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Zailani MAH, Raja Sabudin RZA, Ithnin A, Alauddin H, Sulaiman SA, Ismail E, Othman A. Population screening for glucose-6-phosphate dehydrogenase deficiency using quantitative point-of-care tests: a systematic review. Front Genet 2023; 14:1098828. [PMID: 37388931 PMCID: PMC10301741 DOI: 10.3389/fgene.2023.1098828] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/22/2023] [Indexed: 07/01/2023] Open
Abstract
Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked hereditary disorder and a global public health concern that is most prevalent in malaria-endemic regions including Asia, Africa, and the Mediterranean. G6PD-deficient individuals are at high risk of developing acute hemolytic anemia following treatment with antimalarial drugs including Primaquine and Tafenoquine. However, the currently available tests for G6PD screening are complex and often have been misclassifying cases, particularly for females with intermediate G6PD activity. The latest innovation of quantitative point-of-care (POC) tests for G6PD deficiency provides an opportunity to improve population screening and prevent hemolytic disorders when treating malaria. Aim(s): To assess the evidence on the type and performance of quantitative point-of-care (POC) tests for effective G6PD screening and hence, radical elimination of Plasmodium malaria infections. Methods: Relevant studies published in English language confined from two databases, Scopus and ScienceDirect were searched from November 2016 onwards. The search was conducted using keywords including "glucosephosphate dehydrogenase" or "G6PD", "point-of-care", "screening" or "prevalence", "biosensor" and "quantitative". The review was reported following the PRISMA guidelines. Results: Initial search results yielded 120 publications. After thorough screening and examination, a total of 7 studies met the inclusion criteria, and data were extracted in this review. Two types of quantitative POC tests were evaluated, namely, the CareStartTM Biosensor kit and the STANDARD G6PD kit. Both tests showed promising performance with high sensitivity and specificity ranging mostly from 72% to 100% and 92%-100%, respectively. The positive and negative predictive values (PPV and NPV) ranged from 35% to 72% and 89%-100%, with accuracy ranging from 86% to 98%. Conclusion: In areas with a high prevalence of G6PD deficiency that overlap with malaria endemicity, availability and validation of the diagnostic performance of quantitative POC tests are of absolute importance. Carestart™ biosensor and STANDARD G6PD kits showed high reliability and performed well in comparison to the spectrophotometric reference standard.
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Affiliation(s)
| | | | - Azlin Ithnin
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Hafiza Alauddin
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Siti Aishah Sulaiman
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Endom Ismail
- Department of Biological Sciences Dan Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Ainoon Othman
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
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Zailani MAH, Raja Sabudin RZA, Abdul Jalil D, Ithnin A, Ayub NA, Alauddin H, Jalil N, Md Fauzi A, Cheah FC, Lim LS, Safian N, Yusuf MM, Othman A. Evaluation of quantitative point-of-care test for measurement of glucose-6-phosphate dehydrogenase enzyme activity in Malaysia. Malays J Pathol 2023; 45:31-41. [PMID: 37119244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
INTRODUCTION The treatment of Plasmodium vivax malaria with 8-aminoquinolines is contraindicated in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals due to the risk of acute haemolytic anaemia. Effective G6PD screening is paramount to avoid adverse drug reactions. This study aimed to evaluate the performance of novel quantitative point-of-care (POC) tests as a new screening method for G6PD deficiency in Malaysia. MATERIALS AND METHODS A total of 153 neonatal cord blood, 99 peripheral blood of older children aged between 1 month to 12-years old, and 62 peripheral adult blood were screened for G6PD deficiency using two quantitative POC tests, CareStartTM biosensor (Carestart) and CareStartTM Biosensor 1 (S1). The results were compared with OSMMR2000D kit as a reference assay. Two statistical analyses were performed in this study to evaluate the POC test performances, the Spearman's correlation test and the Cohen's kappa method. RESULTS Both Carestart and S1 tests showed significant positive correlations to OSMMRS000D with r2 = 0.7916 and r2 = 0.7467. Their measurement of agreement showed a kappa (κ) value of 0.805 (p<0.001, 95% CI), and 0.795 (p<0.001, 95% CI), respectively. Analysis of the area under the Receiver Operating Curve (ROC) at 60% cut-off illustrated that the Carestart had 90.2% sensitivity, 98.9% specificity, 98.3% positive predictive value (PPV), and 93.8% negative predictive value (NPV). The corresponding values for the S1 were 95.2%, 100%, 100%, and 96.8%, respectively. CONCLUSION This study showed that the Carestart and S1 biosensors have high-performance reliability for screening of G6PD deficiency, which can guide safe prescriptions of anti-malaria medications and hence, eradication of Plasmodium vivax malaria.
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Affiliation(s)
- M A H Zailani
- Universiti Kebangsaan Malaysia Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia
| | - R Z A Raja Sabudin
- Universiti Kebangsaan Malaysia Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia
| | - D Abdul Jalil
- Universiti Kebangsaan Malaysia Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia
| | - A Ithnin
- Universiti Kebangsaan Malaysia Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia.
| | - N A Ayub
- Universiti Kebangsaan Malaysia Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia
| | - H Alauddin
- Universiti Kebangsaan Malaysia Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia
| | - N Jalil
- Universiti Kebangsaan Malaysia Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia
| | - A Md Fauzi
- Universiti Kebangsaan Malaysia Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia
| | - F C Cheah
- Universiti Kebangsaan Malaysia Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia
| | - L S Lim
- University Science Malaysia, School of Distance Education, Pulau Pinang, Malaysia
| | - N Safian
- Universiti Kebangsaan Malaysia Medical Centre, Department of Community Health, Kuala Lumpur, Malaysia
| | - M M Yusuf
- Universiti Kebangsaan Malaysia Medical Centre, Laboratory Diagnostic Services, Kuala Lumpur, Malaysia
| | - A Othman
- Universiti Sains Islam Malaysia, Faculty of Medicine, Department of Medical Sciences II, Kuala Lumpur, Malaysia
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Md Shahid SNA, Ithnin A, Raja Sabudin RZA, Alauddin H, Tan TL. Evaluation of mean neutrophil volume and immature to total neutrophil ratio as a biomarker for bacterial sepsis in adult patients. Malays J Pathol 2023; 45:77-85. [PMID: 37119248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Mean neutrophil volume (MNV) and immature to total neutrophil ratio (IT Ratio) has been found to support the detection of sepsis in elderly and neonates. This study aimed to assess the diagnostic significance of MNV and IT ratio in adult sepsis population. MATERIALS AND METHODS Sixty-four adult patients presented with suspected bacterial sepsis were included in this study. Relevant cultures and/or pertinent serology tests were performed. Full blood counts were analysed for MNV and IT ratio. RESULTS Fifty-one patients out of 64 recruited subjects were confirmed sepsis. Twentyfour patients had confirmed bacterial infection by cultivation and two were positive for leptospiral serology. MNV was very good in distinguishing sepsis from non-sepsis group (AUC = 0.80, 95% confidence interval (CI) = 0.69-0.91, Accuracy = 0.72, Kappa = 0.40) with a cut-off value of 153.5 (sensitivity = 67%, specificity = 92%). There was no significant difference in IT ratio between sepsis and non-sepsis group (p-value > 0.05). MNV was superior over IT ratio (AUC = 0.85, 95%CI = 0.76-0.95, and AUC = 0.70, 95% CI = 0.56-0.85, respectively) in diagnosing bacterial infection. The optimum cut-off value for MNV in bacterial infection was 154.5 (sensitivity = 67%, specificity = 89%) and for IT ratio was 0.035 (sensitivity = 45%, specificity = 67%). CONCLUSION MNV appears to be a very good marker for diagnosing sepsis and bacterial infection. We recommend including MNV into sepsis workup in ED setting, since it can be determined without additional specimen.
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Affiliation(s)
- S N A Md Shahid
- Universiti Kebangsaan Malaysia Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia
| | - A Ithnin
- Universiti Kebangsaan Malaysia Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia
| | - R Z A Raja Sabudin
- Universiti Kebangsaan Malaysia Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia
| | - H Alauddin
- Universiti Kebangsaan Malaysia Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia
| | - T L Tan
- Universiti Kebangsaan Malaysia Medical Centre, Department of Emergency Medicine, Kuala Lumpur, Malaysia.
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Woo WH, Ithnin A, Raffali MAAFM, Abd. Hamid MF, Abdul Wahid SF, Wan Jamaludin WF. Recurrent pleural effusion in myeloma. Oxf Med Case Reports 2022; 2022:omac091. [PMID: 35991502 PMCID: PMC9389560 DOI: 10.1093/omcr/omac091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/15/2022] [Accepted: 07/13/2022] [Indexed: 11/14/2022] Open
Abstract
Plasma cell (PC) disorders make up a spectrum of diseases which include myeloma and amyloidosis. Pleural effusion in myeloma is rare and may result from myelomatous infiltration of the pleura or heart failure in cardiac amyloidosis. Benign causes of pleural effusion include infection, hypoalbuminemia or chronic renal impairment. Myelomatous pleural effusion (MPE) is diagnosed via pleural fluid cytomorphology and flow cytometry for malignant PCs, protein electrophoresis or pleural biopsy. A 74-year-old man with immunoglobulin A myeloma developed recurrent MPE with possible secondary cardiac amyloidosis. Despite achieving partial remission in serum paraprotein, the effusion was refractory to percutaneous drainage and pleurodesis. The treatment is aimed at eradicating myeloma and relieving respiratory symptoms. Early recognition of myeloma progression into extramedullary infiltration and secondary amyloidosis is important. While chemotherapy intensification in older patients can be challenging, multidisciplinary management is essential in alleviating symptoms and in improving the quality of life.
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Affiliation(s)
- Wing Hang Woo
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Azlin Ithnin
- Department of Pathology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Mohd Asyiq Al-Fard Mohd Raffali
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
- Heart and Lung Centre, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Mohamed Faisal Abd. Hamid
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
- Heart and Lung Centre, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - S Fadilah Abdul Wahid
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
- Cell Therapy Centre, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Wan Fariza Wan Jamaludin
- Correspondence address. Department of Medicine and Cell Therapy Center, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaakob Latif, 56000 Kuala Lumpur, Malaysia. Tel: +60-3-9145-7710; Fax: +60-3-9145-6691; E-mail:
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Wan Mohd Zohdi WA, Ismail AZ, Yusof N, Ithnin A, Shuib S, Masir N, Palaniappan S, Tumian NR. Rare but Potentially Fatal Presentations of Diffuse Large B-cell Lymphoma: Leukemic Phase or Hemophagocytic Syndrome in Bone Marrow. Clin Pathol 2022; 15:2632010X211070774. [PMID: 35036912 PMCID: PMC8753065 DOI: 10.1177/2632010x211070774] [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] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin Lymphoma commonly presenting as a solid tumor either by nodal or extra-nodal manifestations. Here we describe two atypical presentations of lymphoma, finally resulting in the diagnosis of DLBCL. Case 1: A 53-year-old man with a previous history of nasopharyngeal carcinoma presented with a two-week history of B-symptoms and hyperleukocytosis. Peripheral blood film showed 78% abnormal mononuclear cells. Immunohistochemical stain showing Ki-67 of 90%, negative c-myc, BCL2 and BCL6, and negative c-MYC with fluorescence in-situ hybridization studies on the trephine biopsy, concluded the diagnosis of CD5+ DLBCL of ABC subtype. He received intravenous cyclophosphamide and oral prednisolone for cytoreduction, followed by 6 cycles of chemo-immunotherapy. However, he succumbed due to severe sepsis after the completion of therapy. Case 2: A 56-year-old lady who was initially investigated for pyrexia of unknown origin was noted to have hemophagocytosis upon bone marrow aspirate examination. The bone marrow trephine biopsy revealed some atypical clusters of B-cells positive for CD20 which was inconclusive. PET-CT scan noted an enlarged hypermetabolic spleen without lymphadenopathy. Splenic biopsy with immunohistochemical studies revealed DLBCL of ABC subtype. The diagnosis was consistent with primary splenic DLBCL. She became unwell post splenic biopsy and was admitted to the intensive care unit where she passed away 2 weeks later from Candida and Sternotrophomonas septicemia. These cases highlight the atypical presentations of a common subtype of NHL in our center. Arriving at the definitive diagnosis can be difficult especially when patients are acutely ill, hampering the necessary invasive procedures for diagnosis. The outcomes of both cases are briefly discussed hoping to spread awareness among clinicians on the rare and acutely critical presentations of DLBCL.
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Affiliation(s)
| | - Ahmad Zulhimi Ismail
- Department of Pathology, Universiti Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
| | - Nurasyikin Yusof
- Department of Pathology, Universiti Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
| | - Azlin Ithnin
- Department of Pathology, Universiti Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
| | - Salwati Shuib
- Department of Pathology, Universiti Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
| | - Noraidah Masir
- Department of Pathology, Universiti Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
| | - Sivakumar Palaniappan
- Department of Medicine, Universiti Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
| | - Nor Rafeah Tumian
- Department of Medicine, Universiti Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
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Lee HY, Ithnin A, Azma RZ, Othman A, Salvador A, Cheah FC. Glucose-6-Phosphate Dehydrogenase Deficiency and Neonatal Hyperbilirubinemia: Insights on Pathophysiology, Diagnosis, and Gene Variants in Disease Heterogeneity. Front Pediatr 2022; 10:875877. [PMID: 35685917 PMCID: PMC9170901 DOI: 10.3389/fped.2022.875877] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/02/2022] [Indexed: 01/04/2023] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a prevalent condition worldwide and is caused by loss-of-function mutations in the G6PD gene. Individuals with deficiency are more susceptible to oxidative stress which leads to the classical, acute hemolytic anemia (favism). However, G6PD deficiency in newborn infants presents with an increased risk of hyperbilirubinemia, that may rapidly escalate to result in bilirubin induced neurologic dysfunction (BIND). Often with no overt signs of hemolysis, G6PD deficiency in the neonatal period appears to be different in the pathophysiology from favism. This review discusses and compares the mechanistic pathways involved in these two clinical presentations of this enzyme disorder. In contrast to the membrane disruption of red blood cells and Heinz bodies formation in favism, G6PD deficiency causing jaundice is perhaps attributed to the disruption of oxidant-antioxidant balance, impaired recycling of peroxiredoxin 2, thus affecting bilirubin clearance. Screening for G6PD deficiency and close monitoring of affected infants are important aspects in neonatal care to prevent kernicterus, a permanent and devastating neurological damage. WHO recommends screening for G6PD activity of all infants in countries with high prevalence of this deficiency. The traditional fluorescent spot test as a screening tool, although low in cost, misses a significant proportion of cases with moderate deficiency or the partially deficient, heterozygote females. Some newer and emerging laboratory tests and diagnostic methods will be discussed while developments in genomics and proteomics contribute to increasing studies that spatially profile genetic mutations within the protein structure that could predict their functional and structural effects. In this review, several known variants of G6PD are highlighted based on the location of the mutation and amino acid replacement. These could provide insights on why some variants may cause a higher degree of phenotypic severity compared to others. Further studies are needed to elucidate the predisposition of some variants toward certain clinical manifestations, particularly neonatal hyperbilirubinemia, and how some variants increase in severity when co-inherited with other blood- or bilirubin-related genetic disorders.
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Affiliation(s)
- Heng Yang Lee
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Azlin Ithnin
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Raja Zahratul Azma
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Ainoon Othman
- Department of Medical Science II, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Armindo Salvador
- CNC-Centre for Neuroscience Cell Biology, University of Coimbra, Coimbra, Portugal.,Coimbra Chemistry Centre-Institute of Molecular Sciences (CQC-IMS), University of Coimbra, Coimbra, Portugal.,Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal
| | - Fook Choe Cheah
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
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Wong YY, Alauddin H, Raja Sabudin RZA, Ithnin A, Jalil N, Abdul Latiff Z, Loh CK, Alias H, Othman A. Siriraj I Gγ( Aγδβ) 0-thalassaemia causing severe thalassaemia intermedia in compound heterozygous state with IVS1-1(G→T) mutation. Malays J Pathol 2021; 43:95-100. [PMID: 33903312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The Siriraj I Gγ(Aγδβ)0-thalassaemia is a novel mutation involving a 118kb deletion of the β-globin gene cluster. It was first reported in 2012 in two unrelated families from the southern part of Thailand. The carriers in the heterozygous state are clinically asymptomatic. Nonetheless, its complex interaction with other β-thalassaemia could give rise to different clinical phenotypes, ranging from mild thalassaemia intermedia to thalassaemia major. We report here a case of a six-year-old Malay boy, presented with pallor, growth failure and hepatosplenomegaly. His haemoglobin at presentation was 9.2g/dL with a mean cell haemoglobin of 22.6pg and a mean cell volume of 69.9fl. His peripheral blood smear showed features of thalassaemia intermedia. Haemoglobin (Hb) analysis revealed markedly raised Hb F (83%), normal HbA2 levels and absent HbA. Deoxyribonucleic acid (DNA) analysis showed compound heterozygous IVS1-1 (G→T) β-globin gene mutation and Siriraj I Gγ(Aγδβ)0-deletion (genotype βIVS1-1/ β Siriraj I deletion). Both his father and elder sister are carriers of Siriraj I Gγ(Aγδβ)0-thalassaemia while his mother carries IVS1-1 (G→T) gene mutation. Clinically, the patient is transfusion dependent on six weekly regime. To the best of our knowledge, this is the first reported case in Malaysia involving unique Siriraj I Gγ(Aγδβ)0-thalassaemia and IVS1-1 (G→T) in a compound heterozygous state. In summary, detection of Siriraj I Gγ(Aγδβ)0-thalassaemia is essential as this deletion can lead to severe disease upon interaction with a β-thalassemia point mutation as demonstrated in our case. The establishment of effective carrier screening and genetic counselling is important to prevent its adverse consequences.
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Affiliation(s)
- Y Y Wong
- University Kebangsaan Malaysia Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia
| | - H Alauddin
- University Kebangsaan Malaysia Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia.
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Jamali NS, Raja Sabudin RZA, Alauddin H, Ithnin A, Tumian NR, Jalil N, Awai R, Abu Amis SH, Shuib S. H396P mutation in chronic myeloid leukaemia patient on nilotinib - A case report. Malays J Pathol 2021; 43:63-68. [PMID: 33903307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The advent of BCR-ABL1-targeted therapy with the tyrosine kinase inhibitor (TKI), for example, imatinib and nilotinib, marked a turning point in the therapy of chronic myeloid leukaemia (CML). However, a substantial proportion of patients experience primary or secondary disease resistance to TKI. There are multifactorial causes contributing to the treatment failure of which BCR-ABL1 kinase domain mutation being the most common. Here, we describe a case of a CML patient with H396P mutation following treatment with nilotinib. CASE A 60-year-old woman presented with abdominal discomfort and hyperleukocytosis. She was diagnosed as CML in the chronic phase with positive BCR-ABL1 transcripts. Due to the failure to obtain an optimal response with imatinib treatment, it was switched to nilotinib. She responded well to nilotinib initially and achieved complete haematological and cytogenetic responses, with undetectable BCR-ABL1 transcripts. However, in 4 years she developed molecular relapse. Mutation analysis which was done 70 months after commencement of nilotinib showed the presence of BCRABL1 kinase domain mutation with nucleotide substitution at position 1187 from Histidine(H) to Proline(P) (H396P). Currently, she is on nilotinib 400mg twice daily. Her latest molecular analysis showed the presence of residual BCR-ABL1 transcripts at 0.22%. DISCUSSION/CONCLUSION This case illustrates the importance of BCR-ABL1 mutation analysis in CML patients with persistent BCR-ABL1 positivity in spite of treatment. Early detection and identification of the type of BCRABL1 mutation are important to guide appropriate treatment options as different mutation will have different sensitivity to TKI.
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Affiliation(s)
- N S Jamali
- University Kebangsaan Malaysia Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia
| | - R Z A Raja Sabudin
- University Kebangsaan Malaysia Medical Centre, Department of Medicine, Kuala Lumpur, Malaysia.
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Yong WL, Yusof N, Ithnin A, Shuib S, Tumian R, Yousuf R, Abdul Aziz S. Mixed phenotype acute leukaemia with t(9,22), BCR-ABL1: A case report. Malays J Pathol 2020; 42:469-476. [PMID: 33361731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Mixed phenotype acute leukaemia (MPAL) is a rare entity of acute leukaemia. CASE REPORT Here we report a case of a 39-year-old lady, with an incidental finding of hyperleukocytosis (white blood cells count: 139.2 x 109/L). Her peripheral blood film revealed 36% of blasts and a bone marrow aspiration showed 53% of blasts. Immunophenotyping showed a population of blasts exhibiting positivity of two lineages, myeloid lineage and B-lymphoid lineage with strong positivity of CD34 and terminal deoxynucleotidyl transferase (Tdt). A conventional karyotyping revealed the presence of Philadelphia chromosome. She was diagnosed with MPAL with t(9,22), BCR ABL1, which carried a poor prognosis. She was treated with acute lymphoblastic leukaemia (ALL) chemotherapy protocol coupled with a tyrosine kinase inhibitor and was planned for an allogeneic stem cells transplant. CONCLUSION This MPAL case was diagnosed incidentally in an asymptomatic patient during medical check-up. We highlight this rare case report to raise the awareness about this rare disease. Understanding the pathogenesis of the disease with the underlying genes responsible for triggering the disease, uniform protocols for diagnosis and targeted treatment will help for proper management of these patients.
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Affiliation(s)
- W L Yong
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Diagnostic and Laboratory Services, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia.
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Wee SY, Muhamed Said SS, Raja Sabudin RZA, Alauddin H, Ithnin A. Microcytic to hypochromic ratio as a discriminant index of thalassaemia trait in subjects with hypochromic anaemia. Malays J Pathol 2020; 42:195-201. [PMID: 32860371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Differentiating between thalassaemia and iron deficiency anaemia (IDA) in hypochromic anaemia is a challenge to pathologists as it influences the choice of subsequent specialized confirmatory tests. In this study, we aimed to evaluate the performance of microcytic to hypochromic ratio (MicroR/ Hypo-He, M/H ratio) as a discriminant index in hypochromic anaemia. MATERIALS AND METHODS A retrospective study was carried out on 318 subjects with hypochromic anaemia, which comprised 162 IDA and 156 thalassaemia trait subjects with α-thalassemia, β-thalassemia and HbE trait. Optimal cut-off value, sensitivity and specificity of M/H ratio for thalassaemia trait discrimination was determined using Receiver Operating Characteristic (ROC) analysis. RESULTS Subjects with thalassaemia trait showed higher MicroR compared to IDA ( p< 0.001) while subjects with IDA demonstrated higher Hypo-He than thalassaemia trait (p < 0.001). M/H ratio was significantly higher in thalassaemia trait compared to IDA, with medians of 3.77 (interquartile range: 2.57 - 6.52) and 1.73 (interquartile range: 1.27 - 2.38), respectively (p < 0.001). M/H ratio ≥ 2.25 was the optimal cut-off value for discriminating thalassaemia trait from IDA in hypochromic anaemia, with the area under ROC curve (AUC) of 0.83, sensitivity of 80.8% and specificity of 71.6%. CONCLUSIONS M/H ratio is a useful discriminant index to distinguish thalassaemia trait from IDA in hypochromic anaemia prior to diagnostic analysis for thalassaemia confirmation. High M/H ratio is suggestive of thalassaemia trait than of IDA. However, more studies are required to establish the role of M/H ratio as a screening tool for thalassaemia discrimination in hypochromic anaemia.
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Affiliation(s)
- S Y Wee
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Pathology, Unit of Haematology, Malaysia.
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Azma Raja Sabudin RZ, Fauzi AM, Abdul Jalil D, Ithnin A, Alauddin H, Fook-Choe C, Ayub NA, Malisa MY, Norunaluwar J, Ainoon O. Updates on Laboratory Tests for Diagnosis of Glucose-6-Phosphate Dehydrogenase Deficiency in Malaysia. Hemoglobin 2020. [DOI: 10.1080/03630269.2020.1718291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Alina Md Fauzi
- Department of Pathology, UKM Medical Centre, Kuala Lumpur, Malaysia
- Laboratory Diagnostic Services, UKM Medical Centre, Kuala Lumpur, Malaysia
| | | | - Azlin Ithnin
- Department of Pathology, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Hafiza Alauddin
- Department of Pathology, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Cheah Fook-Choe
- Department of Medical Sciences II, Faculty of Medicine, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | | | - Moh Yusuf Malisa
- Paediatric Department, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Jalil Norunaluwar
- Department of Pathology, UKM Medical Centre, Kuala Lumpur, Malaysia
- Paediatric Department, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Othman Ainoon
- Laboratory Diagnostic Services, UKM Medical Centre, Kuala Lumpur, Malaysia
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Norunaluwar J, Azma RZ, Alauddin H, Ithnin A, Latiff ZA, Alias H, Tumian NR, Yusoff MM, Hassan S, Othman A. Application of Molecular Diagnostics in Detection of β-Thalassemia and Hemoglobin Variants at Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia. Hemoglobin 2019. [DOI: 10.1080/03630269.2020.1718904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Jalil Norunaluwar
- Department of Laboratory Diagnostic Services, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia
- Department of Pathology, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia
| | - Raja Zahratul Azma
- Department of Pathology, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia
| | - Hafiza Alauddin
- Department of Pathology, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia
| | - Azlin Ithnin
- Department of Pathology, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia
| | - Zarina Abdul Latiff
- Department of Paediatrics, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia
| | - Hamidah Alias
- Department of Paediatrics, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia
| | - Nor Rafeah Tumian
- Department of Medicine, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia
| | - Malisa Mohd Yusoff
- Department of Laboratory Diagnostic Services, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia
| | - Syahzuwan Hassan
- Haematology Unit, Cancer Research Centre, Institute for Medical Research (IMR), Jalan Pahang, Kuala Lumpur, Malaysia
| | - Ainoon Othman
- Department of Medical Sciences II, Faculty of Medicine, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
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Razak SAA, Murad NAA, Masra F, Chong DLS, Abdullah N, Jalil N, Alauddin H, Sabudin RZAR, Ithnin A, Khai LC, Aziz NA, Muda Z, Ibrahim H, Latiff ZA. Genetic Modifiers of Fetal Haemoglobin (HbF) and Phenotypic Severity in β-Thalassemia Patients. Curr Mol Med 2019; 18:295-305. [PMID: 30289070 DOI: 10.2174/1566524018666181004121604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 04/24/2018] [Revised: 08/19/2018] [Accepted: 09/28/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The phenotypic severity of β-thalassemia is highly modulated by three genetic modifiers: β-globin (HBB) mutations, co-inheritance of α-thalassemia and polymorphisms in the genes associated with fetal haemoglobin (HbF) production. This study was aimed to evaluate the effect of HbF related polymorphisms mainly in the HBB cluster, BCL11A (B-cell CLL/lymphoma 11A) and HBS1L-MYB (HBS1-like translational GTPase-MYB protooncogene, transcription factor) with regards to clinical severity. METHODS A total of 149 patients were included in the study. HBA and HBB mutations were characterised using multiplex PCR, Sanger sequencing and multiplex ligationdependent probe amplification. In addition, 35 HbF polymorphisms were genotyped using mass spectrometry and PCR-restriction fragment length polymorphism (PCRRFLP). The genotype-phenotype association was analysed using SPSS version 22. RESULTS Twenty-one HBB mutations were identified in the study population. Patients with HBB mutations had heterogeneous phenotypic severity due to the presence of other secondary modifiers. Co-inheritance of α-thalassemia (n = 12) alleviated disease severity of β-thalassemia. In addition, three polymorphisms (HBS1LMYB, rs4895441 [P = 0.008, odds ratio (OR) = 0.38 (0.18, 0.78)], rs9376092 [P = 0.030, OR = 0.36 (0.14, 0.90)]; and olfactory receptor [OR51B2] rs6578605 [P = 0.018, OR = 0.52 (0.31, 0.89)]) were associated with phenotypic severity. Secondary analysis of the association between single-nucleotide polymorphisms with HbF levels revealed three nominally significant SNPs: rs6934903, rs9376095 and rs9494149 in HBS1L-MYB. CONCLUSION This study revealed 3 types of HbF polymorphisms that play an important role in ameliorating disease severity of β-thalassemia patients which may be useful as a predictive marker in clinical management.
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Affiliation(s)
- S A A Razak
- UKM Medical Molecular Biology Institute, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - N A A Murad
- UKM Medical Molecular Biology Institute, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - F Masra
- Department of Paediatrics, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - D L S Chong
- Department of Paediatrics, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - N Abdullah
- UKM Medical Molecular Biology Institute, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - N Jalil
- Department of Pathology, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - H Alauddin
- Department of Pathology, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - R Z A R Sabudin
- Department of Pathology, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - A Ithnin
- Department of Pathology, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - L C Khai
- Department of Paediatrics, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - N A Aziz
- Institute for Medical Research (IMR), Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | - Z Muda
- Institute of Paediatrics, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | - H Ibrahim
- Institute of Paediatrics, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | - Z A Latiff
- Department of Paediatrics, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
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14
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Haidary AM, Azma RZ, Ithnin A, Alauddin H, Tumian NR, Tamil AM, Razak NFA, Abu Amis SH, Zin NM, Shuib S. FISH versus real-time quantitative PCR for monitoring of minimal residual disease in chronic myeloid leukaemia patients on tyrosine kinase inhibitor therapy. Malays J Pathol 2019; 41:149-160. [PMID: 31427550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION BCR-ABL fusion gene, the oncogenic driver of CML, results from a translocation between short arms of chromosome 9 and 22. Monitoring of CML patients during treatment is essential, not only for tailoring the treatment but also to detect early relapse to enable timely intervention. Commonly used methods for detection of residual disease are conventional karyotyping, FISH and molecular methods. In this study, we compared FISH with QRT-PCR for detection of residual disease in CML. MATERIALS AND METHODS CML patients on tyrosine kinase inhibitor (TKI) therapy and on regular follow up at University Kebangsaan Malaysia Medical Center (UKMMC) were selected. A comparative study was conducted between FISH and QRT-PCR for BCR-ABL transcripts at diagnosis and during follow-up. RESULTS There was good correlation between FISH and QRT-PCR for BCR-ABL. At 6th month of follow-up post diagnosis, FISH had a sensitivity of 83.3% and specificity of 65.2% (k >0.339, p<0.033). At 12th month, the sensitivity of FISH was 83% and the specificity was 59.1% (k >0.286, p <0.065). Similarly, at the 24th month, FISH had a sensitivity of 100% and specificity of 68.8% (k >0.642, p<0.000). DISCUSSION Early achievement of major molecular response (MMR) and complete cytogenetic remission (CCyR) were reliable predictors of long-term maintenance of molecular remission.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/therapeutic use
- Female
- Fusion Proteins, bcr-abl/analysis
- Humans
- In Situ Hybridization, Fluorescence/methods
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Male
- Middle Aged
- Neoplasm, Residual
- Protein Kinase Inhibitors/therapeutic use
- Real-Time Polymerase Chain Reaction/methods
- Sensitivity and Specificity
- Young Adult
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Affiliation(s)
- A M Haidary
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Pathology, Kuala Lumpur, Malaysia.
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15
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Alauddin H, Kamarudin K, Loong TY, Azma RZ, Ithnin A, Jalil N, Razak NF, Koh-Xuan-Rong D, Ismail E, C-Khai L, Abdul Latiff Z, Alias H, Othman A. A Unique Interaction of IVS-I-1 (G>A) (HBA2: c.95+1G>A) with Hb Adana (HBA2: c.179G>A) Presenting as Transfusion-Dependent α-Thalassemia. Hemoglobin 2019; 42:247-251. [PMID: 30623696 DOI: 10.1080/03630269.2018.1528985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Nondeletional α-globin mutations are known to cause more serious clinical effects than deletional ones. A rare IVS-I-1 (G>A) (HBA2: c.95+1G>A) donor splice site mutation interferes with normal splicing of pre mRNA and results in activation of a cryptic splice site as well as a frameshift mutation. Hb Adana [HBA2: c.179G>A (or HBA1)] is a highly unstable variant hemoglobin (Hb) resulting from a mutation at codon 59 on the HBA2 or HBA1 gene, recognized to cause severe α-thalassemia (α-thal) syndromes. We report a unique case of compound heterozygosity for these two mutations in a 9-year-old boy who presented with a Hb level of 5.3 g/dL and hepatomegaly at the age of 15 months. He required regular blood transfusions in view of a Hb level of <7.0 g/dL and failure to thrive. He had thalassemic red cell indices and peripheral blood film. The Hb electrophoresis only showed a raised Hb F level (3.3%) and a pre run peak but the Hb H inclusion test was negative. His father had thalassemic red cell indices but a normal Hb level. His mother had almost normal Hb levels and red cell indices. Hb Adana involving the HBA2 gene was detected by mutiplex amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) in the proband and his father. DNA sequencing of the HBA2 gene confirmed the IVS-I-1 mutation in the proband and his mother. This case highlighted the unique interaction of the IVS-I-1 mutation with Hb Adana in a young Malay boy presenting with transfusion-dependent α-thal.
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Affiliation(s)
- Hafiza Alauddin
- a Department of Pathology , Universiti Kebangsaan Malaysia Medical Centre , Kuala Lumpur , Malaysia
| | - Khairina Kamarudin
- a Department of Pathology , Universiti Kebangsaan Malaysia Medical Centre , Kuala Lumpur , Malaysia
| | - Tang Yee Loong
- a Department of Pathology , Universiti Kebangsaan Malaysia Medical Centre , Kuala Lumpur , Malaysia
| | - Raja Zahratul Azma
- a Department of Pathology , Universiti Kebangsaan Malaysia Medical Centre , Kuala Lumpur , Malaysia
| | - Azlin Ithnin
- a Department of Pathology , Universiti Kebangsaan Malaysia Medical Centre , Kuala Lumpur , Malaysia
| | - Norunaluwar Jalil
- b Department of Laboratory Diagnostic Services , Universiti Kebangsaan Malaysia Medical Centre , Kuala , Lumpur , Malaysia
| | - Noor-Farisah Razak
- b Department of Laboratory Diagnostic Services , Universiti Kebangsaan Malaysia Medical Centre , Kuala , Lumpur , Malaysia
| | - Danny Koh-Xuan-Rong
- c School of Bioscience and Biotechnology , Universiti Kebangsaan Malaysia , Selangor , Malaysia
| | - Endom Ismail
- c School of Bioscience and Biotechnology , Universiti Kebangsaan Malaysia , Selangor , Malaysia
| | - Loh C-Khai
- d Department of Paediatrics , Universiti Kebangsaan Malaysia Medical Centre , Kuala , Lumpur , Malaysia
| | - Zarina Abdul Latiff
- d Department of Paediatrics , Universiti Kebangsaan Malaysia Medical Centre , Kuala , Lumpur , Malaysia
| | - Hamidah Alias
- d Department of Paediatrics , Universiti Kebangsaan Malaysia Medical Centre , Kuala , Lumpur , Malaysia
| | - Ainoon Othman
- e Department of Medical Science II , Faculty of Medicine and Health Science, Universiti Sains Islam Malaysia , Nilai , Malaysia
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16
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Mansor NA, Yusof N, Tang YL, Ithnin A, Azma RZ, Tumian NR, Shuib S. Myelodysplastic syndrome with fibrosis and complex karyotype arising in a patient with essential thrombocythaemia. Malays J Pathol 2018; 40:191-197. [PMID: 30173238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Essential thrombocythaemia (ET) is a chronic myeloproliferative neoplasm (MPN) characterised by persistent thombocytosis. It is an indolent disorder but transformation to myelofibrosis (MF), acute myeloid leukaemia (AML) or myelodyplastic syndrome (MDS) has been reported. CASE REPORT We described a patient with ET whose disease evolved into MDS with fibrosis and complex karyotype after 15 years of stable disease. She was asymptomatic and was on hydroxyurea (HU) treatment until recently when she presented with worsening anaemia. Physical examination showed mild splenomegaly. Full blood picture showed leukoerythroblastic picture with presence of 3% circulating blasts and background of dysplastic features such as hypogranular cytoplasm and nuclear hyposegmentation of neutrophils. The bone marrow aspiration was haemodiluted but revealed presence of 6% blast cells, trilineage dysplasia and predominant erythroid precursors (60%). Trephine biopsy showed no excess of blast cells and normal quantity of erythroid precursors, but there was increased in fibrosis (WHO grade 2) and presence of dysmegakaryopoeisis such as nuclear hypolobation, multinucleation and micromegakaryocytes. Cytogenetic study showed complex karyotype; monosomy of chromosome 2, chromosome 5, chromosome 18 and presence of a marker chromosome (42~44, XX,-2,-5,-18,+mar). Fluorescence in situ hybridisation (FISH) showed 5q deletion (CSF1R and EGR1). CONCLUSION The findings were consistent with transformation of ET to MDS with fibrosis and complex karyotype. ET progression to MDS is considered rare. The presence of complex karyotype and fibrosis in MDS are associated with unfavourable outcome.
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Affiliation(s)
- N A Mansor
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Pathology, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.
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17
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Wong FL, Ithnin A, Othman A, Cheah FC. Glucose-6-phosphate dehydrogenase (G6PD)-deficient infants: Enzyme activity and gene variants as risk factors for phototherapy in the first week of life. J Paediatr Child Health 2017; 53:705-710. [PMID: 28376293 DOI: 10.1111/jpc.13509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/04/2017] [Indexed: 11/29/2022]
Abstract
AIM Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a recognised cause of severe neonatal hyperbilirubinaemia, and identifying which infants are at risk could optimise care and resources. In this study, we determined if G6PD enzyme activity (EA) and certain gene variants were associated with neonatal hyperbilirubinaemia requiring phototherapy during the first week after birth. METHODS Newborn infants with G6PD deficiency and a group with normal results obtained by the fluorescent spot test were selected for analyses of G6PD EA and the 10 commonly encountered G6PD mutations in this region, relating these with whether the infants required phototherapy before discharge from the hospital in the first week. RESULTS A total of 222 infants with mean gestation and birth weight of 38.3 ± 1.8 weeks and 3.02 ± 0.48 kg, respectively, were enrolled. Of these, n = 121 were deficient with EA ≤6.76 U/g Hb, and approximately half (43%) received phototherapy in the first week after birth. The mean EA level was 3.7 U/g Hb. The EA had good accuracy in predicting phototherapy use, with area under the receiver-operating-characteristic curve of 0.81 ± 0.05. Infants on phototherapy more commonly displayed World Health Organization Class II mutations (<10% residual EA). Logistic regression analysis showed that deficiency in EA and mutation at c.1388G>A (adjusted odds ratio, 1.5 and 5.7; 95% confidence interval: 1.31-1.76 and 1.30-25.0, respectively) were independent risk factors for phototherapy. CONCLUSION Low G6PD EA (<6.76 U/g Hb) and the G6PD gene variant, c.1388G>A, are risk factors for the need of phototherapy in newborn infants during the first week after birth.
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Affiliation(s)
- Fei-Liang Wong
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Azlin Ithnin
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Ainoon Othman
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Fook-Choe Cheah
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Alauddin H, Langa M, Mohd Yusoff M, Raja Sabudin RZA, Ithnin A, Abdul Razak NF, Sardi NH, Hussin NH. Detection of α-thalassaemia in neonates on cord blood and dried blood spot samples by capillary electrophoresis. Malays J Pathol 2017; 39:17-23. [PMID: 28413201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Haemoglobin Bart's (Hb Bart's) level is associated with α-thalassaemia traits in neonates, enabling early diagnosis of α-thalassaemia. The study aimed to detect and quantify the Hb Bart's using Cord Blood (CB) and CE Neonat Fast Hb (NF) progammes on fresh and dried blood spot (DBS) specimen respectively by capillary electrophoresis (CE). METHODS Capillarys Hemoglobin (E) Kit (for CB) and Capillarys Neonat Hb Kit (for NF) were used to detect and quantify Hb Bart's by CE in fresh cord blood and dried blood spot (DBS) specimens respectively. High performance liquid chromatography (HPLC) using the β-Thal Short Programme was also performed concurrently with CE analysis. Confirmation was obtained by multiplex ARMS Gap PCR. RESULTS This study was performed on 600 neonates. 32/600 (5.3%) samples showed presence of Hb Bart's peak using the NF programme while 33/600 (5.5%) were positive with CB programme and HPLC methods. The range of Hb Bart's using NF programme and CB programme were (0.5-4.1%) and (0.5-7.1%), respectively. Molecular analysis confirmed all positive samples possessed α-thalassaemia genetic mutations, with 23/33 cases being αα/--SEA, four -α3.7/-α3.7, two αα/-α3.7 and three αα/ααCS. Fifty Hb Bart's negative samples were randomly tested for α-genotypes, three were also found to be positive for α-globin gene mutations. Thus, resulting in sensitivity of 91.7% and 88.9% and specificity of 100% for the Capillarys Cord Blood programme and Capillarys Neonat Fast programme respectively. CONCLUSION Both CE programmes using fresh or dried cord blood were useful as a screening tool for α-thalassaemia in newborns. All methods show the same specificity (100%) with variable, but acceptable sensitivities in the detection of Hb Bart.
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Affiliation(s)
- H Alauddin
- UKM Medical Center, Faculty of Medicine, Department of Pathology, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia.
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19
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Tan TL, Ahmad NS, Nasuruddin DN, Ithnin A, Tajul Arifin K, Zaini IZ, Wan Ngah WZ. CD64 and Group II Secretory Phospholipase A2 (sPLA2-IIA) as Biomarkers for Distinguishing Adult Sepsis and Bacterial Infections in the Emergency Department. PLoS One 2016; 11:e0152065. [PMID: 27003588 PMCID: PMC4803226 DOI: 10.1371/journal.pone.0152065] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/08/2016] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Early diagnosis of sepsis and bacterial infection is imperative as treatment relies on early antibiotic administration. There is a need to develop new biomarkers to detect patients with sepsis and bacterial infection as early as possible, thereby enabling prompt antibiotic treatment and improving the survival rate. METHODS Fifty-one adult patients with suspected bacterial sepsis on admission to the Emergency Department (ED) of a teaching hospital were included into the study. All relevant cultures and serology tests were performed. Serum levels for Group II Secretory Phospholipase A2 (sPLA2-IIA) and CD64 were subsequently analyzed. RESULTS AND DISCUSSION Sepsis was confirmed in 42 patients from a total of 51 recruited subjects. Twenty-one patients had culture-confirmed bacterial infections. Both biomarkers were shown to be good in distinguishing sepsis from non-sepsis groups. CD64 and sPLA2-IIA also demonstrated a strong correlation with early sepsis diagnosis in adults. The area under the curve (AUC) of both Receiver Operating Characteristic curves showed that sPLA2-IIA was better than CD64 (AUC = 0.93, 95% confidence interval (CI) = 0.83-0.97 and AUC = 0.88, 95% CI = 0.82-0.99, respectively). The optimum cutoff value was 2.13μg/l for sPLA2-IIA (sensitivity = 91%, specificity = 78%) and 45 antigen bound cell (abc) for CD64 (sensitivity = 81%, specificity = 89%). In diagnosing bacterial infections, sPLA2-IIA showed superiority over CD64 (AUC = 0.97, 95% CI = 0.85-0.96, and AUC = 0.95, 95% CI = 0.93-1.00, respectively). The optimum cutoff value for bacterial infection was 5.63μg/l for sPLA2-IIA (sensitivity = 94%, specificity = 94%) and 46abc for CD64 (sensitivity = 94%, specificity = 83%). CONCLUSIONS sPLA2-IIA showed superior performance in sepsis and bacterial infection diagnosis compared to CD64. sPLA2-IIA appears to be an excellent biomarker for sepsis screening and for diagnosing bacterial infections, whereas CD64 could be used for screening bacterial infections. Both biomarkers either alone or in combination with other markers may assist in decision making for early antimicrobial administration. We recommend incorporating sPLA2-IIA and CD64 into the diagnostic algorithm of sepsis in ED.
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Affiliation(s)
- Toh Leong Tan
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nurul Saadah Ahmad
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Dian Nasriana Nasuruddin
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Azlin Ithnin
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Khaizurin Tajul Arifin
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ida Zarina Zaini
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Wan Zurinah Wan Ngah
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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20
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Jalil N, Azma RZ, Mohamed E, Ithnin A, Alauddin H, Baya SN, Othman A. Evaluation of Glucose-6-Phosphate Dehydrogenase stability in stored blood samples. EXCLI J 2016; 15:155-62. [PMID: 27103895 PMCID: PMC4834747 DOI: 10.17179/excli2015-604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/02/2016] [Indexed: 12/05/2022]
Abstract
Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is the commonest cause of neonatal jaundice in Malaysia. Recently, OSMMR2000-D G6PD Assay Kit has been introduced to quantitate the level of G6PD activity in newborns delivered in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). As duration of sample storage prior to analysis is one of the matters of concern, this study was conducted to identify the stability of G6PD enzyme during storage. A total of 188 cord blood samples from normal term newborns delivered at UKMMC were selected for this study. The cord bloods samples were collected in ethylene-diamine-tetra-acetic acid (EDTA) tubes and refrigerated at 2-8 °C. In addition, 32 out of 188 cord blood samples were spotted on chromatography paper, air-dried and stored at room temperature. G6PD enzyme activities were measured daily for 7 days using the OSMMR2000-D G6PD Assay Kit on both the EDTA blood and dried blood samples. The mean value for G6PD activity was compared between days of analysis using Student Paired T-Test. In this study, 172 out of 188 cord blood samples showed normal enzyme levels while 16 had levels corresponding to severe enzyme deficiency. The daily mean G6PD activity for EDTA blood samples of newborns with normal G6PD activity showed a significant drop on the fourth day of storage (p < 0.005) while for samples with severely deficient G6PD activity, significant drop was seen on third day of storage (p = 0.002). Analysis of dried cord blood showed a significant reduction in enzyme activity as early as the second day of storage (p = 0.001). It was also noted that mean G6PD activity for spotted blood samples were lower compared to those in EDTA tubes for all days (p = 0.001). Thus, EDTA blood samples stored at 2-8 °C appeared to have better stability in terms of their G6PD enzyme level as compared to dried blood samples on filter paper, giving a storage time of up to 3 days.
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Affiliation(s)
- Norunaluwar Jalil
- Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur; Department of Medical Laboratory Technology, Universiti Teknologi MARA, Puncak Alam, Selangor
| | - Raja Zahratul Azma
- Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur
| | - Emida Mohamed
- Department of Medical Laboratory Technology, Universiti Teknologi MARA, Puncak Alam, Selangor
| | - Azlin Ithnin
- Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur
| | - Hafiza Alauddin
- Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur
| | - Siti Noor Baya
- Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur
| | - Ainoon Othman
- Department of Medical Sciences II, Faculty of Medicine, Universiti Sains Islam Malaysia, Kuala Lumpur
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Alauddin H, Mohamad Nasir S, Ahadon M, Raja Sabudin RZA, Ithnin A, Hussin NH, Alias H, Loh CK, Abdul Latiff Z, Abdul Murad NA, Othman A. Hb lepore/β0-thalassaemia with α+-thalassaemia interactions, a potential diagnostic pitfall. Malays J Pathol 2015; 37:287-292. [PMID: 26712677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Haemoglobin (Hb) Lepore is a variant Hb consisting of two α-globin and two δβ-globin chains. In a heterozygote, it is associated with clinical findings of thalassaemia minor, but interactions with other haemoglobinopathies can lead to various clinical phenotypes and pose diagnostic challenges. We reported a pair of siblings from a Malay family, who presented with pallor and hepatosplenomegaly at the ages of 21 months and 14 months old. The red cell indices and peripheral blood smears of both patients showed features of thalassaemia intermedia. Other laboratory investigations of the patients showed conflicting results. However, laboratory investigation results of the parents had led to a presumptive diagnosis of compound heterozygote Hb Lepore/β-thalassaemia and co-inheritance α+-thalassaemia (-α3.7). Hb Lepore has rarely been detected in Southeast Asian countries, particularly in Malaysia. These two cases highlight the importance of family studies for accurate diagnosis, hence appropriate clinical management and genetic counseling.
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Affiliation(s)
- Hafiza Alauddin
- UKM Medical Centre, Department of Pathology, Pre-Clinical Building, Level 15, Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia.
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22
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Alauddin H, Jaapar NA, Azma RZ, Ithnin A, Razak NFA, Loh CK, Alias H, Abdul-Latiff Z, Othman A. A case series of α-thalassemia intermedia due to compound heterozygosity for Hb Adana [HBA2: c179G>A (or HBA1); p.Gly60Asp] with other α-thalassemias in Malay families. Hemoglobin 2014; 38:277-81. [PMID: 24829075 DOI: 10.3109/03630269.2014.916720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hb Adana [HBA2: c179G>A (or HBA1); p.Gly60Asp] is a rare hemoglobin (Hb) variant due to a mutation at codon 59 of the α2- or α1-globin gene resulting in a glycine to aspartic acid substitution. Two siblings with a unique coinheritance of Hb Adana and Hb Constant Spring (Hb CS, α142, Term→Gln, TAA>CAA; HBA2: c.427 T>C) (α(codon 59)α/α(CS)α), were compared phenotypically with another two siblings carrying the Hb Adana mutation and a 3.7 kb deletion (α(codon 59)α/-α(3.7)). Although they all had α-thalassemia intermedia (α-TI), the former were clinically more severe than the latter. The first pair of siblings presented at a much younger age than the second pair and showed lower Hb levels and significant extramedullay hemopoiesis. Another case of a hydropic fetus as a result of Hb H/Hb Adana is also described. Their clinical phenotypes and hematological parameters are all presented for comparison.
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Affiliation(s)
- Hafiza Alauddin
- Haematology Unit, Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre , Kuala Lumpur , Malaysia
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Raja-Sabudin RZA, Othman A, Ahmed-Mohamed KAE, Ithnin A, Alauddin H, Alias H, Abdul-Latif Z, Das S, Abdul-Wahid FS, Hussin NH. Immature reticulocyte fraction is an early predictor of bone marrow recovery post chemotherapy in patients with acute leukemia. Saudi Med J 2014; 35:346-349. [PMID: 24749130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To establish the benefits of immature reticulocyte fraction (IRF) measurement using an automated hematology cells analyzer over absolute neutrophil count (ANC) in predicting bone marrow recovery post induction chemotherapy. METHODS A prospective observational study was carried out in the Departments of Pathology, Medicine, and Pediatrics, Universiti Kebangsaan Malaysia, Medical Center (UKMMC), Kuala Lumpur, Malaysia during a period of 19 months from April 2009 to December 2010 to assess the bone marrow recovery in patients with acute leukemia. A total of 22 patients in remission induction phases were enrolled in this study. The blood specimens were collected from day zero after chemotherapy, and every 3 days until patients recovered hematologically. All blood samples were measured for ANC and IRF using an automated hematology analyzer (Beckman-Coulter LH750). RESULTS The percentage of patients showing IRF recovery earlier than ANC recovery was 63.6% (14 out of 22 patients). There was a significant difference in the mean number of days for IRF recovery as compared with ANC recovery (14.05 and 17.18 days), p=0.005. CONCLUSION This study proved that IRF was more useful in predicting bone marrow recovery in a patient with acute leukemia post induction chemotherapy compared with ANC. The IRF is not affected by infection, is easily measured, and inexpensive; thus, it is a reliable parameter to evaluate bone marrow reconstitution.
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Affiliation(s)
- Raja-Zahratul A Raja-Sabudin
- Department of Pathology, University Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak 56000, Kuala Lumpur, Malaysia. Tel. +603 (9) 1455555 Ext. 5780/5356. Fax. +603 (9) 1737340. E-mail:
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Cheah F, Peskin AV, Wong F, Ithnin A, Othman A, Winterbourn CC. Increased basal oxidation of peroxiredoxin 2 and limited peroxiredoxin recycling in glucose‐6‐phosphate dehydrogenase‐deficient erythrocytes from newborn infants. FASEB J 2014; 28:3205-10. [DOI: 10.1096/fj.14-250050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Fook‐Choe Cheah
- Department of PaediatricsUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Alexander V. Peskin
- Centre for Free Radical ResearchDepartment of PathologyUniversity of Otago ChristchurchChristchurchNew Zealand
| | - Fei‐Liang Wong
- Department of PaediatricsUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Azlin Ithnin
- Department of PathologyUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Ainoon Othman
- Department of PathologyUniversiti Sains Islam MalaysiaKuala LumpurMalaysia
| | - Christine C. Winterbourn
- Centre for Free Radical ResearchDepartment of PathologyUniversity of Otago ChristchurchChristchurchNew Zealand
- Gravida National Centre for Growth and DevelopmentUniversity of Otago ChristchurchChristchurchNew Zealand
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Azma RZ, Othman A, Azman N, Alauddin H, Ithnin A, Yusof N, Razak NF, Sardi NH, Hussin NH. Co-inheritance of compound heterozygous Hb Constant Spring and a single -alpha(3.7) gene deletion with heterozygous deltabeta thalassaemia: a diagnostic challenge. Malays J Pathol 2012; 34:57-62. [PMID: 22870600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Haemoglobin Constant Spring (Hb CS) mutation and single gene deletions are common underlying genetic abnormalities for alpha thalassaemias. Co-inheritance of deletional and non-deletional alpha (alpha) thalassaemias may result in various thalassaemia syndromes. Concomitant co-inheritance with beta (beta) and delta (delta) gene abnormalities would result in improved clinical phenotype. We report here a 33-year-old male patient who was admitted with dengue haemorrhagic fever, with a background history of Grave's disease, incidentally noted to have mild hypochromic microcytic red cell indices. Physical examination revealed no thalassaemic features or hepatosplenomegaly. His full blood picture showed hypochromic microcytic red cells with normal haemoglobin (Hb) level. Quantitation of Hb using high performance liquid chromatography (HPLC) and capillary electrophoresis (CE) revealed raised Hb F, normal Hb A2 and Hb A levels. There was also small peak of Hb CS noted in CE. H inclusions was negative. Kleihauer test was positive with heterocellular distribution of Hb F among the red cells. DNA analysis for alpha globin gene mutations showed a single -alpha(-3.7) deletion and Hb CS mutation. These findings were suggestive of compound heterozygosity of Hb CS and a single -alpha(-3.7) deletion with a concomitant heterozygous deltabeta thalassaemia. Co-inheritance of Hb CS and a single -alpha(-3.7) deletion is expected to result at the very least in a clinical phenotype similar to that of two alpha genes deletion. However we demonstrate here a phenotypic modification of alpha thalassemia presumptively as a result of co-inheritance with deltabeta chain abnormality as suggested by the high Hb F level.
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Affiliation(s)
- Raja Zahratul Azma
- Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
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