United Kingdom should be offered screening for sickle cell disease (SCD). Preoperative screening for SCD should be carried out in patients from ethnic groups in which there is a significant prevalence of the condition. Emergency screening with a sickle solubility test must always be followed by definitive analysis. Laboratories performing antenatal screening should utilise methods that are capable of detecting significant variants and are capable of quantitating haemoglobins A2 and F at the cut-off points required by the national antenatal screening programme. The laboratory must ensure a provisional report is available for antenatal patients within three working days from sample receipt.
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Affiliation(s)
- Barbara J Bain
- Centre for Haematology, St Mary's Hospital Campus of Imperial College, St Mary's Hospital, London, UK
| | - Yvonne Daniel
- Synnovis, Guy's and St Thomas Hospital, London, UK
- The NHS Sickle Cell and Thalassaemia (SCT) Screening Programme, London, UK
| | - Joan Henthorn
- The NHS Sickle Cell and Thalassaemia (SCT) Screening Programme, London, UK
| | | | - Amanda Hogan
- The NHS Sickle Cell and Thalassaemia (SCT) Screening Programme, London, UK
| | - Noémi B A Roy
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ciaran Mooney
- Department of Haematology, St Vincent's Hospital, Dublin, Ireland
| | - Lisa Langabeer
- Department of Haematology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - David C Rees
- The NHS Sickle Cell and Thalassaemia (SCT) Screening Programme, London, UK
- Department of Paediatric Haematology, School of Medicine, King's College London, King's College Hospital, London, UK
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Myburgh JK, Szydlo RM, Bain BJ. The accuracy of haemoglobin A 2 measurements in the presence and absence of haemoglobin S. EJHaem 2023; 4:437-441. [PMID: 37206262 PMCID: PMC10188449 DOI: 10.1002/jha2.691] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 05/21/2023]
Abstract
The quantification of haemoglobin A2 by high-performance liquid chromatography (HPLC) was compared with quantification by capillary electrophoresis for control subjects and patients with sickle cell trait or sickle cell anaemia. Significant differences were found, with estimated values being higher by HPLC for control subjects and higher by capillary electrophoresis for sickle cell trait and sickle cell anaemia patients. There is an ongoing need for improved standardisation and alignment of methods.
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Affiliation(s)
| | - Richard M. Szydlo
- Centre for HaematologyDepartment of Immunology and InflammationHammersmith Hospital Campus of Imperial College Faculty of MedicineLondonUK
| | - Barbara J. Bain
- Centre for HaematologyDepartment of Immunology and InflammationSt Mary's Hospital Campus of Imperial College LondonLondonUK
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12
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Hokland P, Daar S, Khair W, Sheth S, Taher AT, Torti L, Hantaweepant C, Rund D. Thalassaemia-A global view. Br J Haematol 2023; 201:199-214. [PMID: 36799486 DOI: 10.1111/bjh.18671] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 11/25/2022] [Revised: 01/10/2023] [Accepted: 01/15/2023] [Indexed: 02/18/2023]
Abstract
The thalassaemias are a group of genetic disorders of haemoglobin which are endemic in the tropics but are now found worldwide due to migration. Basic standard of care therapy includes regular transfusions to maintain a haemoglobin level of around 10 g/dL, together with iron chelation therapy to prevent iron overload. Novel therapies, bone marrow transplantation, and gene therapy are treatment options that are unavailable in many countries with stressed economies. This Wider Perspectives article presents the strategies for management of an adolescent refugee patient with beta thalassaemia, as it would be performed by expert haematologists in six countries: Italy, Lebanon, Oman, the Sudan, Thailand and the United States. The experienced clinicians in each country have adapted their practice according to the resources available, which vary greatly. Even in the current modern era, providing adequate transfusions and chelation is problematic in many countries. On the other hand, ensuring adherence to therapy, particularly during adolescence, is a similar challenge seen in all countries. The concluding section highlights the disparities in available therapies and puts the role of novel therapies into a societal context.
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Affiliation(s)
- Peter Hokland
- Faculty of Health, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Shahina Daar
- College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Wael Khair
- Khartoum Oncology Hospital, Khartoum, Sudan
| | - Sujit Sheth
- Division of Hematology Oncology, Department of Pediatrics, Weill Cornell Medicine, New York City, New York, USA
| | - Ali T Taher
- Division of Hematology & Oncology, Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Lorenza Torti
- Hemoglobinopathies Unit, Hematology Department, S. Eugenio Hospital, (ASL Roma 2), Rome, Italy
| | - Chattree Hantaweepant
- Faculty of Medicine Siriraj Hospital, Division of Hematology, Department of Medicine, Mahidol University, Bangkok, Thailand
| | - Deborah Rund
- Department of Haematology, Hebrew University-Hadassah Medical Centre, Jerusalem, Israel
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13
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Hu J, Gong S, Chen K, Yang R, Wang L, Yang K, Nie L, Zou L, Su T, Chen C, Xu Y, He X, Yang L, Xiao H, Fu B. Haploidentical transplant for paediatric patients with severe thalassaemia using post-transplant cyclophosphamide and methotrexate: A prospectively registered multicentre trial from the Bone Marrow Failure Working Group of Hunan Province, China. Br J Haematol 2023; 200:329-337. [PMID: 36254684 DOI: 10.1111/bjh.18520] [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: 08/25/2022] [Revised: 09/24/2022] [Accepted: 10/05/2022] [Indexed: 01/21/2023]
Abstract
Haploidentical transplantation strategies for patients with transfusion-dependent thalassaemia (TD-TM) remain to be investigated. In this study, 54 paediatric patients with TD-TM were treated with a novel approach using post-transplant cyclophosphamide (PTCy) and low-dose methotrexate (LD-MTX), following a myeloablative regimen. The incidence of neutrophil and platelet engraftment was 96.3% ± 2.6% and 94.4% ± 3.1% respectively. The cumulative incidence of grades II-III acute graft-versus-host disease (GVHD) was 13.8% ± 4.8% at 100 days. At three years, the cumulative incidence of chronic GVHD was 28.5% ± 8.5%. With a median follow-up of 520 days (132-1325 days), the overall survival (OS) and event-free survival (EFS) were 98.1% ± 1.8% and 90.7% ± 3.9% respectively. Compared with the low-dose cyclophosphamide (CTX) conditioning regimen (120 mg/kg), the high-CTX regimen (200 mg/kg) achieved a higher incidence of stable engraftment (100% vs 66.7% ± 15.7%, p = 0.003), a comparable incidence of grades II-III acute GVHD, a lower incidence of chronic GVHD (20.2% ± 8.3% vs 66.6% ± 19.2%, p = 0.011), and better overall survival (100% vs 88.9% ± 10.5%, p = 0.025) as well as EFS (95.6% ± 3.1% vs 66.7% ± 15.7%, p = 0.008). Our results using unmanipulated haploidentical grafts and PTCy with LD-MTX in TD-TM are encouraging. (chictr.org.cn ChiCTR1800017969).
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Affiliation(s)
- Jian Hu
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, China
| | - Susu Gong
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, China
| | - Keke Chen
- Department of Pediatric Hematology, Hunan Provincial People's Hospital, Changsha, China
| | - Rui Yang
- Department of Pediatric Hematology, First People's Hospital of Chenzhou, Chenzhou, China
| | - Leyuan Wang
- Department of Pediatric Hematology, Xiangya Hospital of Central South University, Changsha, China
| | - Kaitai Yang
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, China
| | - Lin Nie
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, China
| | - Lang Zou
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, China
| | - Tao Su
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, China
| | - Cong Chen
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, China
| | - Yajing Xu
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Diseases, Changsha, China.,National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Hangzhou, China
| | - Xianglin He
- Department of Pediatric Hematology, Hunan Provincial People's Hospital, Changsha, China
| | - Liangchun Yang
- Department of Pediatric Hematology, Xiangya Hospital of Central South University, Changsha, China
| | - Hong Xiao
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, China
| | - Bin Fu
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Diseases, Changsha, China.,National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Hangzhou, China
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14
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Nguyen PC, Tiong IS, Westerman DA, Blombery P. A novel ATRX variant with splicing consequences in myelodysplastic syndrome with acquired alpha thalassaemia. Br J Haematol 2023; 200:e13-e16. [PMID: 36278851 DOI: 10.1111/bjh.18525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/08/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Phillip C Nguyen
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ing Soo Tiong
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David A Westerman
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Piers Blombery
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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15
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Tran NT, Sutcharitchan P, Janprasit J, Rojnuckarin P, Morales NP, Luechapudiporn R. Deferiprone, an iron chelator, alleviates platelet hyperactivity in patients with β- thalassaemia/HbE. Drugs Context 2022; 11:dic-2022-7-6. [PMID: 36544626 PMCID: PMC9753601 DOI: 10.7573/dic.2022-7-6] [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: 07/11/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022] Open
Abstract
Background Hyperfunctional platelets play important roles in thromboembolism in patients with β-thalassaemia/ haemoglobin E (β-thal/HbE). Our previous study revealed ex vivo inhibitory effects of deferiprone on normal platelets. Herein, we aimed to investigate the in vivo effects on platelets in patients with β-thal/HbE. Methods A prospective, self-controlled clinical study on 30 patients with β-thal/HbE who had received therapeutic deferiprone (20.8-94.5 mg/kg/day) was conducted. The study included a 4-week washout period followed by 4 and 12 weeks of deferiprone treatment. Platelet aggregation was performed by a turbidimetric method. Levels of deferiprone and soluble platelet (sP)-selectin in serum were measured by high-performance liquid chromatography (HPLC) and enzyme-linked immunosorbent assay (ELISA) kit, respectively. Results The washout period significantly enhanced platelet hyperactivity both in patients who had undergone splenectomy and in those who had not. At 2 hours following the administration of a single dose of deferiprone, platelet sensitivity to ADP and arachidonic acid was significantly reduced. The inhibitory effects of deferiprone were gradually increased over the period of 4 and 12 weeks. Deferiprone also depressed sP-selectin levels, but the effect was stable over longer follow-up periods. Correlation analysis demonstrated the relationship between serum levels of deferiprone, sP-selectin, and platelet activities induced by ADP and arachidonic acid. Conclusion We first demonstrated the in vivo antiplatelet effect and benefit of short-term treatment of deferiprone in patients with β-thal/HbE. The impact on thrombotic outcomes deserves further study.
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Affiliation(s)
- Ngan Thi Tran
- Pharmacology and Toxicology Program, Department of Pharmacology and Physiology, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand,Pharmacy Practice Department, Faculty of Pharmacy, Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Pranee Sutcharitchan
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jindaporn Janprasit
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Ponlapat Rojnuckarin
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Rataya Luechapudiporn
- Department of Pharmacology and Physiology, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand,Center of Excellence in Natural Products for Ageing and Chronic Diseases, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
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16
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Ake-Sittipaisarn S, Sirichotiyakul S, Srisupundit K, Luewan S, Traisrisilp K, Tongsong T. Outcomes of pregnancies complicated by haemoglobin H-constant spring and deletional haemoglobin H disease: A retrospective cohort study. Br J Haematol 2022; 199:122-129. [PMID: 35771858 DOI: 10.1111/bjh.18338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/30/2022] [Accepted: 06/15/2022] [Indexed: 01/19/2023]
Abstract
The objective of the study was to compare the maternal and foetal outcomes of pregnancies complicated by Hb H-constant spring (HbH-CS) disease/deletional HbH (HbH-del) disease and low-risk pregnancies. A retrospective cohort research was undertaken on singleton pregnancies with Hb H-CS and Hb H-del diseases. The controls were randomly selected with a control-to-case ratio of 10:1. A total of 55 cases of HbH-CS disease, 231 cases of HbH-del disease and 2860 controls were compared. The mean gestational age at delivery and birthweight were significantly lower in the HbH-CS group than in the HbH-del and control groups. The clinical course of Hb H-CS was more severe than that of HbH-del disease. The rates of preterm birth, foetal growth restriction and low birthweight were significantly increased in the HbH-CS and Hb H-del groups. These rates were significantly greater in the HbH-CS group than in the H-del group. The maternal outcomes were not significantly different among the three groups. In conclusion, pregnancy worsens the course of HbH disease, more noticeably in HbH-CS disease. Hb H disease significantly increases the risk of adverse foetal outcomes, more noticeably in the HbH-CS group. Pregnancy is relatively safe for women with HbH disease.
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Affiliation(s)
| | - Supatra Sirichotiyakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kasemsri Srisupundit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suchaya Luewan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kuntharee Traisrisilp
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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17
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El-Battrawy I, Longo F, Núñez Gil IJ, Abumayyaleh M, Gianesin B, Estrada V, Aparisi Á, Arroyo-Espliguero R, Balocco M, Barella S, Beccaria A, Bonetti F, Casale M, De Michele E, Denotti AR, Fidone C, Fortini M, Gamberini MR, Graziadei G, Lisi R, Massa A, Marcon A, Rubinski B, Miano M, Motta I, Pinto VM, Piperno A, Mariani R, Putti MC, Quota A, Ribersani M, Marziali M, Roberti D, Rosso R, Tartaglione I, Vitucci A, Voi V, Zecca M, Romero R, Marouneld C, Fernández-Rozas I, Espejo C, Marhaeni W, Garcia Aguado M, Cappellini MD, Perrotta S, De Franceschi L, Piga A, Forni GL, Akin I. Thalassaemia is paradoxically associated with a reduced risk of in-hospital complications and mortality in COVID-19: Data from an international registry. J Cell Mol Med 2022; 26:2520-2528. [PMID: 35355397 PMCID: PMC9077285 DOI: 10.1111/jcmm.17026] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/18/2021] [Accepted: 09/30/2021] [Indexed: 11/29/2022] Open
Abstract
Although numerous patient-specific co-factors have been shown to be associated with worse outcomes in COVID-19, the prognostic value of thalassaemic syndromes in COVID-19 patients remains poorly understood. We studied the outcomes of 137 COVID-19 patients with a history of transfusion-dependent thalassaemia (TDT) and transfusion independent thalassaemia (TIT) extracted from a large international cohort and compared them with the outcomes from a matched cohort of COVID-19 patients with no history of thalassaemia. The mean age of thalassaemia patients included in our study was 41 ± 16 years (48.9% male). Almost 81% of these patients suffered from TDT requiring blood transfusions on a regular basis. 38.7% of patients were blood group O. Cardiac iron overload was documented in 6.8% of study patients, whereas liver iron overload was documented in 35% of study patients. 40% of thalassaemia patients had a history of splenectomy. 27.7% of study patients required hospitalization due to COVID-19 infection. Amongst the hospitalized patients, one patient died (0.7%) and one patient required intubation. Continuous positive airway pressure (CPAP) was required in almost 5% of study patients. After adjustment for age-, sex- and other known risk factors (cardiac disease, kidney disease and pulmonary disease), the rate of in-hospital complications (supplemental oxygen use, admission to an intensive care unit for CPAP therapy or intubation) and all-cause mortality was significantly lower in the thalassaemia group compared to the matched cohort with no history of thalassaemia. Amongst thalassaemia patients in general, the TIT group exhibited a higher rate of hospitalization compared to the TDT group (p = 0.001). In addition, the rate of complications such as acute kidney injury and need for supplemental oxygen was significantly higher in the TIT group compared to the TDT group. In the multivariable logistic regression analysis, age and history of heart or kidney disease were all found to be independent risk factors for increased in-hospital, all-cause mortality, whereas the presence of thalassaemia (either TDT or TIT) was found to be independently associated with reduced all-cause mortality. The presence of thalassaemia in COVID-19 patients was independently associated with lower in-hospital, all-cause mortality and few in-hospital complications in our study. The pathophysiology of this is unclear and needs to be studied in vitro and in animal models.
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Affiliation(s)
- Ibrahim El-Battrawy
- University of Mannheim, Mannheim, Germany.,Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Filomena Longo
- Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación, Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | | | | | - Vicente Estrada
- Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación, Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | | | - Manuela Balocco
- SSD Talassemia. Ospedale Pediatrico Microcitemico A. Cao, Cagliari, Italy
| | | | | | - Federico Bonetti
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | | | - Elisa De Michele
- Unità operativa semplice Studio Emoglobinopatie Simt, Ragusa, Italy
| | - Anna Rita Denotti
- SSD Talassemia. Ospedale Pediatrico Microcitemico A. Cao, Cagliari, Italy
| | - Carmelo Fidone
- Azienda Ospedaliero-Universitaria S.Anna di Ferrara, Ferrara, Italy
| | - Monica Fortini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Giovanna Graziadei
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, Catania, Italy
| | | | - Antonella Massa
- ASST-Monza, S.Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Alessia Marcon
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Irene Motta
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | | | | | - Michela Ribersani
- Azienda Ospedaliero-Universitaria Policlinico "Vittorio Emanuele", Catania, Italy
| | - Marco Marziali
- Azienda Ospedaliera Universitaria Policlinico, Bari, Italy
| | - Domenico Roberti
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | | | - Immacolata Tartaglione
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | | | - Vincenzo Voi
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Marco Zecca
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rodolfo Romero
- HOSPITAL UNIVERSITARIO LA PAZ, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | | | | | - Carolina Espejo
- Pediatrics Department, Hematology-Oncology Division, Faculty of Medicine, Lambung Mangkurat University, Banjarmasin, Indonesia
| | - Wulandewi Marhaeni
- Cardiology Department, Hospital Puerta de Hierro de Majadahonda, Majadahonda, Madrid, Spain
| | - Marcos Garcia Aguado
- Department of Cardiology, BG Universitätsklinikum Bochum, Ruhr-Universität Bochum, Bochum, Germany
| | - Maria Domenica Cappellini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silverio Perrotta
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | | | - Antonio Piga
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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18
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Mohd Nor MA, Idris NS, Mohd Zulkifli M, Abu Bakar R, Ahmad I. Thalassemia screening: Low level of knowledge among unmarried youths in Kota Bharu, Kelantan, Malaysia. Malays Fam Physician 2022; 17:57-65. [PMID: 35440956 PMCID: PMC9004431 DOI: 10.51866/oa.31] [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: 06/14/2023]
Abstract
INTRODUCTION Thalassaemia is a common genetic blood disorder. Knowledge, awareness, attitude towards, and intention to screen for thalassaemia among Malaysians is poor. Screening for thalassaemia in unmarried individuals plays a key role in preventing thalassaemia major births. METHODS A cross-sectional study was conducted on unmarried individuals aged 18 years and older in Kota Bharu, Kelantan, Malaysia. A questionnaire was used to collect the general data of the participants, their knowledge of thalassaemia, attitude towards thalassaemia, and intention to screen for thalassaemia. RESULTS A total of 278 respondents were included in this study. The mean (SD) knowledge score was 8.8 (4.99) out of a possible score of 21, with higher scores indicating better knowledge. The factor associated with good knowledge of thalassaemia was being a professional. Most respondents agreed that unmarried individuals should be screened for thalassaemia before marriage. CONCLUSION In conclusion, knowledge of thalassaemia among unmarried individuals who were not professionals was low.
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Affiliation(s)
- Muhammad Akmal Mohd Nor
- MD, MMed (Family Medicine), Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Nur Suhaila Idris
- MD, MMed (Family Medicine), Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Maryam Mohd Zulkifli
- MBBS, MMed (Family Medicine), Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ruzilawati Abu Bakar
- PhD, Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Imran Ahmad
- MBBS, MMed (Family Medicine), Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia,
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19
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Delaporta P, Terpos E, Solomou EE, Gumeni S, Nitsa E, Apostolakou F, Kyriakopoulou D, Ntanasis-Stathopoulos I, Papassotiriou I, Trougakos IP, Dimopoulos MA, Kattamis A. Immune response and adverse events after vaccination against SARS-CoV-2 in adult patients with transfusion-dependent thalassaemia. Br J Haematol 2022; 197:576-579. [PMID: 35286720 PMCID: PMC9111727 DOI: 10.1111/bjh.18146] [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: 12/19/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
Abstract
Patients with transfusion‐dependent thalassaemia (TDT) are considered an at increased‐risk population for severe and/or morbid coronavirus disease 2019 (COVID‐19) infection. Timely vaccination is the main preventive method for severe COVID‐19. Different adverse events and reactions after vaccination have been reported, with severe ones being extremely rare. Patients with TDT may have altered immunity due to chronic transfusions, iron overload and chelation therapy, and splenic dysfunction. Here, we show that adult patients with TDT following vaccination with the novel messenger RNA vaccines have mild adverse events and can produce protective antibodies comparable to the healthy population.
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Affiliation(s)
- Polyxeni Delaporta
- Thalassaemia Unit, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Elena E Solomou
- Thalassaemia Unit, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Sentiljana Gumeni
- Department of Cell Biology and Biophysics, Faculty of Biology, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Nitsa
- Thalassaemia Unit, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Filia Apostolakou
- Department of Clinical Biochemistry, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Dimitra Kyriakopoulou
- Thalassaemia Unit, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Ioannis P Trougakos
- Department of Cell Biology and Biophysics, Faculty of Biology, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Kattamis
- Thalassaemia Unit, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece
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20
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Borella E, Oosterholt S, Magni P, Pasqua OD. Characterisation of individual ferritin response in patients receiving chelation therapy. Br J Clin Pharmacol 2022; 88:3683-3694. [PMID: 35199367 PMCID: PMC9544664 DOI: 10.1111/bcp.15290] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 08/29/2021] [Revised: 12/21/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022] Open
Abstract
Aims To develop a drug–disease model describing iron overload and its effect on ferritin response in patients affected by transfusion‐dependent haemoglobinopathies and investigate the contribution of interindividual differences in demographic and clinical factors on chelation therapy with deferiprone or deferasirox. Methods Individual and mean serum ferritin data were retrieved from 13 published studies in patients affected by haemoglobinopathies receiving deferiprone or deferasirox. A nonlinear mixed effects modelling approach was used to characterise iron homeostasis and serum ferritin production taking into account annual blood consumption, baseline demographic and clinical characteristics. The effect of chelation therapy was parameterised as an increase in the iron elimination rate. Internal and external validation procedures were used to assess model performance across different study populations. Results An indirect response model was identified, including baseline ferritin concentrations and annual blood consumption as covariates. The effect of chelation on iron elimination rate was characterised by a linear function, with different slopes for each drug (0.0109 [90% CI: 0.0079–0.0131] vs. 0.0013 [90% CI: 0.0008–0.0018] L/mg mo). In addition to drug‐specific differences in the magnitude of the ferritin response, simulation scenarios indicate that ferritin elimination rates depend on ferritin concentrations at baseline. Conclusion Modelling of serum ferritin following chronic blood transfusion enabled the evaluation of drug‐induced changes in iron elimination rate and ferritin production. The use of a semi‐mechanistic parameterisation allowed us to disentangle disease‐specific factors from drug‐specific properties. Despite comparable chelation mechanisms, deferiprone appears to have a significantly larger effect on the iron elimination rate than deferasirox.
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Affiliation(s)
- Elisa Borella
- Department of Industrial Engineering and Informatics, Università degli Studi di Pavia, Pavia, Italy
| | - Sean Oosterholt
- Clinical Pharmacology & Therapeutics Group, University College London, London, United Kingdom
| | - Paolo Magni
- Department of Industrial Engineering and Informatics, Università degli Studi di Pavia, Pavia, Italy
| | - Oscar Della Pasqua
- Clinical Pharmacology & Therapeutics Group, University College London, London, United Kingdom.,Clinical Pharmacology Modelling & Simulation, GlaxoSmithKline, Brentford, United Kingdom
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21
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Zargari A, Wu S, Greenway A, Cheng K, Kaplan Z. Effects of dual chelation therapy with deferasirox and deferoxamine in patients with beta thalassaemia major. Vox Sang 2022; 117:733-737. [PMID: 35014065 DOI: 10.1111/vox.13248] [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: 05/26/2021] [Revised: 12/04/2021] [Accepted: 12/10/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Patients with thalassaemia experience complications related to iron overload. In Australia currently, the two main options for iron chelation are deferasirox and deferoxamine. Optimal iron chelation using monotherapy can be limited due to toxicity or tolerability. Dual chelation therapy (DCT) may provide more aggressive iron chelation. MATERIAL AND METHODS A retrospective, observational study was performed on a state-wide referral centre for patients receiving red cell transfusions for haemoglobinopathies (Monash Health, Australia). All patients prescribed DCT were identified using a local pharmacy dispensing database and were included in the study. Pre-DCT initiation and post-DCT completion were correlated with serum ferritin, cardiac iron loading (based on MRI T2* measurements) and liver iron content (LIC) using Wilcoxon signed-rank test. RESULTS A total of 18 patients (12 adults, 6 children) were identified as receiving DCT. All patients received a combination of deferasirox and deferoxamine. The median duration of therapy was 23 months (range 2-73). Median serum ferritin reduced by 42% (p = 0.004) and there was a 76% reduction in LIC (p = 0.062). No significant changes were seen in cardiac iron loading. CONCLUSION DCT over a prolonged period is effective at reducing serum ferritin and may contribute to improvement in liver iron loading.
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Affiliation(s)
- Ahmad Zargari
- Department of Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Simon Wu
- Department of Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Anthea Greenway
- Department of Haematology, Monash Health, Melbourne, Victoria, Australia.,Haematology Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ken Cheng
- Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Zane Kaplan
- Department of Haematology, Monash Health, Melbourne, Victoria, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
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22
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Shah FT, Porter JB, Sadasivam N, Kaya B, Moon JC, Velangi M, Ako E, Pancham S. Guidelines for the monitoring and management of iron overload in patients with haemoglobinopathies and rare anaemias. Br J Haematol 2022; 196:336-350. [PMID: 34617272 DOI: 10.1111/bjh.17839] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/10/2021] [Accepted: 09/02/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Farrukh T Shah
- Department of Haematology, Whittington Health, London, UK
| | - John B Porter
- Department of Haematology, University College Hospitals, London, UK
| | - Nandini Sadasivam
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - Banu Kaya
- Department of Paediatric Haematology and Oncology, Barts Health NHS Trust, London, UK
| | - James C Moon
- Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, UK
- Institutes for Cardiovascular Science, University College London, London, UK
| | - Mark Velangi
- Department of Haematology, Birmingham Children's Hospital, Birmingham, UK
| | - Emmanuel Ako
- Department of Cardiology, Chelsea and Westminster Hospital, London, UK
| | - Shivan Pancham
- Department of Haematology, Sandwell and West Birmingham NHS Trust, West Bromwich, UK
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23
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Tamana S, Xenophontos M, Minaidou A, Stephanou C, Harteveld CL, Bento C, Traeger-Synodinos J, Fylaktou I, Yasin NM, Abdul Hamid FS, Esa E, Halim-Fikri H, Zilfalil BA, Kakouri AC, Kleanthous M, Kountouris P. Evaluation of in silico predictors on short nucleotide variants in HBA1, HBA2, and HBB associated with haemoglobinopathies. eLife 2022; 11:79713. [PMID: 36453528 PMCID: PMC9731569 DOI: 10.7554/elife.79713] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022] Open
Abstract
Haemoglobinopathies are the commonest monogenic diseases worldwide and are caused by variants in the globin gene clusters. With over 2400 variants detected to date, their interpretation using the American College of Medical Genetics and Genomics (ACMG)/Association for Molecular Pathology (AMP) guidelines is challenging and computational evidence can provide valuable input about their functional annotation. While many in silico predictors have already been developed, their performance varies for different genes and diseases. In this study, we evaluate 31 in silico predictors using a dataset of 1627 variants in HBA1, HBA2, and HBB. By varying the decision threshold for each tool, we analyse their performance (a) as binary classifiers of pathogenicity and (b) by using different non-overlapping pathogenic and benign thresholds for their optimal use in the ACMG/AMP framework. Our results show that CADD, Eigen-PC, and REVEL are the overall top performers, with the former reaching moderate strength level for pathogenic prediction. Eigen-PC and REVEL achieve the highest accuracies for missense variants, while CADD is also a reliable predictor of non-missense variants. Moreover, SpliceAI is the top performing splicing predictor, reaching strong level of evidence, while GERP++ and phyloP are the most accurate conservation tools. This study provides evidence about the optimal use of computational tools in globin gene clusters under the ACMG/AMP framework.
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Affiliation(s)
- Stella Tamana
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and GeneticsNicosiaCyprus
| | - Maria Xenophontos
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and GeneticsNicosiaCyprus
| | - Anna Minaidou
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and GeneticsNicosiaCyprus
| | - Coralea Stephanou
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and GeneticsNicosiaCyprus
| | - Cornelis L Harteveld
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and GeneticsNicosiaCyprus,Leiden University Medical CenterLeidenNetherlands
| | - Celeste Bento
- Centro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | | | - Irene Fylaktou
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of AthensAthensGreece
| | - Norafiza Mohd Yasin
- Haematology Unit, Cancer Research Centre, Institute for Medical Research, National Health of Institutes (NIH), Ministry of Health MalaysiaSelangorMalaysia
| | - Faidatul Syazlin Abdul Hamid
- Haematology Unit, Cancer Research Centre, Institute for Medical Research, National Health of Institutes (NIH), Ministry of Health MalaysiaSelangorMalaysia
| | - Ezalia Esa
- Haematology Unit, Cancer Research Centre, Institute for Medical Research, National Health of Institutes (NIH), Ministry of Health MalaysiaSelangorMalaysia
| | - Hashim Halim-Fikri
- Malaysian Node of the Human Variome Project, School of Medical Sciences, Health Campus, Universiti Sains MalaysiaKelantanMalaysia
| | - Bin Alwi Zilfalil
- Human Genome Centre, School of Medical Sciences, Health Campus, Universiti Sains MalaysiaKelantanMalaysia
| | - Andrea C Kakouri
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and GeneticsNicosiaCyprus
| | | | - Marina Kleanthous
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and GeneticsNicosiaCyprus
| | - Petros Kountouris
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and GeneticsNicosiaCyprus
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24
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Constantinou V, Papayanni PG, Mallouri D, Batsis I, Bouinta A, Papadopoulou D, Papadimitriou V, Kammenou M, Pantelidou D, Sotiropoulos D, Sakellari I, Anagnostopoulos A, Yannaki E. Case study of betibeglogene autotemcel gene therapy in an adult Greek patient with transfusion-dependent β- thalassaemia of a severe genotype. Br J Haematol 2021; 196:1401-1404. [PMID: 34957544 DOI: 10.1111/bjh.17965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Varnavas Constantinou
- Gene and Cell Therapy Center of the Hematology Department/Hematopoietic Cell Transplantation Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Penelope-Georgia Papayanni
- Gene and Cell Therapy Center of the Hematology Department/Hematopoietic Cell Transplantation Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Despina Mallouri
- Gene and Cell Therapy Center of the Hematology Department/Hematopoietic Cell Transplantation Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Ioannis Batsis
- Gene and Cell Therapy Center of the Hematology Department/Hematopoietic Cell Transplantation Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Asimina Bouinta
- Gene and Cell Therapy Center of the Hematology Department/Hematopoietic Cell Transplantation Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Despoina Papadopoulou
- Gene and Cell Therapy Center of the Hematology Department/Hematopoietic Cell Transplantation Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Vasiliki Papadimitriou
- Gene and Cell Therapy Center of the Hematology Department/Hematopoietic Cell Transplantation Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Maria Kammenou
- Gene and Cell Therapy Center of the Hematology Department/Hematopoietic Cell Transplantation Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Damianos Sotiropoulos
- Gene and Cell Therapy Center of the Hematology Department/Hematopoietic Cell Transplantation Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Ioanna Sakellari
- Gene and Cell Therapy Center of the Hematology Department/Hematopoietic Cell Transplantation Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Achilles Anagnostopoulos
- Gene and Cell Therapy Center of the Hematology Department/Hematopoietic Cell Transplantation Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Evangelia Yannaki
- Gene and Cell Therapy Center of the Hematology Department/Hematopoietic Cell Transplantation Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
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25
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Charnay T, Cerino M, Gonnet K, Bonello-Palot N, Bréchard MP, Badens C. A novel SUPT5H variant associated with a beta- thalassaemia trait. Br J Haematol 2021; 196:e70-e71. [PMID: 34854076 DOI: 10.1111/bjh.17985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/22/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Theo Charnay
- Department of genetics, APHM, Marseille, France.,Aix Marseille Univ, MMG, U 1251, Marseille, France
| | - Mathieu Cerino
- Department of genetics, APHM, Marseille, France.,Aix Marseille Univ, MMG, U 1251, Marseille, France
| | | | - Nathalie Bonello-Palot
- Department of genetics, APHM, Marseille, France.,Aix Marseille Univ, MMG, U 1251, Marseille, France
| | | | - Catherine Badens
- Department of genetics, APHM, Marseille, France.,Aix Marseille Univ, MMG, U 1251, Marseille, France
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26
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Chapin J, Cohen AR, Neufeld EJ, Vichinsky E, Giardina PJ, Boudreaux J, Le BC, Kenney K, Trimble S, Thompson AA. An update on the US adult thalassaemia population: a report from the CDC thalassaemia treatment centres. Br J Haematol 2021; 196:380-389. [PMID: 34775608 DOI: 10.1111/bjh.17920] [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: 06/17/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023]
Abstract
Thalassaemia is caused by genetic globin defects leading to anaemia, transfusion-dependence and comorbidities. Reduced survival and systemic organ disease affect transfusion-dependent thalassaemia major and thalassaemia intermedia. Recent improvements in clinical management have reduced thalassaemia mortality. The therapeutic landscape of thalassaemia may soon include gene therapies as functional cures. An analysis of the adult US thalassaemia population has not been performed since the Thalassemia Clinical Research Network cohort study from 2000 to 2006. The Centers for Disease Control and Prevention supported US thalassaemia treatment centres (TTCs) to compile longitudinal information on individuals with thalassaemia. This dataset provided an opportunity to evaluate iron balance, chelation, comorbidities and demographics of adults with thalassaemia receiving care at TTCs. Two adult cohorts were compared: those over 40 years old (n = 75) and younger adults ages 18-39 (n = 201). The older adult cohort was characterized by higher numbers of iron-related comorbidities and transfusion-related complications. By contrast, younger adults had excess hepatic and cardiac iron and were receiving combination chelation therapy. The ethnic composition of the younger cohort was predominantly of Asian origin, reflecting the demographics of immigration. These findings demonstrate that comprehensive care and periodic surveys are needed to ensure optimal health and access to emerging therapies.
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Affiliation(s)
- John Chapin
- Division of Hematology & Medical Oncology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Alan R Cohen
- Division of Hematology, Children's Hospital Philadelphia, Philadelphia, PA, USA
| | - Ellis J Neufeld
- Boston Children's Hospital- Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA.,Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Elliott Vichinsky
- Division of Hematology/Oncology, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Patricia J Giardina
- Division of Pediatric Hematology/Oncology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Jeanne Boudreaux
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA, USA
| | - Binh C Le
- Bleeding Team, Epidemiology & Surveillance Branch, Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristy Kenney
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sean Trimble
- NCIRD, Immunization Services Division, Vaccine Supply and Assurance Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alexis A Thompson
- Robert H Lurie Comprehensive Cancer Center of Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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27
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Roy NBA. Iron overload in inherited anaemias: why one size can't fit all. Br J Haematol 2021; 196:266-267. [PMID: 34708402 DOI: 10.1111/bjh.17905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Noémi B A Roy
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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28
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Rund D. Laboratory diagnosis of iron deficiency: look out for the 'PITTs'. Br J Haematol 2021; 196:464-465. [PMID: 34693513 DOI: 10.1111/bjh.17846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Deborah Rund
- Haematology Department, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel
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29
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Nagiria VR, Vince JD, Duke T. Living with thalassaemia in Papua New Guinea, the experience of children, adolescents and their families. J Paediatr Child Health 2021; 57:1589-1593. [PMID: 33949032 DOI: 10.1111/jpc.15538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Abstract
AIM Thalassaemia, the commonest genetic blood disorder in Papua New Guinea (PNG) presents daunting challenges for the affected children, their parents and families, and the health system. We aimed to describe the quality of life of affected children and adolescents and the experience of and difficulties faced by their parents in the setting of a tertiary referral hospital in PNG. METHODS A mixed-methods longitudinal study involving baseline questionnaire, then serial interviews with parents, children and adolescents living with β-thalassaemia attending Port Moresby General Hospital. RESULTS Twenty-one patients and their families were interviewed over a 6-month period. Most families originated outside the National Capital District and had migrated to be near the Port Moresby General Hospital and its blood bank services. Thirteen patients had at least one affected sibling and four families had experienced the death of at least one other affected child. No child was receiving chelating agents, and most had clinical evidence of iron overload. There were important impacts of thalassemia on quality of life, including very poor school attendance and some aspects of children's self-perception. Families faced significant burdens and made genuine sacrifices to care for their children. CONCLUSION Regular blood transfusions increase the life-span of children with thalassaemia but there is a need to achieve a hyper-transfusion regimen coupled with chelation therapy. As for all chronic illness, a focused and holistic approach is needed to improve the quality of life for affected children and their families.
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Affiliation(s)
- Violet Regina Nagiria
- Paediatric Department, Port Moresby General Hospital, Port Moresby, NCD, Papua New Guinea
| | - John D Vince
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Trevor Duke
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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30
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Badawy SM, Payne AB, Hulihan MM, Coates TD, Majumdar S, Smith D, Thompson AA. Concordance with comprehensive iron assessment, hepatitis A vaccination, and hepatitis B vaccination recommendations among patients with sickle cell disease and thalassaemia receiving chronic transfusions: an analysis from the Centers for Disease Control haemoglobinopathy blood safety project. Br J Haematol 2021; 195:e160-e164. [PMID: 34431082 DOI: 10.1111/bjh.17798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School Medicine, Chicago, IL, USA
| | - Amanda B Payne
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary M Hulihan
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas D Coates
- Cancer and Blood Disease Institute, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | | | - Dominic Smith
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Alexis A Thompson
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School Medicine, Chicago, IL, USA
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31
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Pantelidou D, Pilalas D, Daios S, Polychronopoulos G, Papadopoulou D, Perifanis V, Savopoulos C, Kaiafa G. Hyperhaemolytic transfusion reaction in two β- thalassaemia major patients: The role of eculizumab. J Clin Pharm Ther 2021; 47:411-414. [PMID: 34397109 DOI: 10.1111/jcpt.13510] [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: 04/01/2021] [Revised: 05/26/2021] [Accepted: 08/05/2021] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Hyperhaemolytic transfusion reactions are rare life-threatening events predominantly affecting patients with haemoglobinopathies. We report two cases in β-thalassaemia major patients on chronic transfusion therapy and highlight the role of eculizumab in its management. CASE SUMMARY Patient 1 presented with intravascular haemolysis on day 7 (D7) post-transfusion and responded to treatment with corticosteroids and intravenous immunoglobulin. However, patient 2 presented with severe symptomatic anaemia (D4 post-transfusion) unresponsive to the aforementioned measures. Eculizumab administration led to resolution of the hyperhaemolysis. WHAT IS NEW AND CONCLUSION We report the successful management of hyperhaemolysis with eculizumab in a β-thalassemia major patient.
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Affiliation(s)
| | - Dimitrios Pilalas
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stylianos Daios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Polychronopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Vassilios Perifanis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Kaiafa
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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32
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Abu Shosha GM, Al-Kalaldeh M, Shoqirat N. Nurses' experiences of psychosocial care needs of children with thalassaemia and their families in Jordan: A phenomenological study. Nurs Open 2021; 9:2858-2866. [PMID: 34288571 PMCID: PMC9584467 DOI: 10.1002/nop2.992] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/18/2021] [Accepted: 07/10/2021] [Indexed: 11/09/2022] Open
Abstract
AIM To explore the experiences of Jordanian nurses regarding the psychosocial care needs of children with thalassaemia and their families. DESIGN A descriptive phenomenological approach was employed. METHODS A purposive sampling strategy was used to select 10 nurses who had experience in caring for children with thalassaemia. Unstructured, face-to-face interviews were conducted. Coliazzi's data analysis process was applied. RESULTS The analysis revealed three major themes: (1) valuing psychosocial support; (2) caring for paediatric patients needs certain competencies in nurses and (3) barriers to providing psychosocial care. Nurses expressed the importance of providing psychosocial care. A lack of specialists in psychosocial care as well as a lack of screening tools, and entertainment facilities for children was identified to be impeding effective psychosocial care. Implementing training programmes for nurses concerning providing psychosocial care and making the appropriate changes in nursing curricula at the educational level are recommended.
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33
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Longo F, Piolatto A, Ferrero GB, Piga A. Ineffective Erythropoiesis in β- Thalassaemia: Key Steps and Therapeutic Options by Drugs. Int J Mol Sci 2021; 22:7229. [PMID: 34281283 DOI: 10.3390/ijms22137229] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 01/19/2023] Open
Abstract
β-thalassaemia is a rare genetic condition caused by mutations in the β-globin gene that result in severe iron-loading anaemia, maintained by a detrimental state of ineffective erythropoiesis (IE). The role of multiple mechanisms involved in the pathophysiology of the disease has been recently unravelled. The unbalanced production of α-globin is a major source of oxidative stress and membrane damage in red blood cells (RBC). In addition, IE is tightly linked to iron metabolism dysregulation, and the relevance of new players of this pathway, i.e., hepcidin, erythroferrone, matriptase-2, among others, has emerged. Advances have been made in understanding the balance between proliferation and maturation of erythroid precursors and the role of specific factors in this process, such as members of the TGF-β superfamily, and their downstream effectors, or the transcription factor GATA1. The increasing understanding of IE allowed for the development of a broad set of potential therapeutic options beyond the current standard of care. Many candidates of disease-modifying drugs are currently under clinical investigation, targeting the regulation of iron metabolism, the production of foetal haemoglobin, the maturation process, or the energetic balance and membrane stability of RBC. Overall, they provide tools and evidence for multiple and synergistic approaches that are effectively moving clinical research in β-thalassaemia from bench to bedside.
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34
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Wong PS, Yong LS, Karim NAB, Gan EL, Toh SG, Adam NLB. Rare Presentation of Right Adrenal Mass: Extramedullary Haematopoiesis in a Patient with Thalassaemia Intermedia. J ASEAN Fed Endocr Soc 2021; 36:80-4. [PMID: 34177092 DOI: 10.15605/jafes.036.01.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/25/2021] [Indexed: 11/17/2022] Open
Abstract
Extramedullary hematopoiesis (EMH) is a rare cause of adrenal mass. We present a 44-year-old woman who has thalassaemia intermedia, referred to Endocrinology clinic for huge adrenal mass. Along with a paraspinal lesion discovered in this patient, the leading diagnosis was EMH. The patient was treated with hypertransfusion and hydroxyurea, which led to a reduction in the size of the right adrenal mass and paraspinal mass. This case highlights the challenges in managing this rare condition. Although EMH is a rare cause of adrenal mass, the diagnosis must be considered in any patient with a history of a congenital hemolytic disorder, to avoid unnecessary surgical procedures.
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35
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Xu Y, Alfaro-Magallanes VM, Babitt JL. Physiological and pathophysiological mechanisms of hepcidin regulation: clinical implications for iron disorders. Br J Haematol 2021; 193:882-893. [PMID: 33316086 PMCID: PMC8164969 DOI: 10.1111/bjh.17252] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/04/2020] [Indexed: 02/06/2023]
Abstract
The discovery of hepcidin has provided a solid foundation for understanding the mechanisms of systemic iron homeostasis and the aetiologies of iron disorders. Hepcidin assures the balance of circulating and stored iron levels for multiple physiological processes including oxygen transport and erythropoiesis, while limiting the toxicity of excess iron. The liver is the major site where regulatory signals from iron, erythropoietic drive and inflammation are integrated to control hepcidin production. Pathologically, hepcidin dysregulation by genetic inactivation, ineffective erythropoiesis, or inflammation leads to diseases of iron deficiency or overload such as iron-refractory iron-deficiency anaemia, anaemia of inflammation, iron-loading anaemias and hereditary haemochromatosis. In the present review, we discuss recent insights into the molecular mechanisms governing hepcidin regulation, how these pathways are disrupted in iron disorders, and how this knowledge is being used to develop novel diagnostic and therapeutic strategies.
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Affiliation(s)
- Yang Xu
- Division of Nephrology, Program in Membrane Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Víctor M. Alfaro-Magallanes
- Division of Nephrology, Program in Membrane Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences, Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Jodie L. Babitt
- Division of Nephrology, Program in Membrane Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Sedick Q, Elyamany G, Hawsawi H, Alotaibi S, Alabbas F, Almohammadi M, Alahmari HA, Aljasem H, Ferrer AG, Alzahrani AS, AlMoshary M, Alsuhaibani O. Diagnostic accuracy of reticulocyte parameters on the sysmex XN 1000 for discriminating iron deficiency anaemia and thalassaemia in Saudi Arabia. Am J Blood Res 2021; 11:172-179. [PMID: 34079632 PMCID: PMC8165718] [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] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Iron deficient erythropoiesis and Thalassaemia are both associated with microcytic erythropoiesis albeit from different pathological mechanisms. Given the high prevalence of Hemoglobinopathies in the Mediterranean region, discriminating these two conditions is important. Several algorithms using conventional red cell indices have been developed to facilitate diagnosis, however, their diagnostic accuracy is low. The new generation haematology analyzers enabled the use of more innovative parameters such as reticulocyte parameters. We aimed to evaluate the diagnostic performance of the reticulocyte parameters on the Sysmex XN 1000 to distinguish between IDA and Thalassemia in our population. METHODS We performed a retrospective analysis of blood samples sent to our laboratory for haemoglobin electrophoresis screening. We categorized our cohort into Thalassemia and Iron Deficient patients based on known diagnostic criteria. We analyzed the reticulocyte parameters using receiver operator curve analysis (ROC) and determined the cut off value for each parameter. RESULTS Reticulocyte parameters most accurate for discriminating IDA from Thalassemia patients was: RET, RET-HE and IRF. The RET-HE had the best statistical significance for IDA patients with AUC = 0.69 for cut off 22.25. The RET-HE for dual positive patients was more accurate with AUC = 0.78 for cut off 21.25. The IRF had the best statistical significance for Alpha Thalassemia with AUC = 0.66 for cut off value 18. CONCLUSION An IRF cut off below 15.5 and RET-HE cut off below 22.25 was the most accurate variable in predicting IDA with a sensitivity of 59.4% and 68.3%.
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Affiliation(s)
- Qanita Sedick
- Central Military Laboratory and Blood Bank, Prince Sultan Military Medical CityRiyadh, Kingdom of Saudi Arabia
| | - Ghaleb Elyamany
- Central Military Laboratory and Blood Bank, Prince Sultan Military Medical CityRiyadh, Kingdom of Saudi Arabia
| | - Huda Hawsawi
- Central Military Laboratory and Blood Bank, Prince Sultan Military Medical CityRiyadh, Kingdom of Saudi Arabia
| | - Sultan Alotaibi
- Department of Adult Hematology, Prince Sultan Military Medical CityRiyadh, Kingdom of Saudi Arabia
| | - Fahad Alabbas
- Department of Pediatric Hematology/Oncology, Prince Sultan Military Medical CityRiyadh, Kingdom of Saudi Arabia
| | - Mohammed Almohammadi
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Pathology and Laboratory Medicine, King Abdulaziz Medical CityJeddah, Saudi Arabia
| | - Hassan A Alahmari
- Department of Pediatric Hematology/Oncology, Prince Sultan Military Medical CityRiyadh, Kingdom of Saudi Arabia
| | - Hassan Aljasem
- Department of Adult Hematology, Prince Sultan Military Medical CityRiyadh, Kingdom of Saudi Arabia
| | - Arnel G Ferrer
- Central Military Laboratory and Blood Bank, Prince Sultan Military Medical CityRiyadh, Kingdom of Saudi Arabia
| | - Ahmed S Alzahrani
- Central Military Laboratory and Blood Bank, Prince Sultan Military Medical CityRiyadh, Kingdom of Saudi Arabia
| | - May AlMoshary
- Basic Science Department, College of Medicine, Princess Nourah Bint Abdulrahman UniversityRiyadh, Kingdom of Saudi Arabia
| | - Omar Alsuhaibani
- Central Military Laboratory and Blood Bank, Prince Sultan Military Medical CityRiyadh, Kingdom of Saudi Arabia
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37
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Al-Eisawi Z, Jacoub K, Alsukker A. A large-scale study exploring understanding of the national premarital screening program among Jordanians: Is an at-risk marriage a valid option for Jordanians? Public Underst Sci 2021; 30:319-330. [PMID: 33148133 DOI: 10.1177/0963662520968468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Detecting carrier couples through premarital screening implementation is an effective way of controlling thalassaemia. The aim of this study was to investigate the knowledge of university students towards premarital screening and their possible involvement in an at-risk marriage. Students (n = 976) were chosen randomly from Jordanian universities. The questionnaire consisted of three sections: socio-demographical data, the students' knowledge about the screening programme, and finally their beliefs and future decisions related to it. Most (90%) participants were aware of the premarital screening availability. Females had significantly better understanding of premarital screening compared to males. Despite the majority of the participants not wanting to go ahead with at-risk marriages, 23% would not be deterred from marrying their anticipated partner and believed engaging in at-risk marriage was a valid idea. We suggest providing more effective educational programmes, genetic counselling and free prenatal diagnosis for at-risk couples.
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38
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Farooq A, Waheed U, Saba N, Kaleem M, Majeed N, Wazeer A, Cheema NA, Ahmed S, Arshad M. Molecular and genetic characterization of hepatitis B virus among multitransfused thalassaemia patients in Islamabad, Pakistan. J Family Med Prim Care 2021; 10:998-1002. [PMID: 34041111 PMCID: PMC8138360 DOI: 10.4103/jfmpc.jfmpc_1880_20] [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: 09/13/2020] [Revised: 10/24/2020] [Accepted: 12/09/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Hepatitis B virus (HBV) is the aetiological agent of transfusion-transmitted hepatitis globally. Beta thalassaemia major individuals are at greater risk of contracting HBV infection due to multiple blood transfusions required for the medical management of these patients. Based on HBV genetic variability, it is divided into 10 genotypes. The determination of HBV genotypes has significant implications for clinical management and treatment regimens. Aim: This study was performed to assess the HBV epidemiology and circulating genotypes in multi-transfused β-thalassemia major patients with the aim to be considered while formulating the treatment pattern taking into account particular needs of thalassaemia patients. Materials and Methods: This study was performed from September 2018 to June 2019, at the Department of Pathology and Transfusion Medicine, Shaheed Zulfiqar Ali Bhutto (SZAB) Medical University, Islamabad. A total of 2,260 thalassaemia patients were enrolled in the study. The study was endorsed by the Ethics Committee of the SZAB Medical University, Islamabad. The samples were serologically screened for HBsAg on the LIAISON® XL Murex HBsAg Quant assay (DiaSorin S.p.A., Italy) a chemiluminescence based immunoassay (CLIA). HBV quantitative PCR kit was used to measure the HBV DNA in serum samples. The HBV genotypes were determined using universal primers targeting the P1 and S1 region amplification. Results: Of 2,260 thalassaemia patients, 64.6% were males while 35.4% were females. The HBsAg was identified in 98 individuals (4.33%). The PCR analysis was done for these 98 patients and in this cohort, genotype D was 59.18% (n = 58), genotype A was 21.42% (n = 21) while genotype C was 19.38% (n = 19). Conclusion: The determination of HBV genotypes in the multi-transfused patients is key to the effective management of chronic HBV patients as the severity and course of the disease is dependent on a specific type of genotypes. Quality assured screening of donated blood will prevent the incidence of HBV in thalassaemia patients.
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Affiliation(s)
- Ahmad Farooq
- Department of Biological Sciences, International Islamic University, Islamabad, Pakistan.,Department of Pathology and Transfusion Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Usman Waheed
- Department of Pathology and Transfusion Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan.,Islamabad Blood Transfusion Authority, Ministry of National Health Services, Government of Pakistan
| | - Noore Saba
- Peshawar Regional Blood Centre, Department of Health, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Kaleem
- Department of Pathology, Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur, AJK, Pakistan
| | - Najma Majeed
- Department of Health, College of Medical Technology, Mirpur, AJK, Pakistan
| | - Akhlaaq Wazeer
- Department of Biological Sciences, International Islamic University, Islamabad, Pakistan.,Department of Pathology and Transfusion Medicine, Divisional Headquarters Teaching Hospital, Mirpur, AJK, Pakistan
| | - Naila Arif Cheema
- Department of Biology, National University of Technology, Islamabad, Pakistan
| | - Saeed Ahmed
- Department of Blood Bank, Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Muhammad Arshad
- Department of Biological Sciences, International Islamic University, Islamabad, Pakistan
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Elfaituri MK, Ghozy S, Ebied A, Morra ME, Hassan OG, Alhusseiny A, Abbas AS, Sherif NA, Fernandes JL, Huy NT. Amlodipine as adjuvant therapy to current chelating agents for reducing iron overload in thalassaemia major: a systematic review, meta-analysis and simulation of future studies. Vox Sang 2021; 116:887-897. [PMID: 33634883 DOI: 10.1111/vox.13083] [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: 08/21/2020] [Revised: 11/19/2020] [Accepted: 01/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Iron overload in thalassaemia is a crucial prognostic factor and a major cause of death due to heart failure or arrhythmia. Therefore, previous research has recommended amlodipine as an auxiliary treatment to current chelating agents for reducing iron overload in thalassaemia patients. MATERIALS AND METHODS A systematic review and meta-analysis of the results of three randomized clinical trials evaluating the use of amlodipine in thalassaemia patients through 12 databases were carried out. RESULTS Our final cohort included 130 patients. Insignificant difference in decreasing liver iron concentrations was found between amlodipine and control groups {weighted mean difference = -0·2, [95% confidence interval = (-0·55-0·15), P = 0·26]}. As regards serum ferritin, our analysis also showed no significant difference in serum ferritin between amlodipine and control groups {weighted mean difference [95% confidence interval = -0·16 (-0·51-0·19), P = 0·36]}. Similarly, there was insignificant difference in cardiac T2* between amlodipine and control groups {weighted mean difference [95% confidence interval = 0·34 (-0·01-0·69), P = 0·06]}. CONCLUSIONS Despite the growing evidence supporting the role of amlodipine in reducing iron overload in thalassaemia patients, our meta-analysis did not find that evidence collectively significant. The results of our simulation suggest that when more data are available, a meta-analysis with more randomized clinical trials could provide more conclusive insights.
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Affiliation(s)
| | - Sherief Ghozy
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Neurosurgery Department, El Sheikh Zayed Specialized Hospital, Giza, Egypt
| | - Amr Ebied
- Online Research Club, Nagasaki, Japan.,Egyptian National Blood Transfusion Services, Alexandria, Egypt
| | - Mostafa Ebraheem Morra
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Osama Gamal Hassan
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ahmed Alhusseiny
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Alzhraa Salah Abbas
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Minia University, Minia, Egypt
| | - Nourin Ali Sherif
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Nguyen Tien Huy
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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40
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Vitrano A, Meloni A, Addario Pollina W, Karimi M, El-Beshlawy A, Hajipour M, Di Marco V, Hussain Ansari S, Filosa A, Ricchi P, Ceci A, Daar S, Titi Singer S, Naserullah ZA, Pepe A, Scondotto S, Dardanoni G, Bonifazi F, Vichinsky E, Maggio A. A complication risk score to evaluate clinical severity of thalassaemia syndromes. Br J Haematol 2021; 192:626-633. [PMID: 33216983 DOI: 10.1111/bjh.17203] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 06/01/2020] [Accepted: 09/28/2020] [Indexed: 01/16/2023]
Abstract
The thalassaemia syndromes (TS) show different phenotype severity. Developing a reliable, practical and global tool to determine disease severity and tailor treatment would be of great value. Overall, 7910 patients were analysed with the aim of constructing a complication risk score (CoRS) to evaluate the probability of developing one or more complications. Nine independent variables were included in the investigation as predictors. Logistic regression models were used for Group A [transfusion-dependent thalassaemia (TDT)], Group B [transfused non-TDT (NTDT)] and Group C (non-transfused NTDT). Statistically significant predictors included age (years), haemoglobin levels, hepatic transaminases [alanine aminotransferase (ALT) and aspartate aminotransferase] and left-ventricular ejection fraction (LVEF) for Group A; age (years), age at first chelation (months), ALT and LVEF for Group B; and age (years), mean serum ferritin (SF) levels and LVEF for Group C. The area under the receiver operating characteristic curve was 84·5%, 82·1% and 80·0% for Groups A, Group B and Group C respectively, suggesting the models had good discrimination. Finally, the CoRS for each group was categorised into four risk classes (low, intermediate, high, and very high) using the centiles of its distribution. In conclusion, we have developed a CoRS for TS that can assist physicians in prospectively tailoring patients' treatment.
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Affiliation(s)
- Angela Vitrano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | | | | | - Mehran Karimi
- Haematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mahmoud Hajipour
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vito Di Marco
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Saqib Hussain Ansari
- Department of Paediatric Haematology and Molecular Medicine, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Aldo Filosa
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano, BA, Italy
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
- Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch, South Africa
| | | | | | - Alessia Pepe
- U.O.C. MRI, Fondazione Toscana G. Monasterio, Pisa, Italy
| | | | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano, BA, Italy
| | | | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
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Trompeter S, Estcourt L, Mora A, Wong E, Collett D, Bolton-Maggs P, Poles D, Deary A, Watt A. The haemoglobinopathy survey: The reality of transfusion practice in sickle cell disease and thalassaemia in England. Transfus Med 2020; 30:456-466. [PMID: 33103306 DOI: 10.1111/tme.12732] [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] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/08/2020] [Accepted: 09/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To establish, in an unselected population of London haemoglobinopathy patients, transfusion requirements, blood antigens/alloantibodies, transfusion modalities, burden of transfusion reactions and donor exposure. BACKGROUND Haemoglobinopathy patients are among the most highly transfused patient populations, and the overall population and number of patients on long-term transfusion programmes are increasing. To provide a safe and efficacious transfusion service for patients, it is important to understand current practice, morbidity associated with transfusion, efficacy of different transfusion modalities and geno-/phenotype requirements. METHODS Data on 4451 transfusion episodes in 760 patients from 12 London hospitals were collected retrospectively over a 6-month period in 2011. RESULTS Alloimmunisation prevalence was 17% for sickle cell disease (SCD) and 22% for thalassaemia, most commonly anti-Rh/Kell/Kpa /Cw . Rh phenotypes differed between SCD (Ro r 59.8%/R1 r 15.9%/R2 r 15.6%) and thalassaemia (R1 R1 29.6%/R1 r 28.4%/R1 R2 15.4%). Recording of pheno-/genotypes fell below recommendations. A 2-weekly manual exchange and 3-weekly automated exchange came closest to achieving presumptive targets. In adults with thalassaemia, the mean blood requirement was 36 units per year; for SCD, erythrocytapheresis was carried out every 7 weeks with 66 units; for manual exchange, it was 38 units every 4 weeks; and for simple transfusion, it was 30 units p.a. every 4 weeks. CONCLUSION Transfusion modality choice was influenced by the resources available-children mostly received simple transfusions, and adults received erythrocytapheresis; the relationships between frequency of exchanges/transfusion modality/target HbA% were not simple, possibly reflecting the difference in recipient erythropoiesis and consequent transfusion modality selection bias; adherence to existing and current guidelines regarding geno-/phenotyping was limited; and alloimmunisation had a low incidence and high prevalence in both disorders.
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Affiliation(s)
- Sara Trompeter
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK.,Patient Services, NHS Blood and Transplant, London, UK
| | - Lise Estcourt
- Clinical Trials Unit, NHS Blood and Transplant, Oxford, UK.,Deparment of Medicine, University of Oxford, Oxford, UK
| | - Ana Mora
- Clinical Trials Unit, NHS Blood and Transplant, Cambridge, UK
| | - Esther Wong
- Clinical Trials Unit, NHS Blood and Transplant, Cambridge, UK
| | - David Collett
- Statistics and Clinical Studies Unit, NHS Blood and Transplant, Filton, UK
| | - Paula Bolton-Maggs
- Department of Haematology, University of Manchester, Manchester, UK.,Serious Hazards of Transfusion (SHOT), NHS Blood and Transplant, Manchester, UK
| | - Debbi Poles
- Serious Hazards of Transfusion (SHOT), NHS Blood and Transplant, Manchester, UK
| | - Alison Deary
- Clinical Trials Unit, NHS Blood and Transplant, Cambridge, UK
| | - Alison Watt
- Serious Hazards of Transfusion (SHOT), NHS Blood and Transplant, Manchester, UK
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42
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Chan LKL, Mak VWM, Chan SCH, Yu ELM, Chan NCN, Leung KFS, Ng CKM, Ng MHL, Chan JCW, Lee HKK. Liver complications of haemoglobin H disease in adults. Br J Haematol 2020; 192:171-178. [PMID: 33095929 DOI: 10.1111/bjh.17115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/27/2020] [Indexed: 12/15/2022]
Abstract
Haemoglobin H (HbH) disease is a type of non-transfusion-dependent thalassaemia. This cross-sectional study aimed at determining the prevalence and severity of liver iron overload and liver fibrosis in patients with HbH disease. Risk factors for advanced liver fibrosis were also identified. A total of 80 patients were evaluated [median (range) age 53 (24-79) years, male 34%, non-deletional HbH disease 24%]. Patients underwent 'observed' T2-weighted magnetic resonance imaging examination for liver iron concentration (LIC) quantification, and transient elastography for liver stiffness measurement (LSM) and fibrosis staging. In all, 25 patients (31%) had moderate-to-severe liver iron overload (LIC ≥7 mg/g dry weight). The median LIC was higher in non-deletional than in deletional HbH disease (7·8 vs. 2.9 mg/g dry weight, P = 0·002). In all, 16 patients (20%) had advanced liver fibrosis (LSM >7.9 kPa) and seven (9%) out of them had probable cirrhosis (LSM >11.9 kPa). LSM positively correlated with age (R = 0·24, P = 0·03), serum ferritin (R = 0·36, P = 0·001) and LIC (R = 0·28, P = 0·01). In multivariable regression, age ≥65 years [odds ratio (OR) 4·97, 95% confidence interval (CI) 1·52-17·50; P = 0·047] and moderate-to-severe liver iron overload (OR 3·47, 95% CI 1·01-12·14; P = 0·01) were independently associated with advanced liver fibrosis. The findings suggest that regular screening for liver complications should be considered in the management of HbH disease.
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Affiliation(s)
- Luke K L Chan
- Division of Haematology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Vivien W M Mak
- Division of Haematology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Stanley C H Chan
- Department of Radiology, Princess Margaret Hospital, Hong Kong, China
| | - Ellen L M Yu
- Clinical Research Centre, Princess Margaret Hospital, Hong Kong, China
| | - Nelson C N Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Kate F S Leung
- Division of Haematology, Department of Pathology, Princess Margaret Hospital, Hong Kong, China
| | - Carmen K M Ng
- Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Margaret H L Ng
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Joyce C W Chan
- Division of Haematology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Harold K K Lee
- Division of Haematology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
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43
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Jobanputra M, Paramore C, Laird SG, McGahan M, Telfer P. Co-morbidities and mortality associated with transfusion-dependent beta- thalassaemia in patients in England: a 10-year retrospective cohort analysis. Br J Haematol 2020; 191:897-905. [PMID: 33094842 DOI: 10.1111/bjh.17091] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/30/2020] [Indexed: 12/28/2022]
Abstract
A retrospective cohort analysis to explore 10-year mortality and prevalence of transfusion-dependent β-thalassaemia (TDT)-associated co-morbidities in patients with TDT was undertaken using Hospital Episode Statistics (HES) data from the National Health Service (NHS) in England. A 10-year forward-looking cohort analysis for the period 2009-2018 was completed using HES admitted patient care (APC), outpatient data, and linked HES/Office of National Statistics mortality data for patients with β-thalassaemia (ICD-10 diagnosis code D56.1). TDT-associated co-morbidity rates were high in the 612 patients with TDT, with 76% having at least one co-morbidity, 54% suffering from two of more, and 37% three or more. The three most common TDT-associated co-morbidities, occurring in more than one third of patients were: endocrine disorders (excluding diabetes) 40%, osteoporosis 40%, and diabetes 34%. Cardiac disease was observed in 18% of patients overall, with atrial fibrillation and heart failure being the most common with a prevalence of 11% and 9%, respectively. The crude 10-year mortality rate in the TDT cohort was 6·2% (38/612), significantly greater than the 1·2% age/sex-adjusted mortality rate of the general population (P < 0·001). These data support the notion that the unmet need in TDT remains significant, with high rates of co-morbidity and mortality.
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Affiliation(s)
| | | | | | | | - Paul Telfer
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
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44
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Poon KS, Koay ESC, Tan KML. Significance of variant annotation for molecular diagnosis of thalassaemia. J Clin Pathol 2020; 74:676-677. [PMID: 33082162 DOI: 10.1136/jclinpath-2020-207045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/17/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Kok-Siong Poon
- Department of Laboratory Medicine, National University Hospital, Singapore .,Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Evelyn Siew-Chuan Koay
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Karen Mei-Ling Tan
- Department of Laboratory Medicine, National University Hospital, Singapore
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45
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Rolla R, Paglino G, Puricelli C, Mellone S, Sciancalepore M, Beltrami E, Cerutti C, Piccotti S, Tota S, Scotta A, Pergolini P, Dianzani U, Giordano M. Screening for haemoglobin disorders: The experience of the piedmont north-eastern quadrant. Int J Lab Hematol 2020; 43:e61-e63. [PMID: 33078543 DOI: 10.1111/ijlh.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Roberta Rolla
- Clinical Chemistry Laboratory, Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Giulia Paglino
- Clinical Chemistry Laboratory, Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Chiara Puricelli
- Clinical Chemistry Laboratory, Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Simona Mellone
- Clinical Chemistry Laboratory, Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Maurizio Sciancalepore
- Clinical Chemistry Laboratory, Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Eleonora Beltrami
- Clinical Chemistry Laboratory, Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Chiara Cerutti
- Clinical Chemistry Laboratory, Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Selena Piccotti
- Clinical Chemistry Laboratory, Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Stefania Tota
- Clinical Chemistry Laboratory, Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Annamaria Scotta
- Clinical Chemistry Laboratory, Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Patrizia Pergolini
- Clinical Chemistry Laboratory, Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Umberto Dianzani
- Clinical Chemistry Laboratory, Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Mara Giordano
- Clinical Chemistry Laboratory, Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
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Borbolla Foster A, Smith E, Ross B. Adherence to a selective antenatal haemoglobinopathy screening policy within a tertiary level obstetric unit in Australia. Aust N Z J Obstet Gynaecol 2020; 61:63-68. [PMID: 32815146 DOI: 10.1111/ajo.13228] [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: 09/12/2019] [Accepted: 07/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Haemoglobinopathies represent the most common single gene disorder worldwide; however, significant centre to centre variations in antenatal screening practices exist. AIMS To assess performance of a selective antenatal haemoglobinopathy screening policy within a presumed low-prevalence Australian population. Primary outcome was the failure to screen rate for women with at least one identifiable risk factor. Secondary outcomes included outcomes of maternal screening and rates, gestations and outcomes of paternal, prenatal and neonatal testing. MATERIALS AND METHODS A two-year retrospective cohort study identifying all women attending for public antenatal care with at least one identifiable risk factor for haemoglobinopathy. RESULTS At least one risk factor for haemoglobinopathy was identified in 8.8% of the entire pregnant cohort; however, the failure to screen rate was high at 83.7% overall. Screening was significantly more likely to be undertaken in multiparous women, those with multiple risk factors and women originating from the Middle East. Twenty percent of screened women returned an abnormal result; however, this led to paternal haemoglobinopathy screening in only 66.6%. Where completed, the addition of partner screening reclassified offspring to low-risk status in 85.7% of cases. CONCLUSIONS This study demonstrates an 83.7% screen failure rate within a selective screening model raising concerns regarding the clinical utility and health equity of this approach. This major drawback of selective screening suggests that institution of a universal antenatal screening system for haemoglobinopathies, even in anticipated low-prevalence areas, will improve detection rates and ensure families receive appropriate and timely counselling.
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Affiliation(s)
- Ailsa Borbolla Foster
- Department of Maternal Fetal Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Elloise Smith
- Department of Maternity and Gynaecology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Bryony Ross
- Calvary Mater Hospital, Waratah, New South Wales, Australia.,Pathology NSW, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
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47
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Farmakis D, Giakoumis A, Cannon L, Angastiniotis M, Eleftheriou A. COVID-19 and thalassaemia: A position statement of the Thalassaemia International Federation. Eur J Haematol 2020; 105:378-386. [PMID: 32573838 PMCID: PMC7361751 DOI: 10.1111/ejh.13476] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 05/13/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 01/19/2023]
Abstract
Objectives Many patients with haemoglobinopathies, including thalassaemia and sickle cell disease, are at increased risk of developing severe complications from the coronavirus disease 2019 (COVID‐19). Although epidemiologic evidence concerning the novel coronavirus (SARS‐CoV‐2) infection in these patients is currently lacking, the COVID‐19 pandemic represents a significant challenge for haemoglobinopathy patients, their families and their attending physicians. Methods The present statement summarizes the key challenges concerning the management of haemoglobinopathies, with particular focus on patients with either transfusion‐dependent or non‐transfusion‐dependent thalassaemia, identifies the gaps in knowledge and suggests measures and strategies to deal with the pandemic, based on available evidence and expert opinions. Key areas covered include patients’ risk level, adaptation of haemoglobinopathy care, safety of blood transfusions, blood supply challenges, and lifestyle and nutritional considerations. Conclusions The proposed measures and strategies may be useful as a blueprint for other disorders which require regular hospital visits, as well as for the timely adaptation of patient care during similar future pandemics.
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Affiliation(s)
| | | | - Lily Cannon
- Thalassaemia International Federation, Nicosia, Cyprus
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48
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Mohd Ibrahim H, Muda Z, Othman IS, Mohamed Unni MN, Teh KH, Thevarajah A, Gunasagaran K, Ong GB, Yeoh SL, Muhammad Rivai A, Che Mohd Razali CH, Din ND, Abdul Latiff Z, Jamal R, Mohamad N, Mohd Ariffin H, Alias H. Observational study on the current status of thalassaemia in Malaysia: a report from the Malaysian Thalassaemia Registry. BMJ Open 2020; 10:e037974. [PMID: 32601117 PMCID: PMC7328811 DOI: 10.1136/bmjopen-2020-037974] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Thalassaemia is the most common inherited blood disorder in Malaysia. This study aims to report the current status of thalassaemia in Malaysia and provide a comprehensive understanding of the disease through data obtained from the Malaysian Thalassaemia Registry. DESIGN Data were extracted from the Malaysian Thalassaemia Registry, a web-based system accessible to enrolled users through www.mytalasemia.net.my. SETTING The Malaysian Thalassaemia Registry data was recorded from reports obtained from 110 participating government and university hospitals in Malaysia. PARTICIPANTS The patients were those attending the 110 participating hospitals for thalassaemia treatment. INTERVENTION Data were collected from the Malaysian Thalassaemia Registry from 2007 until the fourth quarter of 2018. PRIMARY OUTCOME MEASURE 7984 out of 8681 patients with thalassaemia registered in the Malaysian Thalassaemia Registry were reported alive. RESULTS Majority of the patients were reported in the state of Sabah (22.72%); the largest age group affected was 5.0-24.9 years old (64.45%); the largest ethnic group involved was Malay (63.95%); and the major diagnosis was haemoglobin E/β-thalassaemia (34.37%). From the 7984 patients, 56.73% were on regular blood transfusions and 61.72% were on chelation therapy. A small fraction (14.23%) has undergone splenectomy, while the percentage of patients with severe iron overload (serum ferritin ≥5000 µg/L) reduced over time. However, cardiac complications are still the main cause of death in patients with thalassaemia. CONCLUSION Data gathered into the registry can be used to understand the progression of the disorder, to monitor iron overload management and to improve the outcomes of treatment, to enhance preventive strategies, reduce healthcare burden and improve the quality of life. Sustainability of the Malaysian Thalassaemia Registry is important for surveillance of thalassaemia management in the country and help the national health authorities to develop more effective policies.
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Affiliation(s)
- Hishamshah Mohd Ibrahim
- Division for Research and Technical Support, Ministry of Health Malaysia, Putrajaya, Wilayah Persekutuan Putrajaya, Malaysia
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Zulaiha Muda
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Ida Shahnaz Othman
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Mohamed Najib Mohamed Unni
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Kok Hoi Teh
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Asohan Thevarajah
- Department of Paediatrics, Sabah Women & Children Hospital, Likas, Kota Kinabalu, Sabah, Malaysia
| | - Kogilavani Gunasagaran
- Department of Paediatrics, Sabah Women & Children Hospital, Likas, Kota Kinabalu, Sabah, Malaysia
| | - Gek Bee Ong
- Department of Paediatrics, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Seoh Leng Yeoh
- Department of Paediatrics, Hospital Pulau Pinang, Georgetown, Pulau Pinang, Malaysia
| | | | | | - Nazzlin Dizana Din
- Department of Paediatrics, Hospital Sultanah Nur Zahirah Kuala Terengganu, Kuala Terengganu, Terengganu, Malaysia
| | - Zarina Abdul Latiff
- Department of Paediatrics, UKM Medical Centre, The National University of Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur, Malaysia
| | - Rahman Jamal
- UKM Medical Molecular Biology Institute, Jalan Yaacob Latif, Cheras, Kuala Lumpur, Malaysia
| | - Norsarwany Mohamad
- Department of Paediatrics, Hospital Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
| | - Hany Mohd Ariffin
- Department of Paediatrics, University of Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Hamidah Alias
- Department of Paediatrics, UKM Medical Centre, The National University of Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur, Malaysia
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49
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Fung EB, Ahmad T, Killilea DW, Hussain R, Lal A. Zinc supplementation improves markers of glucose homeostasis in thalassaemia. Br J Haematol 2020; 190:e162-e166. [PMID: 32488893 DOI: 10.1111/bjh.16771] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/01/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Ellen B Fung
- Department of Hematology, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA.,Children's Hospital Oakland Research Institute, Oakland, CA, USA
| | - Tariq Ahmad
- Department of Endocrinology, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - David W Killilea
- Children's Hospital Oakland Research Institute, Oakland, CA, USA
| | - Rahim Hussain
- Children's Hospital Oakland Research Institute, Oakland, CA, USA
| | - Ashutosh Lal
- Department of Hematology, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
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50
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Yacobovich J, Barzilai-Birenboim S, Steinberg-Shemer O, Stark P, Pazgal I, Tamary H. Splenectomy in childhood for non-malignant haematologic disorders - long-term follow-up shows minimal adverse effects. Br J Haematol 2020; 190:909-915. [PMID: 32342506 DOI: 10.1111/bjh.16657] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 01/31/2020] [Revised: 03/17/2020] [Accepted: 03/20/2020] [Indexed: 12/15/2022]
Abstract
Splenectomy is considered therapeutic in various non-malignant haematologic diseases. Adverse events - specifically infections and thromboembolism - are not extensively documented in the paediatric population, maintaining the concern over risks-versus-benefits of the procedure. We studied a cohort of paediatric haematology patients undergoing splenectomy between 1977 and 2015 to determine short- and long-term complications. We summarised all the patients of the haematology clinic in our major Israeli tertiary centre undergoing splenectomy for therapeutic reasons, capturing infectious and thromboembolic events. The data of 103 patients, comprising 1657 follow-up years, were analysed. The cohort included 33 patients with transfusion-dependent thalassaemia, seven with non-transfusion-dependent thalassaemia, four with sickle-thalassaemia, 41 with hereditary spherocytosis, and 18 with immune thrombocytopenia. Standard presplenectomy vaccinations were noted in most. No typical cases of overwhelming postsplenectomy infection (OPSI) were identified, nor were typical OPSI bacteria isolated. Thalassaemics with central lines were most prone to infection and thrombosis. Beyond this subgroup, thrombotic events were anecdotal. This is the largest study to date to comprehensively analyse infectious and thrombotic complications of childhood splenectomy for the treatment of haematologic diseases. The use of splenectomy appears to be a relatively safe therapeutic option in paediatric patients with proper preoperative vaccination and follow-up care; use of central venous lines or catheters increase the risk in thalassaemic patients and should be avoided if possible.
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Affiliation(s)
- Joanne Yacobovich
- Department of Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Barzilai-Birenboim
- Department of Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orna Steinberg-Shemer
- Department of Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pinhas Stark
- The Comprehensive Center of Thalassemia, Hemoglobinopathies & Rare Anemias, Institute of Hematology, Petah Tikva, Israel
| | - Idit Pazgal
- The Comprehensive Center of Thalassemia, Hemoglobinopathies & Rare Anemias, Institute of Hematology, Petah Tikva, Israel
| | - Hannah Tamary
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Molecular Diagnostic Laboratory, Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
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