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Gong Y, Zheng Q, Long S, Chen H, Liu W, Li C. The first Chinese with Hb Chile leading to chronic anemia and methemoglobinemia: a case report. BMC Pediatr 2023; 23:639. [PMID: 38110882 PMCID: PMC10726640 DOI: 10.1186/s12887-023-04462-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Hemoglobin (Hb) Chile [β28(B10) Leu > Met; HBB: c.85 C > A] is a rare hemoglobin variant caused by a missense mutation in the HBB gene. Only one case of Hb Chile has been reported worldwide so far. It is an unstable hemoglobin, characterized by cyanosis associated with chronic methemoglobinemia and hemolytic anemia induced by sulfonamides or methylene blue. CASE PRESENTATION A 9-year-3-month-old girl had mild anemia of unknown etiology for more than 6 years. She had a slight pallor without other symptoms or signs. The complete blood count revealed normocytic normochromic anemia with a sometimes-elevated reticulocyte count, and the bone marrow cytology showed marked erythroid hyperplasia, but the tests related to hemolysis were normal. Therefore, the whole exome sequencing was performed and showed a heterozygous mutation for HBB: c.85 C > A. With asymptomatic methemoglobinemia confirmed later, she was eventually diagnosed with Hb Chile. CONCLUSIONS This is the first report of Hb Chile in China and the second worldwide. This case shows that Hb Chile is clinically heterogeneous and difficult to diagnose and expands our understanding on the clinical and hematological traits of the disease.
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Affiliation(s)
- Yao Gong
- Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan, 646000, China
| | - Qinxin Zheng
- Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan, 646000, China
| | - Sili Long
- Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan, 646000, China
| | - Hongying Chen
- Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan, 646000, China
| | - Wenjun Liu
- Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan, 646000, China
| | - Cheng Li
- Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Luzhou, China.
- Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan, 646000, China.
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Serôdio M, Silva I, Novais C, Correia C, Marçal M, Tuna M. A Rare Cause of Neonatal Hypoxemia. Indian J Pediatr 2023; 90:523. [PMID: 36826749 DOI: 10.1007/s12098-023-04519-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Margarida Serôdio
- Department of Pediatrics, Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Estr. Forte do Alto Duque, 1449-005, Lisbon, Portugal.
| | - Inês Silva
- Department of Pediatrics, Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Estr. Forte do Alto Duque, 1449-005, Lisbon, Portugal
| | - Cristina Novais
- Department of Pediatrics, Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Estr. Forte do Alto Duque, 1449-005, Lisbon, Portugal
| | - Cátia Correia
- Department of Pediatrics, Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Estr. Forte do Alto Duque, 1449-005, Lisbon, Portugal
| | - Mónica Marçal
- Department of Pediatrics, Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Estr. Forte do Alto Duque, 1449-005, Lisbon, Portugal
| | - Madalena Tuna
- Department of Pediatrics, Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Estr. Forte do Alto Duque, 1449-005, Lisbon, Portugal
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Chandran S, Ross BJ, Kumar M. The journey from blue to pink–a rare cause for self-limiting methemoglobinemia in an Indian baby. CASE REPORTS IN PERINATAL MEDICINE 2022. [DOI: 10.1515/crpm-2021-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
To describe a rare case of methemoglobinemia in a newborn baby with excellent prognosis. Methemoglobinemia in the neonatal period is very rare and when present is usually caused by environmental toxicity from strong oxidizing agents and rarely due to enzyme deficiency or inherited disorders of hemoglobin metabolism.
Case presentation
We report a newborn baby presented with cyanosis and desaturation right from birth, later found to have methemoglobinemia and started medication. Genetic evaluation revealed a mutation in the gamma chain of fetal haemoglobin (HbF) causing abnormal hemoglobin. Physiologically significant mutations in gamma-globin genes cause symptoms in the fetus and neonate that gradually abate in the first few months of life.
Conclusions
Genetic evaluation is advisable in babies with unexplained methemoglobinemia as the prognosis of the condition depends on the underlying mutation. Early diagnosis of methemoglobinemia due to gamma chain mutation in HbF as in our case helps in reassuring the parents and also in preventing unnecessary aggressive investigations.
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Affiliation(s)
- Shanu Chandran
- Department of Neonatology , Christian Medical College , Vellore , Tamil Nadu , India
| | - Benjamin J. Ross
- Department of Neonatology , Christian Medical College , Vellore , Tamil Nadu , India
| | - Manish Kumar
- Department of Neonatology , Christian Medical College , Vellore , Tamil Nadu , India
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Yuan J, Zhu XP. Clinical characteristics on manifestation and gene mutation of a transient neonatal cyanosis: A case report. World J Clin Cases 2020; 8:217-221. [PMID: 31970190 PMCID: PMC6962074 DOI: 10.12998/wjcc.v8.i1.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/16/2019] [Accepted: 11/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We analyzed the main features of an infant diagnosed with temporary neonatal cyanosis in order to strengthen our understanding of the disease.
CASE SUMMARY We report a patient diagnosed with temporary neonatal cyanosis. The main clinical characteristics, gene mutation and treatment are discussed and a review of related literature was conducted. The neonate aged 1 d and 5 h was admitted to hospital due to cyanosis after birth. The main clinical manifestation was cyanosis, which was not improved by auxiliary ventilation and the patient showed no obvious shortness of breath or methemoglobinemia. Gene mutation analysis showed a heterozygous c.190C>T mutation in the HBG2 gene associated with transient neonatal cyanosis, which was derived from his mother. Symptomatic supportive treatment was given for 2 mo. The neonate was discharged and gradually improved with oral administration of vitamin C and vitamin B2 for 2 wk.
CONCLUSION There is no special treatment for temporary neonatal cyanosis caused by heterozygous mutation of the HBG2 gene.
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Affiliation(s)
- Jing Yuan
- Department of Neonatology, Children’s Hospital of Soochow University, Suzhou 215025, Jiangsu Province, China
| | - Xue-Ping Zhu
- Department of Neonatology, Children’s Hospital of Soochow University, Suzhou 215025, Jiangsu Province, China
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Schiemsky T, Penders J, Kieffer D. Failing blood gas measurement due to methemoglobin forming hemoglobin variants: a case report and review of the literature. Acta Clin Belg 2016; 71:167-70. [PMID: 27098765 DOI: 10.1080/17843286.2016.1148299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION We present a case of an arterial blood gas sample analysis from a 33-year old woman where no oximetry results could be obtained using the Radiometer ABL800 FLEX device. Clinical history of this patient learned that she was carrier of a methemoglobin forming hemoglobin variant type Hyde Park (HbM Hyde Park) and raised the question whether or not this variant could be the cause of the errors obtained during analysis. MATERIALS AND METHODS A literature search was performed, focusing on methemoglobin forming hemoglobin variants and their influence on oxygenation measurements. An overview of the currently described methemoglobin forming hemoglobin variants is also included. RESULTS AND DISCUSSION In the presence of dyshemoglobins such as methemoglobin, techniques used to obtain parameters that reflect the patient oxygenation status, such as pulse oximetry and CO-oximetry can be influenced. In these cases, CO-oximetry is the preferred technique because it can compensate for this, in contrast to pulse oximetry. In case of the presence of methemoglobin originating from a hemoglobin variant, it is possible that CO-oximetry data cannot be calculated because the absorbance spectrum of this methemoglobin can differ from regular methemoglobin. Moreover, pulse oximetry devices are actually prone to erroneous results since pulse oximetry data will be calculated in these cases, but unreliable and should be avoided. CONCLUSION Methemoglobin forming hemoglobin variants are rare genetic mutations. However, they can possibly interfere with the calculation of CO-oximetry values. In these cases, pulse oximetry data should be avoided because they could lead to incorrect medical decisions.
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Hooven TA, Hooper EM, Wontakal SN, Francis RO, Sahni R, Lee MT. Diagnosis of a rare fetal haemoglobinopathy in the age of next-generation sequencing. BMJ Case Rep 2016; 2016:10.1136/bcr-2016-215193. [PMID: 27095814 DOI: 10.1136/bcr-2016-215193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Neonatal cyanosis resulting from a fetal methaemoglobin variant is rare. Most such variants are only described in a few published case reports. We present the case of a newborn with unexplained persistent cyanosis, ultimately determined to have a γ-chain mutation causing Hb FM-Fort Ripley. This neonatal haemoglobinopathy can be challenging to diagnose, as significant oxygen desaturation may result from barely detectable levels of the mutant haemoglobin and co-oximetry studies may show a falsely normal methaemoglobin level. Our analysis of the infant's haemoglobin included high-performance liquid chromatography, cellulose acetate electrophoresis and citrate agar electrophoresis, which showed trace amounts of a suspected variant. Ultimately, the diagnosis was made through a novel application of next-generation sequencing (NGS). NGS-based diagnostic approaches are becoming increasingly available to clinicians, and our case provides a framework and evidence for the utilisation of such testing paradigms in the diagnosis of a rare cause of neonatal cyanosis.
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Affiliation(s)
- Thomas A Hooven
- Department of Pediatrics, New York University Langone Medical Center, New York, New York, USA Department of Pediatrics, Columbia University, New York, New York, USA
| | - Ellen M Hooper
- Department of Pediatrics, Columbia University, New York, New York, USA
| | | | - Richard O Francis
- Department of Pathology, Columbia University, New York, New York, USA
| | - Rakesh Sahni
- Department of Pediatrics, Columbia University, New York, New York, USA
| | - Margaret T Lee
- Department of Pediatrics, Columbia University, New York, New York, USA
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Ghotra S, Jangaard K, Pambrun C, Fernandez CV. Congenital methemoglobinaemia due to Hb F-M-Fort Ripley in a preterm newborn. BMJ Case Rep 2016; 2016:bcr-2016-214381. [PMID: 26969357 DOI: 10.1136/bcr-2016-214381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Methemoglobinaemia is a rare cause of cyanosis in newborns. Congenital methemoglobinaemias due to M haemoglobin or deficiency of cytochrome b5 reductase are even rarer. We present a case of congenital methemoglobinaemia presenting at birth in a preterm infant. A baby boy born at 29 weeks and 3 days of gestation had persistent central cyanosis immediately after delivery, not attributable to a respiratory or cardiac pathology. Laboratory methemoglobin levels were not diagnostic. Cytochrome b5 reductase levels were normal and a newborn screen was unable to pick up any abnormal variants of fetal haemoglobin. Genetic testing showed a γ globin gene mutation resulting in the M haemoglobin, called Hb F-M-Fort Ripley. The baby had no apparent cyanosis at a corrected gestational age of 42 weeks. Although rare, congenital methaemoglobin aemia should be considered in the differential in a preterm with central cyanosis and investigated with genetic testing for γ globin chain mutations if other laboratory tests are non-conclusive.
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Carreira R, Palaré MJ, Prior AR, Garcia P, Abrantes M. An unusual cause of neonatal cyanosis…. BMJ Case Rep 2015; 2015:bcr-2014-208371. [PMID: 25754164 DOI: 10.1136/bcr-2014-208371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of a female neonate whose pulse oximetry screening for congenital heart disease at 40 h of life was positive. The pregnancy was uneventful with no relevant family history. The neonate presented with bluish discolouration of the skin lasting until day 15. Cardiovascular examination and chest radiography were normal. Septic screening was negative. Oxygen therapy was started with poor response; investigations revealed a methaemoglobinaemia of 7.4%. The methaemoglobin level reached a peak of 15% on day 10, falling thereafter. The infant was discharged by day 20 with a normal physical examination and a methaemoglobinaemia of 11.4%. By 2 months of age this had fallen to 2.4%. Further investigation revealed a haemoglobin M variant: a heterozygous mutation of the γ globin gene known as Hb F-M Viseu. The mutation occurs in the γ chain, therefore the methaemoglobinaemia is transitory, resolving with the transition from fetal to adult haemoglobin.
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Affiliation(s)
- Raquel Carreira
- Department of Pediatrics, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, EPE, Lisbon Academic Medical Center, Lisbon, Portugal
| | - Maria João Palaré
- Pediatric Hematology Unit. Department of Pediatrics, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, EPE, Lisbon Academic Medical Center, Lisbon, Portugal
| | - Ana Rita Prior
- Neonatology Unit, Department of Pediatrics, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, EPE, Lisbon Academic Medical Center, Lisbon, Portugal
| | - Paula Garcia
- Neonatology Unit, Hospital da Luz, Lisbon, Portugal
| | - Margarida Abrantes
- Pediatric Hematology Unit. Department of Pediatrics, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, EPE, Lisbon Academic Medical Center, Lisbon, Portugal
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Abstract
Thalassemia is the most common monogenic inherited disease worldwide and it affects most countries to various extents. This review summarizes the current approaches to phenotypic and genotypic diagnosis of thalassemia in clinical practice. Prevention strategies that encompass carrier screening, genetic counseling and prenatal diagnosis are discussed. The importance of public education and an awareness of a changing perception regarding this group of diseases are emphasized. It also addresses the impact of the rapidly increasing knowledge in disease severity modification by hemoglobin F (Hb F).
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Affiliation(s)
- Ho-Wan Ip
- Department of Pathology and Clinical Biochemistry, Queen Mary Hospital , Hong Kong SAR , China and
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